Volunteer physician faculty and the changing face of medicine

How Full Is Your Tank? A Qualitative Exploration of Faculty Volunteerism in a National Professional Development Program

OBJECTIVE

Professional development programs (PDPs) within academic professional organizations rely on faculty volunteers, but little is known about the volunteering process and experience. Our aim was to gain insights into the initial decision to volunteer, the experience of volunteering and the decision to re-volunteer or not (ie, remain or leave as a volunteer). The study setting was a PDP of the Academic Pediatric Association, the Educational Scholars Program.

METHODS

In 2014, 13 Educational Scholars Program faculty members participated in semistructured phone interviews. The authors performed a general inductive analysis of the data, inductively created codes, and analyzed coded data for emergent themes that led to the creation of a model for recruiting and sustaining volunteers.

RESULTS

Four themes related to the initial volunteer decision and the decision to re-volunteer or not (self-interest and altruism, reputation of the program, relevant skill set, and doability), and 4 themes related to the experience of volunteering (emotional impact, career advancement and professional recognition, professional growth, and doability) emerged. The relationship among the themes led to the creation of a model of volunteering, involving a metaphorical volunteerism "tank" that is full when faculty initially volunteer and subsequently fills or empties as a result of dynamic interplay between the themes for each individual.

CONCLUSIONS

Leaders of PDPs may find our model of volunteering beneficial for enhancing the emotional and tangible benefits and minimizing the logistical issues of volunteering. This information should contribute to success in recruiting and retaining the volunteers who are essential for developing and sustaining PDPs.

Can the Recruitment of Senior Transitioning Clinician Educators Enhance the Number and Quality of Resident Observations? Thinking Outside the Box

Issue: The Accreditation Council for Graduate Medical Education's Next Accreditation System has forever changed the way faculty evaluate residents, fellows, and medical students, mandating direct observation by faculty of trainee performance. Evidence: The literature suggests that institutional culture does not support trainee observation, and faculty perceive that they have limited time to observe trainees in an efficient and effective manner. These factors contribute to an inadequate number of trainee observations, limiting faculty ability to assess trainees' achievement of competency. Hiring more faculty to increase observations has not been feasible or a priority, nor have faculty development programs been universally effective in recruiting faculty to enhance observations. Implications: To alleviate this important problem, the author proposes recruiting senior clinician educators transitioning to retirement. These are faculty who in their full-time careers have established themselves as playing a major role in teaching and might be interested in continuing their relationship with the academic health center. The number of these physicians is increasing and therefore there will be a larger pool seeking an opportunity to continue their commitment to education. Recruitment of senior clinician educators transitioning to retirement could significantly increase the number and quality of resident observations, addressing a previously insoluble problem with a relatively significant return on investment to the academic health center.

Exploring the components of physician volunteer engagement: a qualitative investigation of a national Canadian simulation-based training programme

OBJECTIVES

Conceptual clarity on physician volunteer engagement is lacking in the medical literature. The aim of this study was to present a conceptual framework to describe the elements which influence physician volunteer engagement and to explore volunteer engagement within a national educational programme.

SETTING

The context for this study was the Acute Critical Events Simulation (ACES) programme in Canada, which has successfully evolved into a national educational programme, driven by physician volunteers. From 2010 to 2014, the programme recruited 73 volunteer healthcare professionals who contributed to the creation of educational materials and/or served as instructors.

METHOD

A conceptual framework was constructed based on an extensive literature review and expert consultation. Secondary qualitative analysis was undertaken on 15 semistructured interviews conducted from 2012 to 2013 with programme directors and healthcare professionals across Canada. An additional 15 interviews were conducted in 2015 with physician volunteers to achieve thematic saturation. Data were analysed iteratively and inductive coding techniques applied.

RESULTS

From the physician volunteer data, 11 themes emerged. The most prominent themes included volunteer recruitment, retention, exchange, recognition, educator network and quasi-volunteerism. Captured within these interrelated themes were the framework elements, including the synergistic effects of emotional, cognitive and reciprocal engagement. Behavioural engagement was driven by these factors along with a cue to action, which led to contributions to the ACES programme.

CONCLUSION

This investigation provides a preliminary framework and supportive evidence towards understanding the complex construct of physician volunteer engagement. The need for this research is particularly important in present day, where growing fiscal constraints create challenges for medical education to do more with less.

Selecting, training and assessing new general practice community teachers in UK medical schools

BACKGROUND

Standards for undergraduate medical education in the UK, published in Tomorrow's Doctors, include the criterion 'everyone involved in educating medical students will be appropriately selected, trained, supported and appraised'.

AIMS

To establish how new general practice (GP) community teachers of medical students are selected, initially trained and assessed by UK medical schools and establish the extent to which Tomorrow's Doctors standards are being met.

METHOD

A mixed-methods study with questionnaire data collected from 24 lead GPs at UK medical schools, 23 new GP teachers from two medical schools plus a semi-structured telephone interview with two GP leads. Quantitative data were analysed descriptively and qualitative data were analysed informed by framework analysis.

RESULTS

GP teachers' selection is non-standardised. One hundred per cent of GP leads provide initial training courses for new GP teachers; 50% are mandatory. The content and length of courses varies. All GP leads use student feedback to assess teaching, but other required methods (peer review and patient feedback) are not universally used.

CONCLUSIONS

To meet General Medical Council standards, medical schools need to include equality and diversity in initial training and use more than one method to assess new GP teachers. Wider debate about the selection, training and assessment of new GP teachers is needed to agree minimum standards.

How can clinician-educator training programs be optimized to match clinician motivations and concerns?

BACKGROUND

Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns.

METHODS

Review of medical education literature using the terms "attitudes", "motivations", "physicians", "teaching", and "undergraduate medical education" resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students.

RESULTS

A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability.

CONCLUSION

Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education.

Legitimate workplace roles and activities for early learners

OBJECTIVES

Given the calls for earlier student engagement in clinical experiences, educators are challenged to define roles for pre-clerkship students that enable legitimate participation in clinical practice. This study aimed to determine the student roles and activities, as well as the clinic characteristics, that allow early student engagement within a specific clinical experience.

METHODS

The authors conducted semi-structured interviews in December 2011 and January 2012 with a purposive sample of medical student and faculty volunteers at student-run clinics (SRCs). They were asked to discuss and compare student roles in SRCs with those in the core curriculum. An inductive approach and iterative process were used to analyse the interview transcripts. Themes identified from initial open coding were organised using the sensitising concepts of workplace learning and communities of practice and subsequently applied to code all transcripts.

RESULTS

A total of 22 medical students and four faculty advisors were interviewed. Thematic analysis revealed pre-clerkship student roles in direct patient care (patient triage, history and physical examinations, patient education, laboratory and immunisation procedures) and in clinic management (patient follow-up, staff management, quality improvement). Students took ownership of patients and occupied central roles in the function of the clinic, with faculty staff serving as peripheral resources. Clinic-related features supporting this degree of legitimate participation included defined scopes of practice, limited presenting illnesses, focused student training, and clear protocols and operations manuals.

CONCLUSIONS

Pre-clerkship students are capable of legitimately participating in patient care experiences to an extent not usually available to them. The SRC represents one example of how early clinical experiences in the core curriculum might be transformed through the provision of patient care activities of narrow scope.

A community continuity programme: volunteer faculty mentors and continuity learning

BACKGROUND

Longitudinal generalist preceptorship experiences early in medical education can have beneficial effects on how students practise the art and science of medicine, regardless of their eventual career choices.

DESCRIPTION

We evaluated the first 2 years of implementation of an integrated, regional campus-based, early clinical experience programme, the Community Continuity Program, at our new community-based medical school that is under the supervision of volunteer primary care faculty members acting as continuity mentors (CMs). Curricular components for years 1 and 2 consisted of three annual 1-week community-based experiences with CMs, extensive physical diagnosis practice, interprofessional learning activities, a multigenerational family care experience, a mandatory Community Health Research Project (CHRP) in year 1 and a mandatory Quality Improvement Project in year 2.

EVALUATION

Outcome measures included student, faculty member and programme evaluations, student reflective narratives in portal-based e-journals, a Liaison Committee on Medical Education (LCME) self-study student survey and serial level-of-empathy surveys.

RESULTS

  Students found all elements of this integrated community experience programme beneficial and worthwhile, especially the CMs and the use of standardised and real-life patients. CMs noted effective and professional student-patient interactions. The number of reflective e-journal postings per student during year1 ranged from 14 to 81 (mean, 47). Serial empathy questionnaires administered over 2 years demonstrated preservation of student empathy, and students believed that the programme had a positive effect on their personal level of empathy.

CONCLUSION

  An integrative, longitudinal, community-based, early clinical experience programme driven by volunteer CMs provides patient-centered instruction for preclinical students in the clinical, social, behavioural, ethical and research foundations of medicine.

A survey to assess family physicians' motivation to teach undergraduates in their practices

Background

In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs’ motivation to teach medical students in their practices is lacking.

Purpose

To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument.

Methods

The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation.

Results

A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). ‘Helping others’ and ‘interest’ were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern.

Conclusion

German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.

A faculty and resident development program to improve learning and teaching skills

OBJECTIVE

To assess the value of a faculty and resident medical education development program.

STUDY DESIGN

Modules on Accreditation Council for Graduate Medical Education (ACGME) competencies and evaluation, teaching methods, and Residency Review Committee guidelines were created, beta tested, and installed on a website. Pretests and posttests were developed. Faculty and residents were required to complete the course. At initiation and 6 months after training, residents completed a feedback perception survey. Statistical analysis was performed using Student t test. P < .05 was considered significant.

RESULTS

Forty-nine voluntary faculty members and residents completed the course. The posttest scores on all the ACGME competencies were significantly higher than the pretest scores (P < .05). The results of the residents' survey indicated that the educational development program significantly improved their perceptions of corrective and immediate feedback by faculty.

CONCLUSION

A formal Internet-based program significantly increases short-term cognitive knowledge about the ACGME competencies among participants and improves trainees' perceptions of the quality of faculty feedback up to 6 months after training.

An association between paying physician-teachers for their teaching efforts and an improved educational experience for learners

BACKGROUND

Medical schools often rely on faculty volunteerism to address clinical teaching needs for students. Increasing time pressures on physicians has made it difficult to secure commitments for clinical instruction. In the 2005-2006 academic year, the Johns Hopkins University School of Medicine (JHUSOM) launched the Colleges Program, recruiting 24 salary-supported physician-faculty to serve as advisors to students as well as teachers of the second year course, 'clinical skills'. We hypothesized that compensating physician educators would have a measurable positive impact on the students' experiences in this course.

MATERIALS AND METHODS

Students' assessments of paid colleges faculty (CF) preceptors from the 2005-2006 year were compared to those of volunteer preceptors from the two prior years (2003-2005 academic years) along six different teaching parameters linked to the course's objectives. Multivariable regression analysis was used to identify the factors independently associated with higher preceptor scores.

RESULTS

Fifty-eight preceptors taught clinical skills over the 3-year study period. The overall response rate for preceptor evaluations by medical learners was 77% (277/359). CF, more likely than volunteer preceptors to have a full-time academic appointment (100 vs 63%, p < .01), have an additional advanced degree (48 vs 15%, p < .01) and prior faculty development training (52 vs 17%, p < .01). Scores for all six evaluation domains were higher for CF compared to those from the two previous years combined (all p < .001). In the fully adjusted regression model, only CF status was independently associated with high preceptor evaluation scores (Odds Ratio 4.3, 95% CI 1.01-18.20).

CONCLUSIONS

Salary support for teaching efforts in the time-intensive CS course coupled with the prestige of being appointed to the CF was associated with higher student evaluations.

The satisfaction, motivation, and future of community preceptors: the North Carolina experience

PURPOSE

To measure satisfaction and motivation of community-based preceptors, and to examine differences between degree groups of physicians, pharmacists, advanced-practice nurses (nurse practitioners and certified nurse midwives), and physician assistants.

METHOD

In spring 2005, the authors mailed a four-page, 24-item survey to all 2,061 community-based primary care preceptors served by the North Carolina Area Health Education Centers system. The survey measured preceptor satisfaction, likelihood of continuing as a preceptor, influence of having students, motivation for teaching, satisfaction in professional practice, satisfaction with incentives, and value of incentives.

RESULTS

Response rate was 69.3%, or 1,428 preceptors. Most preceptors (93.0%) reported high satisfaction with their precepting experience, and 90.9% indicated high likelihood of continuing to precept for the next five years. Almost all preceptors (93.7%) reported they were satisfied with their professional life. Many community preceptors (57.2%) were satisfied with incentives. They placed greater value on the intrinsic reasons for precepting (i.e., enjoyment of teaching) rather than extrinsic rewards (such as no-cost online library resources). Degree groups placed differing values on intrinsic and extrinsic rewards. Physicians reported more negativity about the influence of students and regarding aspects of their professional lives.

CONCLUSIONS

Tailoring support to better meet individual degree groups' preferences can maximize resources and may encourage preceptor retention. Special attention to physicians' needs may be warranted to avoid decreased preceptor numbers in this at-risk group. Future studies are needed to determine whether these findings are unique to North Carolina, which has a strong infrastructure to support preceptors.

Benefits And Pitfalls In Applying The Experience Of Prepaid Group Practices To The U.S. Physician Supply

The paper by Jonathan Weiner includes important improvements in the methodology used to compare the physician workforce in prepaid group practices (PGPs) with the U.S. physician workforce. It also provides valuable insights for policymakers and researchers. Despite the improvements, concerns remain regarding the comparability of the populations served and physician activities in PGPs and the country as a whole. While PGPs appear to offer valuable lessons on how to use physicians effectively and efficiently, it is inappropriate to use the PGP physician rates to determine the number of physicians needed in the United States.