Teaching the teachers: national survey of faculty development in departments of medicine of U.S. teaching hospitals

Primary Care Perspectives on Education Scholarship: A Qualitative Synthesis

BACKGROUND AND OBJECTIVES

A significant portion of medical education takes place in primary care settings with family medicine clinician teachers that have variable backgrounds in teaching. Ernest Boyer's concept of education scholarship calls on faculty to systematically study and innovate their teaching practices. This meta-ethnographic review synthesizes the literature on primary care clinician teachers' perspectives and experiences of integrating education scholarship in practice.

METHODS

We conducted an electronic database search in PubMed/Medline, Scopus, ERIC, and Web of Science for primary research articles published between January 2000 and August 2021. In the included articles, researchers studied primary care physicians' and/or residents' perspectives of clinical teaching and reported qualitative results (eg, interviews, focus groups). Of the 1,454 articles found in the search, we included 33 in the final synthesis. We used line-by-line descriptive coding of the qualitative data to develop analytical themes.

RESULTS

Four main themes emerged from our synthesis: (1) perceptions of clinical teaching (lack of confidence, presumed teaching competency, lack of formal recognition); (2) clinical teaching strategies (learner-centered teaching, ad hoc teaching, role modeling, mentorship); (3) benefits of clinical teaching (shared learning experience, networking, personal interest, career satisfaction); and (4) challenges of clinical teaching (inadequate time, compensation, conflicting responsibilities).

CONCLUSIONS

Clinician teachers identified several common factors regarding their scholarly roles but had difficulty describing them in relation to education scholarship. Institutional support, resources, and awareness are needed to assist family medicine clinician teachers to further implement Boyer's concept of education scholarship in practice-specifically, to study, evaluate, and innovate current clinical teaching strategies.

The Objective Structured Teaching Encounter (OSTE) in health professions education: A systematic review

PURPOSE

New emphasis on the assessment of health professions educators' teaching competence has led to greater use of the Objective Structured Teaching Encounter (OSTE). The purpose of this study is to review and further describe the current uses and learning outcomes of the OSTE in health professions education.

MATERIALS AND METHODS

PubMed, MEDLINE, and CINAHL (March 2010 to February 2022) were searched for English-language studies describing the use of an OSTE for any educational purpose within health professions education.

RESULTS

Of the 29 articles that met inclusion criteria, over half of the studies (17 of 29, 58.6%) were published during or after 2017. Seven studies described OSTE use outside of the traditional medical education context. These new contexts included basic sciences, dental, pharmacy, and Health Professions Education program graduates. Eleven articles described novel OSTE content, which included leadership skills, emotional intelligence, medical ethics, inter-professional conduct, and a procedural OSTE. There is increasing evidence supporting the use of OSTEs for the assessment of clinical educators' teaching skills.

CONCLUSIONS

The OSTE is a valuable tool for the improvement and assessment of teaching within a variety of health professions education contexts. Further study is required to determine the impact of OSTEs on teaching behaviors in real-life contexts.

Translation of surface electromyography to clinical and motor rehabilitation applications: The need for new clinical figures

Advanced sensors/electrodes and signal processing techniques provide powerful tools to analyze surface electromyographic signals (sEMG) and their features, to decompose sEMG into the constituent motor unit action potential trains, and to identify synergies, neural muscle drive, and EEG-sEMG coherence. However, despite thousands of articles, dozens of textbooks, tutorials, consensus papers, and European and International efforts, the translation of this knowledge into clinical activities and assessment procedures has been very slow, likely because of lack of clinical studies and competent operators in the field. Understanding and using sEMG-based hardware and software tools requires a level of knowledge of signal processing and interpretation concepts that is multidisciplinary and is not provided by most academic curricula in physiotherapy, movement sciences, neurophysiology, rehabilitation, sport, and occupational medicine. The chasm existing between the available knowledge and its clinical applications in this field is discussed as well as the need for new clinical figures. The need for updating the training of physiotherapists, neurophysiology technicians, and clinical technologists is discussed as well as the required competences of trainers and trainees. Indications and examples are suggested and provide a basis for addressing the problem. Two teaching examples are provided in the Supplementary Material.

A mixed-methods study of the effectiveness and perceptions of a course design institute for health science educators

BACKGROUND

Most health care professionals get their start in academics without formal teaching training. As such, institutions encourage participation in opportunities to address gaps in faculty's knowledge of pedagogy and learning theory in order to promote both successful student and patient outcomes. This study aimed to examine the reception of a faculty development program focused on teaching participants the basics of course design.

METHODS

Applying a mixed-method approach, this retrospective study used pre/post-tests, assignment grades, self-assessment questionnaires, and focus groups to elucidate the impact of the faculty development intervention on course design. The participants (n = 12) were health educators from a private all-graduate level university with campus locations across the United States, including in the Southwest and Midwest. In the Course Design Institute (CDI), the participating faculty learned evidence-based instructional approaches and techniques to implement contemporary teaching practices.

RESULTS

The data from the pre/post-tests and focus groups suggest that participants learned about topics including instructional alignment, learning goals and objectives, instructional strategies, assessment planning, feedback approaches, communicating expectations, and adult learning theories by participating in this course. The final deliverable scores indicate that the CDI graduates were able to apply a backward design process to plan their own instruction. Data from both the survey and the focus groups suggest that participants were satisfied with the experience and particularly appreciated that the course was relevant to them as educators in the health sciences.

CONCLUSIONS

The results of this study indicate that the CDI was influential in developing the faculty's knowledge of the course design process, promoted the application of course design and pedagogy skills amongst CDI graduates, and positively impacted self-reported attitudes about their teaching abilities. In addition, feedback from participants indicates that they recognized the value of this program in their own development and they believed it should be a required course for all educators at the institution.

Faculty Development Offered by US Medical Schools: A National Survey of Pediatric Educators

INTRODUCTION

There are limited data on the status of faculty development (FD) in the United States. Through a national survey of pediatric educators, we explored the frequency and topics of FD on teaching skills offered at US medical schools, as well as the strategies' schools use to encourage and track participation.

METHODS

Five piloted questions were included in the 2017 Annual Council on Medical Student Education in Pediatrics Survey. We used descriptive statistics.

RESULTS

Ninety-seven (66%) of the 148 surveyed US medical schools responded to at least one FD question. Ninety-eight percent of respondents reported being offered FD on teaching, with 97% of those respondents reporting that FD occurred at least annually. A variety of FD topics were reported, with feedback and precepting being most common. Incentives included continuing medical education (CME credit) (39%) and being relieved of clinical duties (23%). However, 29% reported little support for FD. Only 20% of schools reported their department tracked FD participation outside the department.

DISCUSSION

Our data suggest that the majority of medical schools offer FD on teaching skills at least yearly, with a variety of topics. Institutions utilize a variety of incentives for participation. However, a significant minority of respondents reported little support for FD. Further, departments rarely track faculty FD participation.

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

OBJECTIVES

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

DESIGN

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

SETTING

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

SUBJECTS

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

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

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

CONCLUSIONS

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

Effectiveness and Needs Assessment of Faculty Development Programme for Medical Education: Experience from Saudi Arabia

Objectives

Faculty members are the most important resource in any institution of higher education as medical education has been, and continues to be, a priority for medical colleges in Saudi Arabia. This study aimed to assess faculty members' perceptions of faculty development programmes (FDPs) in supporting important goals in medical education. In addition, this study aimed to assess faculty members' perceived needs.

Methods

This cross-sectional study was conducted between August 2016 and August 2017 and involved participants from six universities in Saudi Arabia's Western Province. The survey consisted of 31 items designed to assess FDP effectiveness and 49 items designed to assess needs in FDPs.

Results

A total of 210 faculty members participated in the study (response rate = 52.5%) and identified 49 needs. Faculty members perceived personal improvement in delivering medical education and the provision of greater educational involvement as the most effective considerations in an FDP. The respondents considered 13 needs to be of utmost importance; the remaining were considered important.

Conclusion

This study assessed and identified faculty needs and important skills to consider when establishing an FDP. Furthermore, it provided information addressing the needs of, or gaps between, current and desired conditions in medical education in Saudi Arabia. The study also identified the most important elements (i.e. personal improvement) of faculty-perceived effectiveness for a successful FDP in medical education.

VA Boston Healthcare System First Friday Faculty Development Presentation Series

A multidisciplinary online and in-person continuing education program utilizing the teaching, research, awards, interprofessional, networking (TRAIN) framework has provided nearly 1,000 credits for health care professionals across multiple specialties.

Exploring faculty development opportunities and strategies in departments of medicine of U.S. community-based teaching hospitals

Background: Faculty development (FD) activities are offered as a tool to health-care professionals to improve their knowledge, skills, and role as teachers and educators, leaders, researchers, and scholars. Formal FD activities have been more readily available at university-based teaching hospitals than at community-based hospitals. Yet the majority of Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs are sponsored by community-based teaching hospitals.

Methods: An electronic survey along with the cover letter/consent form were sent via email to members of the Association of Program Directors of Internal Medicine (APDIM) of Community-Based Teaching Hospitals Assembly. Two researchers analyzed responses and reviewed all answers independently. Consensus was reached by comparison and discussion.

Results: A total of 75 program or associate program directors from 53 U.S. Community-Based Teaching Hospitals with internal medicine residency programs participated in the survey.

Eleven percent of the respondents reported that they had no faculty development activities in their departments, 44% reported occasional activities, and 45% reported ongoing activities. Forty-three percent reported making arrangements for faculty to attend FD offsite. However, 78% sent less than five people to those programs in the past 2 years.

Discussion: The results of this study suggest that for the academic year 2014–2015 still a minority of non-university-based teaching hospitals had ongoing faculty development activities associated with their institution. Increased program commitment and adequate resources for FD instructors and funding can produce the desired increase in the number as well as the quality of the FD programs.

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.

A needs assessment for faculty development at two medical colleges of Dow University of Health Sciences, Karachi

Objective:

To identify the perceptions of the faculty about their current level of pedagogical skills and their desire to improve these skills in future.

Methods:

This cross-sectional study was conducted at two medical colleges of Dow University of Health Sciences, Karachi from March 1, 2015 to April 30, 2015. A re-validated questionnaire was used comprising three parts; 1) Demographic details, 2) Fifteen educational domains each having 2 statements, first indicating minimum knowledge of domain and second showing maximum. Each statement had two 9-point anchored scales, first indicating current knowledge and second, desired knowledge of the faculty. 3) Factors which are important considerations for attending educational workshops. The data was analyzed by statistical software SPSS 17.

Results:

The response rate was 54%. The mean age of faculty was 43.42 ± 8.41, largest proportion being assistant professors (85; 47%). For all educational domains, faculty perceived their knowledge to be moderately high (Mean = 5.9 +/- 1.8 to 6.8 +/- 1.7 and Median: 6 to 7). However, they desired to improve their pedagogical skills further in all domains (Mean = 8.2 +/- 1.1 to 8.4 +/- 1.1, Median: 9), p-values < 0.001. Nearly 95% teachers are willing to attend faculty development workshops.

Conclusion:

Our faculty perceives their current pedagogical skills to be moderately high. However, they would like to improve these skills to a higher level in all educational domains.

A framework for faculty development programming at VA and non-VA Academic Medical Centers

VA and non-VA Academic Medical Centers (AMCs) serve as training environments for learners from many different professions and academic affiliates, including regional medical campuses. Faculty members at these AMCs need programming to help create and enhance the educational environment for learners. In this paper, we provide a framework for AMCs to develop and implement faculty development programming and provide a case example of how this programming was implemented at one VA AMC. It is the hope that this framework and programming can be adopted by other AMCs to provide faculty members with the programming needed to sustain high quality training environments.

Medical educators: How they define themselves - Results of an international web survey

BACKGROUND

Little is known about medical educators' self-definition.

AIMS

The aim of this study is to survey an international community of medical educators focusing on the medical educators' self-definition.

METHODS

Within a comprehensive, web-based survey, an open question on the participants' views of how they would define a "medical educator" was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis.

RESULTS

Of the, 2200 medical educators invited to participate, 685 (31.1%) provided a definition of a "medical educator". The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as "Professional Expert", "Facilitator", "Information Provider", "Enthusiast", "Faculty Developer", "Mentor", "Undergraduate and Postgraduate Trainer", "Curriculum Developer", "Assessor and Assessment Creator", and "Researcher".

CONCLUSIONS

Our survey revealed that medical educators predominantly define themselves as "Professional Experts" and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.

A National Faculty Development Needs Assessment in Emergency Medicine

OBJECTIVES

Emergency physicians who work in academic settings enjoy an expanding number of roles beyond that of the skilled clinician. Faculty development (FD) encompasses the broad range of activities that institutions use to renew skill-sets and assist faculty members in these multiple roles. This study seeks to define the current FD needs and interests of Canadian academic emergency physicians (AEPs).

METHODS

An online survey was administered to 943 AEPs in eight centers across Canada to determine their current FD activities, provide a detailed understanding of their FD needs and interests, elucidate the perceived barriers to and motivation for engaging in FD, and identify preferred methods of delivery for FD activities.

RESULTS

This national, cross-sectional survey was completed by 336 respondents. It shows that need for FD is universally high, particularly in traditional domains of scholarship, leadership and education (79%, 80%, 87% overall interest, respectively). However, the study also suggests that there is increasing need for FD in areas where current participation is lowest, namely research and social accountability (12% and 13% more interest, respectively). Senior and junior faculty evince equivalent overall FD interest (p>0.05), whereas female AEPs expressed greater overall FD needs in leadership (1.82 vs 1.44 activities, p=0.003) than males. Continued participation in FD activities is best promoted by offering relevant topics, at convenient times and locations.

CONCLUSIONS

This study reports the first comprehensive national FD needs assessment of Canadian academic emergency physicians.

Success of a Faculty Development Program for Teachers at the Mayo Clinic

BACKGROUND

There has been limited research on the improvement of underperforming clinical teachers.

OBJECTIVE

To determine whether a faculty development program could improve the evaluations of clinical teachers in an internal medicine residency program.

METHODS

A total of 123 teachers completed faculty development at the Mayo Clinic from 2009 to 2012. The faculty enhancement and education development program (FEED) consists of 6 interactive, small group, 2-hour sessions taught by experienced Mayo Clinic faculty over 1 year. These sessions address the following competencies: asking questions, diagnosing learners, giving feedback, using teaching frameworks, recognizing learning styles, and providing clinical supervision. Resident-of-faculty Mayo teaching effectiveness (MTE) scores have previously demonstrated content, internal structure, and criterion validity. Teachers were grouped into the top 80% or the bottom 20%, according to baseline MTE scores. Mixed linear models were used to compare these groups regarding changes in MTE scores after completion of FEED. Results were adjusted for teacher age, sex, medical specialty, academic rank, and teaching awards.

RESULTS

For all participants combined, the adjusted MTE scores (mean; standard error) improved from baseline (3.80; 0.04) to completion of FEED (3.93; 0.04; P < .001). However, the bottom 20% had a significantly greater improvement in scores than the top 80% (score-change difference  =  0.166, P < .001).

CONCLUSIONS

We describe a low-intensity faculty development intervention that benefited all clinical teachers, but was particularly effective for underperforming teachers in internal medicine. The approach may be suitable for adoption or adaptation in other graduate medical education programs.

Developing medical educators--a mixed method evaluation of a teaching education program

BACKGROUND

It is well accepted that medical faculty teaching staff require an understanding of educational theory and pedagogical methods for effective medical teaching. The purpose of this study was to evaluate the effectiveness of a 5-day teaching education program.

METHODS

An open prospective interventional study using quantitative and qualitative instruments was performed, covering all four levels of the Kirkpatrick model: Evaluation of 1) 'Reaction' on a professional and emotional level using standardized questionnaires; 2) 'Learning' applying a multiple choice test; 3) 'Behavior' by self-, peer-, and expert assessment of teaching sessions with semistructured interviews; and 4) 'Results' from student evaluations.

RESULTS

Our data indicate the success of the educational intervention at all observed levels. 1) Reaction: The participants showed a high acceptance of the instructional content. 2) Learning: There was a significant increase in knowledge (P<0.001) as deduced from a pre-post multiple-choice questionnaire, which was retained at 6 months (P<0.001). 3) Behavior: Peer-, self-, and expert-assessment indicated a transfer of learning into teaching performance. Semistructured interviews reflected a higher level of professionalism in medical teaching by the participants. 4) Results: Teaching performance ratings improved in students' evaluations.

CONCLUSIONS

Our results demonstrate the success of a 5-day education program in embedding knowledge and skills to improve performance of medical educators. This multimethodological approach, using both qualitative and quantitative measures, may serve as a model to evaluate effectiveness of comparable interventions in other settings.

Are we closing the gap in faculty development needs for feedback training?

STUDY OBJECTIVE

To determine needs, adequacy, types of resources, and challenges in teaching faculty how to provide feedback to residents.

DESIGN

Survey instrument.

SETTING

Academic medical center.

PARTICIPANTS

Of the 115 anesthesia residency program directors surveyed, 69 responses were received (60% response rate).

MEASUREMENTS

Percentages of respondents who indicated categories of need, adequacy, and types of resources for teaching faculty to give feedback to residents were recorded, as were narrative descriptions of challenges confronted by respondents.

MAIN RESULTS

While the percentage of programs with faculty development resources has increased from 20.2% in 1999 to 48% today, an overwhelming majority of program directors (90%) feel that faculty require more training in providing feedback to residents. The majority of program directors also want more resources to train their faculty in providing feedback.

CONCLUSIONS

While the perceived gap in providing training for faculty in giving feedback to anesthesia residents has narrowed, program director responses suggest a substantial unmet need remains. Innovative new approaches are in order.

Emotional congruence in learning and health encounters in medicine: addressing an aspect of the hidden curriculum

This paper aims to draw attention to and provide insights into an area that is of educational significance for clinical teachers, namely the need to acknowledge and respond appropriately to the emotional context of both learning and health encounters in order to improve the outcomes of both. This need has been highlighted by recent calls for more attention to be paid to the role of emotion within medical education and within health care provision. What is already known about the role of emotion in learner-teacher encounters and in patient-doctor encounters will be used to develop the concept of emotional congruence within these two types of encounter as a challenge to clinical teachers to examine their own practice. The reasons why emotional congruence is not always apparent in the learning environment of the teaching hospital will be discussed using the model of the 'hidden curriculum'. It will be suggested that explicit strategies to counteract the hidden curriculum in relation to emotion can bring about transformative change in individual practice and the health care environment that has the potential to improve both learning and health outcomes.

Future focus for professional development

Professional development has evolved from individually focused sabbaticals and professional leaves to institutionally focused programs with an interest in developing faculty members' ability to teach in various environments as well as to succeed in the many endeavors they undertake. We address various issues related to professional development in the medical school arena. Professional development in medical school takes place in a context where faculty are stretched to engage in research and service not only for their own sake but also to financially support their institutions. This obligates professional developers to acknowledge and address the environments in which teaching faculty work, and to use approaches to professional development that honor the time and efforts of teaching faculty. These approaches may be brief interventions that make use of principles of education, and may include online offerings. Professional development will be most effective when professional developers acknowledge that most faculty members aspire to excellence in teaching, but they do so in an environment that pushes them to address competing concerns. Offering professional development opportunities that fit within the workplace environment, take little time, and build upon faculty's existing knowledge will assist in enhancing faculty success.

Defining a core curriculum for education scholarship fellowships in emergency medicine

A trained cadre of medical education scholars with a focus on methodologically sound research techniques is needed to ensure development of innovations that can be translated to educational practice, rigorous evaluation of instructional strategies, and progress toward improving patient care outcomes. Most established educational programs are aimed at existing faculty members and focus primarily on the development of teaching and leadership skills. At the 2012 Academic Emergency Medicine (AEM) consensus conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success," a breakout session was convened to develop training recommendations for postgraduate fellowship programs in medical education scholarship that would enable residency graduates to join academic faculties armed with the skills needed to perform research in medical education. Additionally, these graduates would enjoy the benefits of established mentorships. A group of 23 medical education experts collaborated to address the following objectives: 1) construct a formal needs assessment for fellowship training in medical education scholarship in emergency medicine (EM), 2) compare and contrast current education scholarship programs in both EM and non-EM specialties, and 3) develop a set of core curriculum guidelines for specialized fellowship training in medical education scholarship in EM. Fellowship-trained faculty need to be proficient in learner instruction and assessment, organizational leadership, curriculum development, educational methodology, and conducting generalizable hypothesis-driven research to improve patient care.

Basic essential education program (BEEP): a brief introductory faculty development course for medical teachers

BACKGROUND

Physicians have a unique role in teaching future physicians and allied health professionals. Yet, most medical doctors have limited instruction in this critical component of their daily activity.

METHODS

This study was a prospective cohort study of the effectiveness of a local teaching program at two teaching hospitals for junior faculty. Based on a needs analysis and literature review, the teaching program was developed in an accessible and compact format of six consecutive, one-hour "lunch and learn" sessions, held locally over a six week period. Pre-post questionnaires and focus groups were used to evaluate the program.

RESULTS

Participants reported being satisfied with the course as whole, particularly in respect to the format and location. There was an improvement in their knowledge in all content areas covered. The greatest benefits were derived from fostering a community of practice and having the opportunity to role play and simulate teaching skills. An attitudinal change towards teaching was noted.

CONCLUSIONS

A brief, local faculty development program was effective in enhancing physicians' knowledge, skills, and attitudes in teaching.

A curriculum development simulation in a graduate program

OBJECTIVE

To implement and evaluate a curriculum development seminar in which graduate students experienced circumstances that occur when faculty members develop and attempt to secure colleague approval for a curriculum.

DESIGN

Learning activities for the graduate seminar included classroom lectures, active learning, and a group project in which simulated faculty committees created new curriculums for the pharmacy practice department's 3 research areas.

ASSESSMENT

Responses on pre- and post-seminar surveys indicated that graduate students' self-confidence in their ability to conduct key curriculum development activities increased (p < 0.05). In a post-seminar focus group, graduate students stated that they valued participating in the faculty simulation, learning about curriculum development and research programs other than their own, and collaborating with their peers.

CONCLUSION

A curriculum development faculty simulation was an effective tool for preparing graduate students for curriculum development responsibilities and generated valuable documents that the department could use in the revision of the 3 pharmacy practice graduate school curricula.

Through the looking glass: how reflective learning influences the development of young faculty members

BACKGROUND

Faculty development is needed that will influence clinical teachers to better enable them to transmit humanistic values to their learners and colleagues.

PURPOSE

We sought to understand the processes whereby reflective learning influenced professional growth in a convenience sample of young faculty members.

METHODS

We analyzed appreciative inquiry narratives written over 4 years using the constant comparative method to identify major underlying themes and develop hypotheses concerning how reflective learning influenced participants in the faculty development program. Six of the participants and the facilitator were participant observers in the qualitative analysis.

RESULTS

Group support, validation, and cohesion led to adoption of common values that informed the professional development of the participants over 4 years of the study. Common values influenced the group members as they progressed in their careers.

CONCLUSIONS

Faculty development programs that focus on humanism and reflective learning can facilitate the growth of young faculty members by influencing their values and attitudes at crucial phases of their careers.

A systematic review of the use and effectiveness of the Objective Structured Teaching Encounter

BACKGROUND

The Objective Structured Teaching Encounter (OSTE) has been proposed as a means of promoting and assessing the teaching skills of medical faculty.

AIMS

To describe the uses of the OSTE and the evidence supporting its effectiveness.

METHOD

MEDLINE (January 1966 through February 2010) was searched for English-language studies detailing the use of an OSTE for any educational purpose. Reference lists from relevant review articles and identified studies were also searched. Of the 354 papers initially identified, 22 were included in the review.

RESULTS

The OSTE has been used to assess and improve teaching performance and to assess the impact of other means of faculty development. Although qualitative results have been generally positive, there is little quantitative data to support using the OSTE as a means of improving teaching performance. There is moderate evidence suggesting the OSTE is a reliable and valid means of assessing teaching, although few ratings instruments have been adequately studied.

CONCLUSIONS

The OSTE is a promising innovation with potential application to assessing and promoting the teaching skills of medical faculty. Further study is required to determine the most effective OSTE design.

Faculty development: if you build it, they will come

OBJECTIVES

The goals of this study were three-fold: to explore the reasons why some clinical teachers regularly attend centralised faculty development activities; to compare their responses with those of colleagues who do not attend, and to learn how we can make faculty development programmes more pertinent to teachers' needs.

METHODS

In 2008-2009, we conducted focus groups with 23 clinical teachers who had participated in faculty development activities on a regular basis in order to ascertain their perceptions of faculty development, reasons for participation, and perceived barriers against involvement. Thematic analysis and research team consensus guided the data interpretation.

RESULTS

Reasons for regular participation included the perceptions that: faculty development enables personal and professional growth; learning and self-improvement are valued; workshop topics are viewed as relevant to teachers' needs; the opportunity to network with colleagues is appreciated, and initial positive experiences promote ongoing involvement. Barriers against participation mirrored those cited by non-attendees in an earlier study (e.g. volume of work, lack of time, logistical factors), but did not prevent participation. Suggestions for increasing participation included introducing a 'buddy system' for junior faculty members, an orientation workshop for new staff, and increased role-modelling and mentorship.

CONCLUSIONS

The conceptualisation of faculty development as a means to achieve specific objectives and the desire for relevant programming that addresses current needs (i.e., expectancies), together with an appreciation of learning, self-improvement and networking with colleagues (i.e., values), were highlighted as reasons for participation by regular attendees. Medical educators should consider these 'lessons learned' in the design and delivery of faculty development offerings. They should also continue to explore the notion of faculty development as a social practice and the application of motivational theories that include expectancy-value constructs to personal and professional development.

Pedagogical training of medicine professors

This study examines the pedagogical training process of medical professors at a Brazilian university, the meanings attributed to it, and the positive and negative aspects identified in it. This is a descriptive-exploratory study, using a qualitative approach with a questionnaire utilizing open-ended and closed questions and a semi-structured interview. The majority of queried individuals had no formal teacher training and learned to be teachers through a process of socialization that was in part intuitive or by modeling those considered to be good teachers; they received pedagogical training mainly in post-graduate courses. Positives aspects of this training were the possibility of refresher courses in pedagogical methods and increased knowledge in their educational area. Negative factors were a lack of practical activities and a dichotomy between theoretical content and practical teaching. The skills acquired through professional experience formed the basis for teaching competence and pointed to the need for continuing education projects at the institutional level, including these skills themselves as a source of professional knowledge.

Expertise, needs and challenges of medical educators: Results of an international web survey

BACKGROUND

Little is known about how medical educators perceive their own expertise, needs and challenges in relation to medical education.

AIM

To survey an international community of medical educators with a focus on: (1) their expertise, (2) their need for training and (3) perceived challenges.

METHODS

A web-based survey comprising closed and open free-text questions was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe.

RESULTS

Of the 2200 medical educators invited to participate, 860 (39%) from 76 different countries took part in the survey. In general, their reported areas of expertise mainly comprised principles of teaching, communication skills training, stimulation of students in self-directed learning and student assessment. Respondents most often indicated a need for training with respect to development in medical-education-research methodology, computer-based training, curriculum evaluation and curriculum development. In the qualitative analysis of 1836 free-text responses concerning the main challenges faced, respondents referred to a lack of academic recognition, funding, faculty development, time for medical education issues and institutional support.

CONCLUSIONS

The results of this survey indicate that medical educators face several challenges, with a particular need for more academic recognition, funding and academic qualifications in medical education.

Clinical teaching improvement: The transportability of the Stanford Faculty Development Program

BACKGROUND

The Stanford Faculty Development Center (SFDC) at Stanford University developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model. We were curious to see if cultural factors might influence the applicability and impact of the course when delivered to non-American participants by a facilitator from that culture.

METHODS

A Swedish anaesthesiologist at Uppsala University Hospital, Sweden, was trained in October 2004 at Stanford University. From January 2005 to March 2007 he delivered five faculty development seminar series at Uppsala University Hospital to 40 physicians from different departments. Participants rated the usefulness of the seminar series and retrospective pre- and post-seminar ratings were used to assess effects on participants' teaching skills and behaviours.

RESULTS

Participants rated the seminars as highly useful (M = 4.8, SD = 0.4). Participants' ratings of their teaching ability indicated significant increases across a variety of clinical and non-clinical teaching settings (p < 0.001), and positive changes in teaching behaviours were found for all seven educational categories assessed (p < 0.001).

CONCLUSIONS

This faculty development model is highly transportable to medical teachers in Sweden, and capable of producing positive results, consistent with those found in the United States.

Can performance indicators be used for pedagogic purposes in disaster medicine training?

Background

Although disaster simulation trainings were widely used to test hospital disaster plans and train medical staff, the teaching performance of the instructors in disaster medicine training has never been evaluated. The aim of this study was to determine whether the performance indicators for measuring educational skill in disaster medicine training could indicate issues that needed improvement.

Methods

The educational skills of 15 groups attending disaster medicine instructor courses were evaluated using 13 measurable performance indicators. The results of each indicator were scored at 0, 1 or 2 according to the teaching performance.

Results

The total summed scores ranged from 17 to 26 with a mean of 22.67. Three indicators: 'Design', 'Goal' and 'Target group' received the maximum scores. Indicators concerning running exercises had significantly lower scores as compared to others.

Conclusion

Performance indicators could point out the weakness area of instructors' educational skills. Performance indicators can be used effectively for pedagogic purposes.

What predicts residency accreditation cycle length? Results of a national survey

PURPOSE

To determine whether residency program baseline characteristics, program director characteristics, and the date of the most recent Accrediation Council for Graduate Medical Education (ACGME) site visit would affect program accreditation cycle length.

METHOD

A survey asked about cycle length as well as program and program director characteristics. The survey was sent to all 391 accredited internal medicine residency programs registered with the Association of Program Directors in Internal Medicine in March 2005. Bivariate and multivariate regressions were performed to find factors independently associated with cycle length.

RESULTS

The mean cycle length was 3.8 years among respondents (70% response rate). Program characteristics associated with longer cycle length included having a higher three-year American Board of Internal Medicine (ABIM) board pass rate. Program characteristics associated with shorter cycle length included being reviewed by the Residency Review Committee in Internal Medicine (RRC-IM) shortly after the July 2003 ACGME program requirement changes, being a university-based program, and having a large percentage of voluntary teaching faculty. Program director characteristics associated with longer cycle length included time spent in clinic. Other program and program director characteristics had no effect on cycle length.

CONCLUSIONS

Several program and program director characteristics are associated with RRC-IM cycle length. Programs should be wary of the dates of their Residency Review Committee site visits in relation to ACGME programmatic rule changes. The percentage of voluntary faculty at each program, the ABIM board pass rate, and the amount of time the program director spends in clinic also affect a program's cycle length.

Faculty development: a 'field of dreams'?

OBJECTIVES

Participants in faculty development workshops often comment that 'those who need faculty development the most attend the least'. The goals of this study were to explore the reasons why some clinical teachers do not participate in centralised faculty development activities and to learn how we can make faculty development programmes more relevant to teachers' needs.

METHODS

In 2006, we conducted focus groups with 16 clinical teachers, who had not participated in faculty development activities, to ascertain their perceptions of faculty development, reasons for non-participation and perceived barriers to involvement. Content analysis and team consensus guided the data interpretation.

RESULTS

Focus group participants were aware of faculty development offerings and valued the goals of these activities. Important reasons for non-participation emerged: clinical reality, which included volume of work and lack of (protected) time; logistical issues, such as timing and the central location of organised activities; a perceived lack of financial reward and recognition for teaching, and a perceived lack of direction from, and connection to, the university.

CONCLUSIONS

Clinical reality and logistical issues appeared to be greater deterrents to participation than faculty development goals, content or strategies. Moreover, when asked to discuss faculty development, teachers referred to their development as faculty members in the broadest sense, which included personal and career development. They also expressed the desire for clear guidance from the university, financial rewards and recognition for teaching, and a sense of 'belonging'. Faculty development programmes should try to address these organisational issues as well as teachers' personal and professional needs.

Long-term follow-up of a 10-month programme in curriculum development for medical educators: a cohort study

CONTEXT

There is an ongoing need for curriculum development (CD) in medical education. However, only a minority of medical teaching institutions provide faculty development in CD. This study evaluates the long-term impact of a longitudinal programme in curriculum development.

METHODS

We surveyed eight cohorts of participants (n = 64) and non-participants (n = 64) from 1988 to 1996 at baseline and at 6-13 years after completion of a 10-month, one half-day per week programme offered annually, which included a mentored CD project, workshops on CD steps, a final paper and a presentation.

RESULTS

Fifty-eight participants (91%) and 50 non-participants (78%) returned completed follow-up surveys. In analyses, controlling for background characteristics and baseline self-rated proficiencies, participants were more likely than non-participants at follow-up to report having developed and implemented curricula in the past 5 years (65.5% versus 43.7%; odds ratio [OR] 2.41, 95% confidence interval [CI] 1.03-5.66), to report having performed needs assessment when planning a curriculum (86.1% versus 58.8%; OR 5.59, 95% CI 1.20-25.92), and to rate themselves highly in developing (OR 3.57, 95% CI 1.36-9.39), implementing (OR 3.04, 95% CI 1.16-7.93) and evaluating (OR 2.74, 95% CI 1.10-6.84) curricula. At follow-up, 86.2% of participants reported that the CD programme had made a moderate or great impact on their professional careers. Responses to an open-ended question on the impact confirmed continued involvement in CD work, confidence in CD skills, application of CD skills and knowledge beyond CD, improved time management, and lasting relationships formed because of the programme.

CONCLUSIONS

Our results suggest that a longitudinal faculty development programme that engages and supports faculty in real CD work can have long-lasting impact.

A controlled study of the short- and long-term effects of a Train the Trainers course

Objectives This study aimed to establish the longterm effects of a 3-day 'Training for Trainers' course (TTC) on doctors' knowledge, teaching behaviour and clinical learning climate. Methods The study was designed as an intervention study with pre-, post- and long-term measurements. The intervention group (I-group) included 118 doctors from the departments of internal medicine and orthopaedic surgery at one university hospital. The control group (C-group) consisted of 125 doctors from the corresponding departments at another university hospital. Gains in knowledge about teaching skills were assessed by a written test. Teaching behaviour and learning climate were evaluated by questionnaires. Results In the I-group, 98.4% of doctors, both specialists and trainees, participated in a TTC. Response rates on the written test varied from 90% at baseline to 70% at 6 months after the intervention. Knowledge about teaching skills increased in the I-group by 25% after the TTC and was sustained at 6 months. Questionnaire response rates varied from 98.4% at baseline to 84.8% at 6 months. Post-course, the teaching behaviour of the I-group significantly changed and its learning climate improved compared with the C-group. Scores for use of feedback and supervision in the I-group increased from 4-5 to 6-7 (maximum score = 9). This was significantly higher than in the C-group. Conclusions A 3-day residential TTC has a significant impact in terms of gains of knowledge concerning teaching skills, teaching behaviour and learning climate after 6 months. The positive effects demonstrated in this study were rooted in both the specialists and trainees who attended the course.

Physician-teacher characteristics associated with learner-centered teaching skills

BACKGROUND

Academic institutions do not have a way to identify physician-teachers who are proficient in learner-centered teaching.

AIM

To identify physician characteristics associated with being highly learner-centered.

METHODS

A cohort of 363 physicians was surveyed. Measured items included personal characteristics, professional characteristics, teaching activities, self-assessed teaching proficiencies and behaviors, and scholarly activities. A learner-centeredness scale was developed using factor analysis. Logistic regression models were used to determine which characteristics were independently associated with scoring highly on the learner-centeredness scale.

RESULTS

Two hundred and ninety-nine physicians responded (82%) of whom 262 (88%) had taught medical learners in the prior 12 months. Six variables combined to form the learner-centeredness scale and the Cronbach Alpha of the scale was 0.73. The eight characteristics independently associated with high learner-centered scores for physician teachers were (i) proficiency in giving lectures or presentations (OR ;= ;5.1, 95% CI: 1.3-19.6), (ii) frequently helping learners identify resources to meet their own needs (OR ;= ;3.7, 95% CI: 1.3-10.3), (iii) proficiency in eliciting feedback from learners (OR ;= ;3.7, 95% CI: 1.7-8.5), (iv) frequently attempting to detect and discuss emotional responses of the learners (OR ;= ;2.9, 95% CI: 1.2-6.9), (v) frequently reflecting on the validity of feedback from the learners (OR ;= ;2.8, 95% CI: 1.1-7.4), (vi) frequently identifying available resources to meet the teacher's learning needs (OR ;= ;2.8, 95% CI: 1.1-7.2), (vii) having given an oral presentation related to education at a national/regional meeting (OR ;= ;2.6, 95% CI: 1.1-6.0), and (viii) frequently letting learners know how different situations affect the teacher (OR ;= ;2.5, 95% CI: 1.1-5.5).

CONCLUSIONS

The clinical competence and professional growth of medical learners can be most effectively facilitated by learner-centered educational methods. It may now be possible to identify medical educators who are more learner-centered in their teaching.

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.

Long-term effect of a course on in-training assessment in postgraduate specialist education

BACKGROUND

In-training assessment has become an important part of clinical teachers' responsibilities. One way to ensure that clinical teachers are qualified for this role is setting up a course. A "Teach the teachers" course focusing on in-training assessment was designed for anaesthesiologists in Denmark.

AIMS

To evaluate short and longer term effects of a course on in-training assessment for clinical teachers in Anaesthesiology.

METHOD

Fifty-one anaesthesiologists attended a 2-day interactive course about in-training assessment. Effects of the course on knowledge were assessed using identical pre- and post- tests. Longer- term effects were measured six months after the course using the same test. Self-reported use of in-training assessment methods was evaluated using supplemental questions in the follow-up test.

RESULTS

There were significant increases in knowledge about in-training assessment immediately following the course (effect size, Cohens d = 1, 5). The knowledge was retained six months later. Knowledge about assessment by clinical structured observation and by written assignments showed further increases in the follow-up period. Participants used the various assessment methods in their daily practice during the six-month study period.

CONCLUSION

A focused "Teach the teachers" course during the implementation phase of a new assessment programme increased participants' knowledge about in-training assessment.

Faculty Development for the 21st Century: Lessons from the Society of General Internal Medicine–Hartford Collaborative Centers for the Care of Older Adults

In this review of a recent set of faculty development initiatives to promote geriatrics teaching by general internists, nontraditional strategies to promote sustained change were identified, included enrolling a limited number of "star" faculty, creating ongoing working relationships between faculty, and developing projects for clinical or education program improvement. External funding, although limited, garnered administration support and was associated with changes in individual career trajectories. Activities to enfranchise top leadership were felt essential to sustain change. Traditional faculty development programs for clinician educators are periodic, seminar-based interventions to enhance teaching and clinical skills. In 2003/04 the Collaborative Centers for Research and Education in the Care of Older Adults were funded by the John A. Hartford Foundation and administered by the Society of General Internal Medicine. Ten academic medical centers received individual grants of $91,000, with required cost sharing, to develop collaborations between general internists and geriatricians to create sustained change in geriatrics clinical teaching and learning. Through written and structured telephone surveys, activities designed to foster sustainability at funded sites were identified, and the activities and perceived effects of funding at the 10 funded sites were compared with those of the 11 highest-ranking unfunded sites. The experience of the Collaborative Centers supports the conclusion that modest, targeted funding can provide the credibility and legitimacy crucial for clinician educators to allocate time and energy in new directions. Key success factors likely include high intensity and duration, integration into career trajectories, integration into clinical programs, and activities to enfranchise institutional leadership.

A ten-month program in curriculum development for medical educators: 16 years of experience

BACKGROUND

Despite increased demand for new curricula in medical education, most academic medical centers have few faculty with training in curriculum development.

OBJECTIVE

To describe and evaluate a longitudinal mentored faculty development program in curriculum development.

DESIGN

A 10-month curriculum development program operating one half-day per week of each academic year from 1987 through 2003. The program was designed to provide participants with the knowledge, attitudes, skills, and experience to design, implement, evaluate, and disseminate curricula in medical education using a 6-step model.

PARTICIPANTS

One-hundred thirty-eight faculty and fellows from Johns Hopkins and other institutions and 63 matched nonparticipants.

MEASUREMENTS

Pre- and post-surveys from participants and nonparticipants assessed skills in curriculum development, implementation, and evaluation, as well as enjoyment in curriculum development and evaluation. Participants rated program quality, educational methods, and facilitation in a post-program survey.

RESULTS

Sixty-four curricula were produced addressing gaps in undergraduate, graduate, or postgraduate medical education. At least 54 curricula (84%) were implemented. Participant self-reported skills in curricular development, implementation, and evaluation improved from baseline (p < .0001), whereas no improvement occurred in the comparison group. In multivariable analyses, participants rated their skills and enjoyment at the end of the program significantly higher than nonparticipants (all p < .05). Eighty percent of participants felt that they would use the 6-step model again, and 80% would recommend the program highly to others.

CONCLUSIONS

This model for training in curriculum development has long-term sustainability and is associated with participant satisfaction, improvement in self-rated skills, and implementation of curricula on important topics.

Mistaken, misshapen and mythical images of nurse education: Creating a shared identity for clinical nurse educator practice

The hospital-based clinical nurse educator is pivotal to the integration of formal learning and clinical practice. Clinical nurse educators are generally considered to be expert nurses within a particular clinical environment; however, many of those who are expert clinicians suffer some loss of identity when assuming clinical teaching roles. It is necessary to facilitate the expression of identity in order to foster collective agency and to empower individuals and groups. In a health care system that is awash with change, the importance of this may often be overlooked. This paper reports on the process and outcomes of a series of workshops with clinical nurse educators in a New South Wales area health service that sought to create a shared identity and role for clinical nurse educators within the health service. Challenges in role demarcation and delineation of the roles and functions of clinical nurse educators clinical nurse specialists, clinical nurse consultants, practice development facilitators and nurse educators have been reported. Each of these has overlapping and complementary roles to support learning, however, the primary focus and area of responsibility varies among each of these groups.

Bioterrorism training in U.S. emergency medicine residencies: has it changed since 9/11?

OBJECTIVES

To assess the change in prevalence of bioterrorism training among emergency medicine (EM) residencies from 1998 to 2005, to characterize current training, and to identify characteristics of programs that have implemented more intensive training methods.

METHODS

This was a national cross sectional survey of the 133 U.S. EM residencies participating in the 2005 National Resident Matching Program; comparison with a baseline survey from 1998 was performed. Types of training provided were assessed, and programs using experiential methods were identified.

RESULTS

Of 112 programs (84.2%) responding, 98% reported formal training in bioterrorism, increased from 53% (40/76) responding in 1998. In 2005, most programs with bioterrorism training (65%) used at least three methods of instruction, mostly lectures (95%) and disaster drills (80%). Fewer programs used experiential methods such as field exercises or bioterrorism-specific rotations (35% and 13%, respectively). Compared with other programs, residency programs with more complex, experiential methods were more likely to teach bioterrorism-related topics at least twice a year (83% vs. 59%; p = 0.018), to teach at least three topics (60% vs. 40%; p = 0.02), and to report funding for bioterrorism research and education (74% vs. 45%; p = 0.007). Experiential and nonexperiential programs were similar in program type (university or nonuniversity), length of program, number of residents, geographic location, and urban or rural setting.

CONCLUSIONS

Training of EM residents in bioterrorism preparedness has increased markedly since 1998. However, training is often of low intensity, relying mainly on nonexperiential instruction such as lectures. Although current recommendations are that training in bioterrorism include experiential learning experiences, the authors found the rate of these experiences to be low.

Direct observation of faculty with feedback: an effective means of improving patient-centered and learner-centered teaching skills

BACKGROUND

In 2002 Lehigh Valley Hospital and Health Network Internal Medicine residency program sought to establish a faculty development program for their teaching faculty that emphasized learner-centered teaching of patient-centered care.

DESCRIPTION

Medical educators trained in observational research practices shadowed teaching teams for 24 months and observed 24 General Internal Medicine faculty teach on inpatient rounds and provided timely written feedback to faculty. Within 48 hr, faculty received a completed Observation Feedback Sheet and summary comments.

EVALUATION

Teaching skills were seen to improve over time after feedback was provided and repeat observations occurred. Observation ratings mirrored the results of the established Department of Medicine resident ranking of faculty teaching: Observed faculty receiving feedback improved their ranking, whereas faculty not observed did not.

CONCLUSIONS

Observation of teaching with written feedback is an effective means of individualizing faculty development and improving learner-centered and microskill teaching of patient-centered care.