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Effect of Residents-as-Teachers in Rural Community-Based Medical Education on the Learning of Medical Students and Residents: A Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312410. [PMID: 34886136 PMCID: PMC8656610 DOI: 10.3390/ijerph182312410] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.
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Serling-Boyd N, Miloslavsky EM. Enhancing the Inpatient Consultation Learning Environment to Optimize Teaching and Learning. Rheum Dis Clin North Am 2021; 46:73-83. [PMID: 31757288 DOI: 10.1016/j.rdc.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Subspecialty consultation is an increasingly used resource in inpatient medicine. Teaching the primary team is an important element of effective consultation and has many potential benefits. However, within academic medical centers many barriers to effective consultation and the consult learning environment exist. High workload, burnout, inexperience, lack of familiarity between teams, quality of the consult requests, and pushback may impede teaching and learning. Herein, the authors review the role of teaching and learning during consultation, challenges to effective consultation facing fellows, and interventions that can enhance primary team-fellow interactions and learning.
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Affiliation(s)
- Naomi Serling-Boyd
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Eli M Miloslavsky
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA.
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McNabney MK, Suh TT, Sellers V, Wilner D. Aligning geriatric medicine fellowships with the Program of All-Inclusive Care for the Elderly (PACE). GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:2-12. [PMID: 30558514 DOI: 10.1080/02701960.2018.1532891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Geriatric medicine fellowship programs provide comprehensive training to one-year clinical fellows and must demonstrate successful progression of competence among fellows by reporting on 23 milestones to the Accreditation Council for Graduate Medical Education (ACGME). The Program of All-inclusive Care for the Elderly (PACE) is a model of care located throughout the United States and can serve as a training venue for fellows. We surveyed 113 fellowship program directors with a response rate of 42% (n = 48). The purpose of the survey was to assess: (1) familiarity and access to PACE and (2) perceived value of PACE to the fellowship program with regard to training and ability to achieve success in the 23 reporting milestones. Milestones involving communication and team management skills were most consistently identified as very valuable with a PACE clinical rotation. We then convened a focus group of four PACE medical directors who developed a fellowship curriculum for use in training fellows at PACE. We discuss the limitations of our design as well as the opportunities to build on the strengths of that model as a training site for fellows.
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Affiliation(s)
- Matthew K McNabney
- Hopkins ElderPlus
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University
| | - Theodore T Suh
- Turner Geriatric Clinic at East Ann Arbor
- Department of Medicine, University of Michigan and the Geriatric Research, Education and Clinical Center, Ann Arbor VA Medical Center
| | - Verna Sellers
- Geriatric Services and Program of All-Inclusive Care for the Elderly, Centra Health
| | - David Wilner
- Capstone Performance Systems
- University of Massachusetts Medical School
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Teacher training for rheumatology fellows: a national needs assessment of fellows and program directors. Clin Rheumatol 2019; 39:673-680. [PMID: 31832802 DOI: 10.1007/s10067-019-04829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Teaching is an integral part of what we do as physicians, and exposure to training on how to effectively teach is not consistently implemented in the curricula within medical training. METHODS We administered anonymous, in-person surveys to fellows and program directors (PDs) at the 2017 American College of Rheumatology national conference to evaluate fellow and PD attitudes regarding development of programs dedicated to teaching fellows on how to teach. RESULTS One hundred seven of 150 fellows returned surveys (response rate 71%). About 60% demonstrated interest in pursuing a teaching-focused career. About 97% felt their teaching skills can be improved; 88% felt improved teaching skills will be valuable for their career. With 61% response rate (57/94 PD surveys), most PDs agreed their fellows could use additional instruction in teaching. About 90% noted this would be an asset for fellows' careers. When compared, 56% of fellows reported no structured training in education during fellowship, while 64% of PDs said this type of training was available. All agreed fellow teaching skills can be improved but significantly more fellows than faculty felt confident in the fellows' ability to give feedback (p = 0.03). Both groups identified time constraints and other faculty interest as barriers. CONCLUSION There is significant need to develop effective fellow-as-teacher programs aimed at enhancing fellows' teaching skills, with focus on giving feedback and working within fellow and faculty time constraints. The program can help address a curriculum gap identified by fellows as well as PDs before fellowship-to-faculty transition.Key Points• There is a notable gap between faculty physicians' expectations to teach as clinician-educators and the lack of training dedicated to learning how to teach during medical training. Despite the fact that past clinical educators have identified instructional design and assessment as low-confidence areas, there is a paucity of structured program dedicated to developing these teaching skills during fellowship training.• With 97% fellows and 84% program directors, both groups agreed fellows could use additional instruction in teaching skills, but there was a significant discrepancy between fellow and program director perspectives regarding fellows' ability to give feedback.• Consistent with past needs assessments in other medical specialties, lack of time and potential faculty interest were recognized as potential barriers, calling for a structured training program dedicated to education on didactics that takes into account trainee and faculty time constraints.• Our needs assessment can direct future research on analyzing effectiveness of fellow-as-teacher program implementation by focusing on improvement of fellow teaching and feedback skills.
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McSparron JI, Huang GC, Miloslavsky EM. Developing internal medicine subspecialty fellows' teaching skills: a needs assessment. BMC MEDICAL EDUCATION 2018; 18:221. [PMID: 30249229 PMCID: PMC6154890 DOI: 10.1186/s12909-018-1283-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 07/19/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND For academic physicians, teaching represents an essential skill. The proliferation of educator training programs aimed at residents and medical students signals the increasing commitment of training programs to develop teaching skills in their trainees as early as possible. However, clinical fellowships represent an important opportunity to advance training as educators. In addition to enriching the pipeline of future teachers, developing fellows as teachers augments the training experience for more junior trainees and may impact patient care. Fellows' needs for programs to improve teaching skills have been largely unexplored. METHODS We conducted a multi-institutional needs assessment of internal medicine (IM) subspecialty fellows to gauge interest in teaching and improvement of teaching skills. We surveyed IM subspecialty fellows at three academic medical centers about their access to fellow-as-teacher programs and other mechanisms to improve their teaching skills during fellowship. We also elicited their attitudes towards teaching and interest in training related to teaching skills. RESULTS One hundred eighty-three fellows representing 20 programs and nine different subspecialties responded to the survey (48% response rate). The majority of participants (67%) reported having no specific training focused on teaching skills and only 12% reported receiving regular feedback about their teaching during their fellowship. Seventy-nine percent of fellows anticipated teaching to be part of their careers, and 22% planned to participate in medical education scholarship. Fellows reported a strong interest in teaching and programs aimed at improving their teaching skills. CONCLUSIONS The majority of fellows reported a lack of mechanisms to advance their teaching skills as fellows, despite anticipating teaching to be an important aspect of their future careers and having strong interest in such programs. Our findings at three academic medical centers confirm a lost opportunity among subspecialty fellowships to accelerate teaching skills development for future educators.
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Affiliation(s)
- Jakob I. McSparron
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Grace C. Huang
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 USA
| | - Eli M. Miloslavsky
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Yawkey Center for Outpatient Care, 55 Fruit Street, Suite 2C, Boston, MA 02114 USA
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Chen DC, Miloslavsky EM, Winn AS, McSparron JI. Fellow as Clinical Teacher (FACT) Curriculum: Improving Fellows' Teaching Skills During Inpatient Consultation. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10728. [PMID: 30800928 PMCID: PMC6342376 DOI: 10.15766/mep_2374-8265.10728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Multiple barriers, including time constraints, a demanding teaching environment, and lack of longitudinal relationships with residents, make it challenging for fellows and learners to engage in effective teaching during consultation. METHODS The Fellow as Clinical Teacher (FACT) curriculum was developed to overcome such barriers and improve fellow teaching in the setting of inpatient consultation. The FACT curriculum consists of two 45- to 60-minute small-group sessions designed for subspecialty fellows. The first session focuses on overcoming barriers to teaching and application of the principles of adult learning theory. The second introduces the PARTNER (partner with resident, assess the learner, reinforce positives, teaching objectives, new knowledge, execute recommendations, review) framework for teaching during consultation and uses video examples to model the application of this framework, allowing fellows to practice its implementation through role-play. RESULTS Previously, the FACT curriculum was shown to improve teaching skills of rheumatology and pulmonary/critical care fellows as evaluated by objective structured teaching exercises. Here, the curriculum has been expanded to 51 internal medicine and pediatrics fellows in 15 different training programs. The curriculum improved fellow teaching skills as assessed by self-assessment surveys. It was highly rated by participants, and fellows reported being more likely to teach during consultation following this educational intervention. DISCUSSION The FACT curriculum can be integrated into subspecialty training programs to improve the teaching skills of internal medicine and pediatrics fellows in the setting of inpatient consultation. Ultimately, improved teaching from fellows may have broad-reaching effects for residents, patients, and the fellows themselves.
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Affiliation(s)
- Debbie C Chen
- Internal Medicine Resident, Massachusetts General Hospital
| | - Eli M Miloslavsky
- Assistant Professor of Medicine, Harvard Medical School
- Member, Division of Rheumatology, Massachusetts General Hospital
| | - Ariel S Winn
- Instructor in Pediatrics, Harvard Medical School
- Member, Division of General Pediatrics, Boston Children's Hospital
| | - Jakob I McSparron
- Assistant Professor, Division of Pulmonary and Critical Care Medicine, University of Michigan
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Won CW, Kim S, Swagerty D. Why Geriatric Medicine Is Important for Korea: Lessons Learned in the United States. J Korean Med Sci 2018; 33:e175. [PMID: 29930487 PMCID: PMC6010741 DOI: 10.3346/jkms.2018.33.e175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/19/2018] [Indexed: 01/25/2023] Open
Abstract
With the rapid increase in the number of Korean older adults, developing and integrating quality, expert older adult care in the Korean health care system will be essential and a tremendous benefit to these older adult patients, their families, and Korean society. While the awareness of geriatric medicine as a specialty for physicians caring exclusively for older adults has improved greatly in recent decades among Korean health care providers and older adult patients, there is still great opportunity to improve training opportunities for all medical students, primary care physicians, and specialty Geriatrics. Korea must also formally establish uniform geriatric medicine fellowships and certification. However, a number of barriers such as insufficient expertise, low incentives, and competitive geriatric societies exist to implement widespread, quality geriatric medicine in the Korean health care system.
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Affiliation(s)
- Chang Won Won
- Department of Family Medicine, Senior Health Care Center, Kyung Hee University Medical Center, Seoul, Korea
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, Senior Health Care Center, Kyung Hee University Medical Center, Seoul, Korea
| | - Daniel Swagerty
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Geriatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
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Dilly CK, Carlos WG, Hoffmann-Longtin K, Buckley J, Burgner A. Bridging the gap for future clinician-educators. CLINICAL TEACHER 2017; 15:488-493. [DOI: 10.1111/tct.12737] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christen K Dilly
- Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
| | - W Graham Carlos
- Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
| | - Krista Hoffmann-Longtin
- Office of Faculty Affairs and Professional Development; Indiana University School of Medicine; Indianapolis Indiana USA
| | - John Buckley
- Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
| | - Anna Burgner
- Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee USA
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Miloslavsky EM. Use of Fellow as Clinical Teacher (FACT) Curriculum for Teaching During Consultation: Effect on Subspecialty Fellow Teaching Skills. J Grad Med Educ 2017; 9. [PMID: 28638515 PMCID: PMC5476386 DOI: 10.4300/jgme-d-16-00464.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Subspecialty consultation in inpatient care is increasing. Teaching by subspecialty fellows in a consultation setting may be an important source of work-based learning for students and residents. However, teaching and evaluation of learners in this context may be challenging due to personal and systems-based barriers. OBJECTIVE We developed and evaluated a framework designed to overcome barriers to teaching and to improve fellow teaching skills during inpatient consultation. METHODS The PARTNER (Partner with resident, Assess the learner, Reinforce positives, Teaching objectives, New knowledge, Execute recommendations, Review) framework was delivered to rheumatology and pulmonary and critical care medicine fellows at 3 academic medical centers as part of a 2-session Fellow as Clinical Teacher (FACT) curriculum. Fellows' teaching skills were evaluated using an objective structured teaching exercise (OSTE) pre- and postcurriculum, and at the end of the academic year. Self-assessment surveys were used to evaluate fellows' self-perception of teaching skills. RESULTS Twelve of 16 eligible fellows (75%) participated in the program and completed 73 OSTE cases. Teaching skills measured by OSTEs and self-assessment surveys improved after administration of the FACT curriculum. There was no significant skill decay at the end-of-year evaluation. The curriculum was rated highly, and 73% (8 of 11) of fellows stated they would teach more frequently as a result of the intervention. CONCLUSIONS The FACT curriculum was practical and feasible, and significantly improved fellows' teaching skills teaching during inpatient consultation.
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Abstract
Fellows are expected to educate trainees, peers, and patients, during and long after fellowship. However, there has been relatively little emphasis on the acquisition of teaching skills in fellowship programs. Challenges to teaching by fellows during subspecialty training include demanding clinical duties, their limited knowledge base in the field, brief contact time with learners during consultative roles, and, for new fellows, personal unfamiliarity with the learners and hospital culture. Fellows' teaching skills can be improved by formal curricula addressing teaching, and by direct observation and feedback of teaching akin to what is provided for learning clinical care. Further expansion of fellow-as-teacher programs will allow in-depth training for fellows seeking careers as medical educators. Even without such dedicated programs, emphasis on honing teaching skills during fellowship will telegraph the importance of teaching and help evolve divisional culture. Such efforts can have a positive impact on patients and learners, and enhance the teaching skills of future faculty.
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Fleming GM, Brook MM, Herman BE, Kennedy C, McGann KA, Mason KE, Weiss P, Myers AL. Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey. Acad Pediatr 2016; 16:415-418. [PMID: 27150512 DOI: 10.1016/j.acap.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Geoffrey M Fleming
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn.
| | - Michael M Brook
- University of California San Francisco, San Francisco, Calif
| | - Bruce E Herman
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Chris Kennedy
- Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Katherine E Mason
- Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Pnina Weiss
- Department of Pediatrics, Yale University, New Haven, Conn
| | - Angela L Myers
- Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
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