Training Tomorrow's Teachers Today: a national medical student teaching and leadership retreat

Developing Clinician-Educators: a Qualitative Analysis of Structured Reflections from Participatory Teaching in the Final Year in an Integrated Medical School Program

Objective

This study aimed to describe fourth-year medical students' experiences, recorded and tracked in structured reflective teaching logs (RTLs), as participants in a year-long longitudinal medical student-as-teacher elective.

Methods

Thirteen (13) participants from two medical student-as-teacher elective cohorts completed 20 contact hours of self-selected teaching. Participants chose three different learning environments spanning the first 3 years of the medical school curriculum. Reflections were entered into an online spreadsheet with guided prompts (RTL). Open-ended text in the RTLs was analyzed using an inductive qualitative research approach. Open coding was applied across all meaningful segments of text, identifying themes that were validated internally with three co-authors and one methodology expert without formal program involvement.

Results

Narratives revealed detailed descriptions and reflections of participant experiences. Analysis revealed eight themes: (1) Joy of Teaching; (2) Teaching Effectiveness; (3) Feedback; (4) Effective Patient-Physician Communication; (5) Assessment; (6) Differential Diagnosis Development; (7) Standardized Case Development; and (8) Training for Teaching in Residency.

Conclusion

Fourth-year medical student participants in a longitudinal medical student-as-teacher elective effectively used RTLs from participatory teaching to help facilitate their own development as clinician-educators. Themes identified in RTLs reflect students' awareness of teaching skill requirements and readiness for the next workplace, residency. Informed by situativity theory, formal teaching opportunities in authentic learning environments bestow students with critical formative teaching experience and awareness of the roles as clinician-educators during their undergraduate years.

The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease

Background

This study aimed to evaluate the effectiveness and efficiency of PBL–CBL combined teaching in thyroid surgery and make observations from the students’ perspectives, based on their satisfaction with the learning process.

Methods

We prospectively enrolled 354 fourth-year students majoring in clinical medicine, along with 232 residents, from September 2014 to June 2019. These participants were randomly allocated into either the combined PBL–CBL teaching group or the traditional lecture-based classroom group to attend a course about thyroid nodules. Both pre- and post-class quizzes were conducted. An anonymous questionnaire was also administered to both groups to evaluate the students’ perceptions and experiences. We compared the two teaching methods among all the students as well as with the fourth-year students and residents in subgroups.

Results

The traditional group’s pre-class quiz scores were significantly higher than the PBL–CBL group’s (as determined by a two-tailed t-test at a 95% confidence interval, T = 16.483, P < 0.001). After class, in the PBL–CBL group, the mean total quiz score and the basic knowledge and case analysis scores increased significantly (P < 0.001). The PBL–CBL group’s performance improvement was significantly higher than the traditional group’s (increasing from 52.76 to 70.51 vs. from 67.03 to 71.97). Furthermore, the scores for learning motivation, understanding, student–teacher interaction, the final examination, communication skills, clinical thinking skills, self-learning skills, teamwork skills, and knowledge absorption, as measured by the survey, were significantly higher in the PBL–CBL group than in the traditional group (P < 0.001). Meanwhile, the survey scores representing the amount of students’ free time the course consumed were significantly lower in the PBL–CBL group than in the traditional group (P < 0.001).

Conclusions

PBL combined with CBL may be an effective method for improving medical students’ and residents’ performance and enhancing their clinical skills.

Assessment of medical students' leadership traits in a problem/case-based learning program

BACKGROUND

Healthcare delivery is shifting to team-based care and physicians are increasingly relied upon to lead and participate in healthcare teams. Educational programs to foster the development of leadership qualities in medical students are needed to prepare future physicians for these roles.

OBJECTIVE

Evaluate the development of leadership attributes in medical students during their first 2 years of medical school while participating in leadership training integrated into a problem/case-based learning program utilizing the Leadership Traits Questionnaire assessment tool.

DESIGN

Ninety-eight students enrolled at Zucker School of Medicine participated in Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), a hybrid problem/case-based learning program, during the first and second years of medical school. The Leadership Traits Questionnaire, designed to measure 14 distinct leadership traits, was utilized. It was administered to students, peers in students' PEARLS groups and their faculty facilitators. Participants completed questionnaires at three-time points during the study. Likert scale data obtained from the questionnaire was analyzed using a two-level Hierarchal Linear Model.

RESULTS

Complete data sets were available for 84 students. Four traits, including self-assured, persistent, determined, and outgoing, significantly increased over time by measurements of both peer and facilitator-rated assessments. Six additional traits significantly increased over time by measurement of facilitator-rated assessment. By contrast, a majority of student self-rated assessments trended downward during the study.

CONCLUSIONS

Medical students demonstrated development of several important leadership traits during the first 2 years of medical school. This was accomplished while participating in the PEARLS program and without the addition of curricular time. Future work will examine the impact of third year clerkships on leadership traits.

Peer teacher training for health professional students: a systematic review of formal programs

BACKGROUND

Skills in peer teaching, assessment and feedback are documented internationally as required graduate attributes for health professional students, placing emphasis on universities to prepare health professional graduates with teaching skills. The aim of this systematic review was to determine the rational, design, content and evaluation of student peer teacher training skills programs across the health professions.

METHODS

In October 2017, a search was conducted of five databases (Pubmed, Embase, CINAHL, ERIC and Cochrane Collection) using combinations of key search terms: 'Student as teacher', 'near-peer teaching', 'student teacher', 'peer teacher', 'peer-to-peer', 'undergraduate', 'medical education', 'curriculum', 'program', 'training', 'allied health', 'health science', 'pharmacy', 'nurse', and 'medicine', with results restricted to articles published in English within the decade. Articles were excluded if they were not original research, focused on a teaching approach other than peer assisted learning or teaching, did not adequately describe a student teacher training component of at least 3 hrs duration, or addressed only clinical skills training and not teaching skills training.

RESULTS

The two authors independently assessed 42 full-text articles for eligibility, with 19 articles satisfying criteria for inclusion. Dominating results were uni-disciplinary, faculty-led, non-mandated programs, targeting participants in senior years of training. Medicine was the dominant profession, with an obvious underrepresentation of the other health professions. Common program content included the foundations of education theory, teaching methods and techniques, and providing feedback. Summary and comparison of program design is restricted by gaps and inconsistencies in reporting, while the evaluation of programs remains largely subjective.

CONCLUSIONS

Teaching is increasingly recognised as a core professional skill across the health workforce, with expectations to teach peers and colleagues, within and across professional disciplines, as well as to educate patients. Students, faculty and institutes may benefit from training programs being designed for implementation in any health profession; and further to this, implemented within an interprofessionally context. Consistent reporting of teacher training programs, and objective methods of evaluation would enable more in-depth investigation.

How a teaching rotation in medical school affects graduates' subsequent careers

INTRODUCTION

Teaching opportunities and teacher courses for medical students are increasingly offered by medical schools but little has been investigated about their long-term effect. The aim of our study was to investigate the long-term career effect of an intensive elective teaching experience for final year medical students.

METHODS

We approached UMC Utrecht medical graduates who had taken a final year, 6‑week full time student teaching rotation (STR) elective, 6 to 9 years after graduation, with an online survey to ask about their educational activities and obtained teaching certificates, their current roles related to education, and their appreciation of the rotation, even if this was a long time ago. In addition, we surveyed control groups of students who had not taken the STR, divided into those who had expressed interest in the STR but had not been placed and those who had not expressed such interest.

RESULTS

We received responses from 50 STR graduates and 88 non-STR graduates (11 with interest and 77 without interest in the STR). STR graduates were more educationally active, had obtained more university teaching certificates and were more enthusiastic teachers. However, we could not exclude confounding, caused by a general interest in education even before the STR.

CONCLUSIONS

Our findings indicate a high appreciation of the student teaching rotation and a likely but not proven long-term association between STR participation and building an educational career.

A first step toward understanding best practices in leadership training in undergraduate medical education: a systematic review

PURPOSE

To characterize leadership curricula in undergraduate medical education as a first step toward understanding best practices in leadership education.

METHOD

The authors systematically searched the PubMed, Education Resources Information Center, Academic Search Complete, and Education Full Text databases for peer-reviewed English-language articles published 1980-2014 describing curricula with interventions to teach medical students leadership skills. They characterized educational settings, curricular format, and learner and instructor types. They assessed effectiveness and quality of evidence using five-point scales adapted from Kirkpatrick's four-level training evaluation model (scale: 0-4) and a Best Evidence Medical Education guide (scale: 1-5), respectively. They classified leadership skills taught into the five Medical Leadership Competency Framework (MLCF) domains.

RESULTS

Twenty articles describing 24 curricula met inclusion criteria. The majority of curricula (17; 71%) were longitudinal, delivered over periods of one semester to four years. The most common setting was the classroom (12; 50%). Curricula were frequently provided to both preclinical and clinical students (11; 46%); many (9; 28%) employed clinical faculty as instructors. The majority (19; 79%) addressed at least three MLCF domains; most common were working with others (21; 88%) and managing services (18; 75%). The median effectiveness score was 1.5, and the median quality of evidence score was 2.

CONCLUSIONS

Most studies did not demonstrate changes in student behavior or quantifiable results. Aligning leadership curricula with competency models, such as the MLCF, would create opportunities to standardize evaluation of outcomes, leading to better measurement of student competency and a better understanding of best practices.

Training of leadership skills in medical education

BACKGROUND

Effective team performance is essential in the delivery of high-quality health-care. Leadership skills therefore are an important part of physicians' everyday clinical life. To date, the development of leadership skills are underrepresented in medical curricula. Appropriate training methods for equipping doctors with these leadership skills are highly desirable.

OBJECTIVE

The review aims to summarize the findings in the current literature regarding training in leadership skills in medicine and tries to integrate the findings to guide future research and training development.

METHOD

The PubMED, ERIC, and PsycArticles, PsycINFO, PSYNDEX and Academic search complete of EBSCOhost were searched for training of leadership skills in medicine in German and English. Relevant articles were identified and findings were integrated and consolidated regarding the leadership principles, target group of training and number of participants, temporal resources of the training, training content and methods, the evaluation design and trainings effects.

RESULTS

Eight studies met all inclusion criteria and no exclusion criteria. The range of training programs is very broad and leadership skill components are diverse. Training designs implied theoretical reflections of leadership phenomena as well as discussions of case studies from practice. The duration of training ranged from several hours to years. Reactions of participants to trainings were positive, yet no behavioral changes through training were examined.

CONCLUSIONS

More research is needed to understand the factors critical to success in the development of leadership skills in medical education and to adapt goal-oriented training methods. Requirements analysis might help to gain knowledge about the nature of leadership skills in medicine. The authors propose a stronger focus on behavioral training methods like simulation-based training for leadership skills in medical education.

Preparing students to be academicians: a national student-led summer program in teaching, leadership, scholarship, and academic medical career-building

Medical schools have the responsibility of producing future leaders in academic medicine, yet few students choose academic medicine as a career. In 2009, the American Medical Student Association (AMSA) and the George Washington University School of Medicine and Health Sciences joined forces to provide students with a comprehensive introduction to careers in academic medicine through the redesign of an existing annual summer program for medical students. Since 2004, AMSA had hosted the Medical Education Leadership Institute, a weeklong program that attracted medical students from across the country who were interested in gaining teaching skills. In the redesigned sixth annual program, the authors expanded the curriculum to include principles of leadership, of medical education scholarship (or project development), and of academic medicine career-building. The purpose of this article is to describe the features of this comprehensive program and to share the lessons learned from its development and implementation. The authors also describe the multifaceted approach they used to evaluate the program, which featured a rubric they derived from social cognitive career theory.

Medical students as teachers at CoSMO, Columbia University's student-run clinic: a pilot study and literature review

BACKGROUND

Although medical students are expected to teach as soon as they begin residency, medical schools have just recently begun adding teacher training to their curricula. Student-run clinics (SRCs) may provide opportunities in clinical teaching before residency.

AIM

The aim of this pilot study was to examine students' experiences in clinical teaching at Columbia Student Medical Outreach (CoSMO), Columbia University's SRC, during the 2009-2010 school year.

METHODS

A mixed-methods approach was used. Data included closed and open-ended surveys (n = 34), combined interviews with preclinical and clinical student pairs (n = 5), individual interviews (n = 10), and focus groups (n = 3). The transcripts were analyzed using the principles of grounded theory.

RESULTS

Many students had their first clinical teaching experience while volunteering at CoSMO. Clinical students' ability to teach affected the quality of the learning experience for their preclinical peers. Preclinical students who asked questions and engaged in patient care challenged their clinical peers to balance teaching with patient care. Clinical students began to see themselves as teachers while volunteering at CoSMO.

CONCLUSION

The practical experiences in clinical teaching that students have at SRCs can supplement classroom-based trainings. Medical schools might revisit their SRCs as places for exposure to clinical teaching.

Radiology resident teaching skills improvement: impact of a resident teacher training program

RATIONALE AND OBJECTIVES

Teaching is considered an essential competency for residents to achieve during their training. Instruction in teaching skills may assist radiology residents in becoming more effective teachers and increase their overall satisfaction with teaching. The purposes of this study were to survey radiology residents' teaching experiences during residency and to assess perceived benefits following participation in a teaching skills development course.

MATERIALS AND METHODS

Study participants were radiology residents with membership in the American Alliance of Academic Chief Residents in Radiology or the Siemens AUR Radiology Resident Academic Development Program who participated in a 1.5-hour workshop on teaching skills development at the 2010 Association of University Radiologists meeting. Participants completed a self-administered, precourse questionnaire that addressed their current teaching strategies, as well as the prevalence and structure of teaching skills training opportunities at their institutions. A second postcourse questionnaire enabled residents to evaluate the seminar and assessed new knowledge and skill acquisition.

RESULTS

Seventy-eight residents completed the precourse and postcourse questionnaires. The vast majority of respondents indicated that they taught medical students (72 of 78 [92.3%]). Approximately 20% of residency programs (17 of 78) provided residents with formal didactic programs on teaching skills. Fewer than half (46.8%) of the resident respondents indicated that they received feedback on their teaching from attending physicians (36 of 77), and only 18% (13 of 78) routinely gave feedback to their own learners. All of the course participants agreed or strongly agreed that this workshop was helpful to them as teachers.

CONCLUSIONS

Few residency programs had instituted resident teacher training curricula. A resident teacher training workshop was perceived as beneficial by the residents, and they reported improvement in their teaching skills.

Radiology residents as teachers: Current status of teaching skills training in United States residency programs

RATIONALE AND OBJECTIVES

Radiology residents often teach medical students and other residents. Workshops developed with the goal of improving resident teaching skills are becoming increasingly common in various fields of medicine. The purpose of this study was to determine the prevalence and structure of resident-teacher training opportunities within radiology programs in the United States.

METHOD AND MATERIALS

Program directors with membership in the Association of Program Directors in Radiology (APDR) were surveyed to determine views on a panel of topics related to resident-teacher training programs.

RESULTS

A total of 114 (56%) of 205 APDR members completed an online survey. Approximately one-third (32%) stated that their program provided instruction to residents on teaching skills. The majority of these programs (72%) were established within the last 5 years. Residents provided teaching to medical students (94%) and radiology residents (90%). The vast majority of program directors agreed that it is important for residents to teach (98%) and that these teaching experiences helped residents become better radiologists (85%). Ninety-four percent of program directors felt that the teaching skills of their residents could be improved, and 85% felt that residents would benefit from instruction on teaching methods. Only one-third of program directors felt their program adequately recognized teaching provided by residents.

CONCLUSION

Program directors identified residents as being active contributors to teaching in most programs. Although teaching was viewed as an important skill to develop, few programs had instituted a resident-teacher curriculum. Program directors felt that residents would benefit from structured training to enhance teaching skills. Future studies are needed to determine how best to provide teaching skills training for radiology trainees.

Short-term outcomes and long-term impact of a programme in medical education for medical students

OBJECTIVES

There is growing appreciation of the value of early preparation of future medical educators. Staff development programmes, conferences and workshops pertaining to the training of educators may be crucial to the pursuit of a school's larger educational mission to educate students, doctors and scholars and to provide comprehensive knowledge, research, patient care and service. This study examined the efficacy of a 1-week educational intervention aimed at preparing medical students to become effective doctor educators by building skills early in their careers. The study asked whether participation in a 5-day teacher training programme led to increased knowledge of instructional methods, more favourable attitudes towards teaching, and the integration of structured instructional design methods in a student-developed teaching project.

METHODS

A mixed methods research design was employed with quantitative data captured through pre- and post-test inventories, qualitative components captured through written comments, and a 2-year post-intervention survey. Quantitative analyses included pre-/post-intervention repeated measures with calculated effect sizes. Qualitative analysis was conducted using constant comparative methods.

RESULTS

Subjects demonstrated improved content knowledge and more positive attitudes towards motivation, teaching confidence, teacher roles, varied pedagogy, and use of assessment, instructional planning, and evaluation. Subjects were able to incorporate the programme's teaching theory and methods into their teaching projects and assessment of peers' and others' teaching in their own institutions 2 years post-training.

CONCLUSIONS

This study demonstrates that a well-designed programme for teacher preparation can be pedagogically effective for training medical students to become better educators and that this learning can be incorporated into long-term practice.

Faculty development: yesterday, today and tomorrow

Medical education has evolved to become a discipline in its own right. With demands on medical faculties to be socially responsible and accountable, there is now increasing pressure for the professionalisation of teaching practice. Developing a cadre of professional and competent teachers, educators, researchers and leaders for their new roles and responsibilities in medical education requires faculty development. Faculty development is, however, not an easy task. It requires supportive institutional leadership, appropriate resource allocation and recognition for teaching excellence. This guide is designed to assist those charged with preparing faculty for their many new roles in teaching and education in both medical and allied health science education. It provides a historical perspective of faculty development and draws on the medical, health science and higher education literature to provide a number of frameworks that may be useful for designing tailored faculty development programmes. These frameworks can be used by faculty developers to systematically plan, implement and evaluate their staff development programmes. This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.