The teacher, the physician and the person: how faculty's teaching performance influences their role modelling

Qualities of Role Models of Internal Medicine Residents in a Tertiary National University Hospital in the Philippines

Background

Teachers in medicine do not only teach scientific facts about health and disease to their learners but they are also looked up to as role models. Little is known about the qualities of consultant-faculty members who are regarded as role models by Filipino internal medicine residents.

Objective

This study aimed to determine the reasons why consultant-faculty members are considered role models by Filipino internal medicine residents.

Methods

A cross-sectional survey was conducted among internal medicine residents at a tertiary national university hospital in the Philippines. Participants were asked to give the reasons for citing consultant-faculty members who they consider as role models.

Results

There were 81 residents who participated (93% response rate) who gave a total of 332 qualities as reasons for citing them as role models. The most commonly cited quality category was those of personal qualities (35.84% of all responses). This was followed by academic, clinical, teaching, leadership and research qualities. Physical qualities were the least cited (0.30% of all responses). Across the four batches of residents, personal qualities were consistently cited the most number of times, while physical qualities were consistently cited the least.

Conclusion

Filipino internal medicine residents identified personal qualities as the most frequent reason for considering their consultant-faculty as role models.

Resident Assessment of Clinician Educators According to Core ACGME Competencies

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) requires faculty to pursue annual development to enhance their teaching skills. Few studies exist on how to identify and improve the quality of teaching provided by faculty educators. Understanding the correlation between numeric scores assigned to faculty educators and their tangible, practical teaching skills would be beneficial.

OBJECTIVE

This study aimed to identify and describe qualities that differentiate numerically highly rated and low-rated physician educators.

DESIGN

This observational mixed-methods study evaluated attending physician educators between July 1, 2015, and June 30, 2021. Quantitative analysis involved descriptive statistics, normalization of scores, and stratification of faculty into tertiles based on a summary score. We compared the highest and lowest tertiles during qualitative analyses of residents' comments.

PARTICIPANTS

Twenty-five attending physicians and 111 residents in an internal medicine residency program.

MAIN MEASURES

Resident evaluations of faculty educators, including 724 individual assessments of faculty educators on 15 variables related to the ACGME core competencies.

KEY RESULTS

Quantitative analyses revealed variation in attending physician educators' performance across the ACGME core competencies. The highest-rated teaching qualities were interpersonal and communication skills, medical knowledge, and professionalism, while the lowest-rated teaching quality was systems-based practice. Qualitative analyses identified themes distinguishing high-quality from low-quality attending physician educators, such as balancing autonomy and supervision, role modeling, engagement, availability, compassion, and excellent teaching.

CONCLUSIONS

This study provides insights into areas where attending physicians' educational strategies can be improved, emphasizing the importance of role modeling and effective communication. Ongoing efforts are needed to enhance the quality of faculty educators and resident education in internal medicine residency programs.

Role modelling in professional identity formation: a systematic scoping review

BACKGROUND

Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP).

METHODS

A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices.

RESULTS

12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences.

CONCLUSION

Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.

Clinical teachers' perceptions of role modeling: a qualitative study

BACKGROUND

Role modeling has been significantly considered in medical education in recent decades. In the clinical course, students learn necessary skills and accordingly their professional identity is formed by observing and working among clinical educators. Given the importance of the role modeling in medical education, in the present study, it was attempted to explore the clinical teachers' perceptions of being a role model for medical students using a qualitative method.

METHODS

A qualitative design, based on the content analysis approach, was used to analyze the perspectives of 15 clinical teachers. Participants were chosen by purposeful sampling. Data were collected using reflection paper writing.

RESULTS

During the data analysis, five main categories emerged: influencing others, developing different dimensions of student, situational self-awareness, feedback and continuous effort.

CONCLUSIONS

This study will be useful to form role modeling educational programs. Encouraging clinical teachers to make continuous efforts to improve role modeling and educating time management and self-control skills can help reduce the challenges of role modeling for clinical teachers.

Clinical supervisors' reflections on their role, training needs and overall experience as dental educators

OBJECTIVES

The aims of this study were to understand the views of clinical supervisors overseeing final year dental students and investigate their perceived role, level of support and training available, and ways to improve the supervisory experience.

METHODS

Clinical supervisors who oversaw fifth-year dental students in 2019 were invited to participate in an online survey. Respondents who indicated their willingness to participate were contacted for a semi-structured interview which were analysed using Constant Comparative Methodology.

RESULTS

Sixteen supervisors completed the survey, with a response rate of 73%. Respondents reported low levels of formal training in clinical supervision (38%) and most (75%) felt further training would be beneficial for their role. While nearly all (94%) reported they had developed as a dental professional through supervision, most (63%) were not positively encouraged to develop a career as a supervisor, with tensions between health service delivery and academia identified as a key challenge. The driving motivator to supervise was a desire to teach (62.5%). Seven (44%) participants completed the semi-structured interview. Participants' perception of their role varied depending on career stage and clinic location. Lack of recognition and defined career pathways were the biggest challenges reported by participants.

CONCLUSION

Retention and morale of supervisors may increase with better-defined career pathways and meaningful professional development opportunities. There is a need to develop tailored training programs for supervisors that enable them to teach critical thinking and clinical judgement while ensuring patient safety.

Improving Role Modeling in Clinical Teachers: A Narrative Literature Review

INTRODUCTION

Students observe role models and learn from them in a variety of educational settings. Although it is known that role models impact on professional and character development of students, some clinical teachers are poor role models. We conducted a review to summarize evidence that could help clinical teachers promote their role modeling.

METHODS

We performed a review search and by using specific keywords (curriculum, role model*, faculty development, teach*, program* and education), through electronic databases (PubMed, EMBASE, and ERIC). We obtained 320 qualitative and quantitative studies. Having removed the duplicate references, we read 244 titles and excluded irrelevant ones. Eighty-two articles were retained and the abstract of each was read. Finally, 20 articles were included.

RESULTS

According to the results of our review, three major themes were identified: 1) features of a good role model composed of teaching, clinical, and personal-interpersonal skills 2) self-improvement of role modeling, and 3) faculty development programs.

CONCLUSIONS

Role models have a profound effect on the attitudes and behaviors of medical students. It is important for clinical teachers to make an intentional effort to articulate what aspects they are modeling. This study can help faculty members be an effective role model. Also, finding of this review could form the foundation of a faculty development program in order to foster role modeling in clinical settings.

Educational roles as a continuum of mentoring's role in medicine - a systematic review and thematic analysis of educational studies from 2000 to 2018

BACKGROUND

Recent studies have gone to great lengths to differentiate mentoring from teaching, tutoring, role modelling, coaching and supervision in efforts to better understand mentoring processes. This review seeks to evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may in fact all be part of the mentoring process. To evaluate this theory, this review scrutinizes current literature on teaching, tutoring, role modelling, coaching and supervision to evaluate their commonalities with prevailing concepts of novice mentoring.

METHODS

A three staged approach is adopted to evaluate this premise. Stage one involves four systematic reviews on one-to-one learning interactions in teaching, tutoring, role modelling, coaching and supervision within Internal Medicine, published between 1st January 2000 and 31st December 2018. Braun and Clarke's (2006) approach to thematic analysis was used to identify key elements within these approaches and facilitate comparisons between them. Stage two provides an updated view of one-to-one mentoring between a senior physician and a medical student or junior doctor to contextualise the discussion. Stage three infuses mentoring into the findings delineated in stage one.

RESULTS

Seventeen thousand four hundred ninety-nine citations were reviewed, 235 full-text articles were reviewed, and 104 articles were thematically analysed. Four themes were identified - characteristics, processes, nature of relationship, and problems faced in each of the four educational roles.

CONCLUSIONS

Role modelling, teaching and tutoring, coaching and supervision lie within a mentoring spectrum of increasingly structured interactions, assisted by assessments, feedback and personalised support that culminate with a mentoring approach. Still requiring validation, these findings necessitate a reconceptualization of mentoring and changes to mentor training programs and how mentoring is assessed and supported.

Clinical teachers as positive and negative role models: an explanatory sequential mixed method design

Today, role modeling is an essential component of medical education that facilitates the students' learning and affects their attitudes and behaviors. Hence, this study aimed to examine the characteristics of positive and negative role models using a mixed method approach. In the quantitative part, data were collected using a questionnaire with 24 items. The research population included medical students who were in their clinical period between May 2017 and December 2018 at Shiraz University of Medical Sciences (n = 750). A total of 282 questionnaires were completed by these students, and in the qualitative part, 26 semi-structured interviews were conducted with them.

The most important components of role modeling for students included: individual characteristics, clinical skills and competence, teaching skills and professionalism, in that order. The qualitative analysis confirmed the results of the quantitative analysis. The findings showed that the characteristics of a negative role model can also be classified in four main components. The results demonstrated that 46.8% of the students identified one or more medical teachers as negative models.

Students paid attention to not only the positive characteristics of their teachers, but also their negative features, stating that they had been influenced by both. Therefore, it can be concluded that clinical teachers should improve their performance as positive role models through reducing these negative effects and reinforcing positive characteristics.

Assessing residents' knowledge of patient satisfaction: a cross-sectional study at a large academic medical centre

OBJECTIVES

Patient satisfaction impacts healthcare quality and outcomes. Residents play an important role in patient satisfaction at academic institutions. This study aims to assess residents' patient satisfaction knowledge and determine which learning experiences contributed to their knowledge acquisition.

SETTINGS

This study was conducted at a health science university in a large, urban, tertiary-care academic medical centre in the USA.

PARTICIPANTS

All residents from internal medicine (n=185) and paediatrics (n=156) were asked to participate.

DESIGN

Residents completed a survey from April 2013 to December 2013 that assessed (1) knowledge of factors that impact patient satisfaction and (2) learning experiences that may have contributed to their understanding of the drivers of patient satisfaction (eg, experiential (personal or clinical) or didactics). Trainees identified the importance of factors in determining patient satisfaction on a five-point Likert scale; answers were compiled into a knowledge score. The score was correlated with prior personal/clinical experience and didactics.

RESULTS

Of the 341 residents, 247 (72%) completed the survey. No difference was found in knowledge among training levels or residency programme. More than 50% incorrectly thought physician board certification, patient's education, patient's income and physician's age impacted satisfaction. Personal experience, through hospitalisation of a relative or friend, was correlated with higher knowledge (67% vs 71%, p=0.03). Ninety-nine per cent (n=238) stated peer observation, and all stated faculty feedback impacted their patient satisfaction knowledge. Seventy-seven per cent (n=185) had attended didactics on satisfaction, but attendance did not correlate with higher scores.

CONCLUSIONS

Our study showed trainees have a few gaps in their patient satisfaction knowledge, and attending past educational sessions on patient satisfaction did not correlate with higher knowledge scores. Our data suggest that academic centres should leverage residents' personal experiences, their observations of peers and faculty feedback to enhance patient satisfaction knowledge.

The perspective of medical students regarding the roles and characteristics of a clinical role model

Background

As medical students spend most of their time with their clinical teachers and imitate their roles and characteristics during the school year, it is important to identify the roles and characteristics that they find essential in their role models. These traits play a part in their future professions as doctors.

Objective

The aim of this study was to determine the perspective of students, interns, and residents regarding the roles and characteristics of a clinical role model.

Methods

In an analytical cross-sectional study, a structured and self-developed questionnaire was completed by 185 medical students at educational hospitals of Kerman University of Medical Sciences during April and May 2015. Participants were selected using convenience sampling method. For data analysis, we used descriptive and inferential statistics. SPSS software version 16 was used as needed.

Results

In total, 90 medical students (48.7%), 65 interns (35.1%), and 30 residents (16.2%) participated in this study. Male respondents (n=75) comprised 40.5% and female respondents (n=110) 59.5% of the study sample. The three most important roles of a clinical teacher were organizer role (99.7), teacher role (101.7), and supporter role (109.5) for students, interns, and residents respectively. On the other hand, supporter role (85.4), communicator role (86.4) and organizer role (83.4) were ranked as the least important for students, interns, and residents respectively. There was no significant association among the three batches and the roles of a clinical teacher (p>0.05). Conversely, Females rated the roles of a clinical teacher significantly higher than males (p<0.05).

Conclusions

As teachers are frequently perceived by students as role models in medical schools, great attention should be given to their roles. Teachers must be aware that their roles have an impact on students’ professional development and performance.

Redesign of the System for Evaluation of Teaching Qualities in Anesthesiology Residency Training (SETQ Smart)

BACKGROUND

Given the increasing international recognition of clinical teaching as a competency and regulation of residency training, evaluation of anesthesiology faculty teaching is needed. The System for Evaluating Teaching Qualities (SETQ) Smart questionnaires were developed for assessing teaching performance of faculty in residency training programs in different countries. This study investigated (1) the structure, (2) the psychometric qualities of the new tools, and (3) the number of residents' evaluations needed per anesthesiology faculty to use the instruments reliably.

METHODS

Two SETQ Smart questionnaires-for faculty self-evaluation and for resident evaluation of faculty-were developed. A multicenter survey was conducted among 399 anesthesiology faculty and 430 residents in six countries. Statistical analyses included exploratory factor analysis, reliability analysis using Cronbach α, item-total scale correlations, interscale correlations, comparison of composite scales to global ratings, and generalizability analysis to assess residents' evaluations needed per faculty.

RESULTS

In total, 240 residents completed 1,622 evaluations of 247 faculty. The SETQ Smart questionnaires revealed six teaching qualities consisting of 25 items. Cronbach α's were very high (greater than 0.95) for the overall SETQ Smart questionnaires and high (greater than 0.80) for the separate teaching qualities. Interscale correlations were all within the acceptable range of moderate correlation. Overall, questionnaire and scale scores correlated moderately to highly with the global ratings. For reliable feedback to individual faculty, three to five resident evaluations are needed.

CONCLUSIONS

The first internationally piloted questionnaires for evaluating individual anesthesiology faculty teaching performance can be reliably, validly, and feasibly used for formative purposes in residency training.

Factors associated with students' perceptions of role modelling

OBJECTIVES

To determine which professional and humanistic attributes demonstrated by teachers in the health disciplines caused them to be perceived by students as positive or negative role models.

METHODS

Quantitative empirical data were gathered using a self-administered questionnaire by graduating students in medical, dentistry, and pharmacy schools at Kerman University of Medical Sciences. A total of 3 graduating cohorts, comprising about 220 students, were selected for this study. Surveys were distributed during January-March 2013.

RESULTS

In total, 183 students participated in the study. Altogether, students considered 504 and 473 academic staff as positive and negative role models (PRMs and NRMs), respectively. Women were considered more negatively than men (mean scores: -12.13 vs. -11.6, p=0.04). While clinicians were considered more positively than basic scientists (mean scores: 12.65 vs. 10.67, p=0.001), dentists received higher positive scores than physicians or pharmacists (average scores: 13.27 vs. 12.99 and 9.82). There was a significant relationship between the personality of the students and the overall characteristics of their perceived role models (β for PRMs=0.35, p<0.0001; and β for NRMs= 0.20, p= 0.039).

CONCLUSIONS

Humanistic and professional attributes were proposed as major components of personal traits in perceived role models. Demonstration of humanistic attributes by teachers was strongly correlated with the students' perception of the role models. It is suggested that the role of humanistic and professional attributes should be highlighted across medical disciplines in an effort to develop or improve role modelling by academic staff.

Student-Valued Measurable Teaching Behaviors of Award-Winning Pharmacy Preceptors

OBJECTIVE

To identify specific preceptor teaching-coaching, role modeling, and facilitating behaviors valued by pharmacy students and to develop measures of those behaviors that can be used for an experiential education quality assurance program.

METHODS

Using a qualitative research approach, we conducted a thematic analysis of student comments about excellent preceptors to identify behaviors exhibited by those preceptors. Identified behaviors were sorted according to the preceptor's role as role model, teacher/coach, or learning facilitator; measurable descriptors for each behavior were then developed.

RESULTS

Data analysis resulted in identification of 15 measurable behavior themes, the most frequent being: having an interest in student learning and success, making time for students, and displaying a positive preceptor attitude. Measureable descriptors were developed for 5 role-modeling behaviors, 6 teaching-coaching behaviors, and 4 facilitating behaviors.

CONCLUSION

Preceptors may need to be evaluated in their separate roles as teacher-coach, role model, and learning facilitator. The developed measures in this report could be used in site quality evaluation.

Evaluating clinicians' teaching performance

Evaluations of clinicians' teaching performance are usually a preliminary, although essential, activity in quality management and improvement activities. This PhD project focused on testing the validity, reliability and impact of a performance evaluation system named the System of Evaluation of Teaching Qualities (SETQ) across specialities and centres in the Netherlands. The results of this project show that the SETQ questionnaires can provide clinicians with valid and reliable performance feedback that can enhance their teaching performance. Also, we tried to investigate the predictive validity of the SETQ. In conclusion, the SETQ appears to be a helpful tool for improving clinicians' teaching performance.

Residents' engagement and empathy associated with their perception of faculty's teaching performance

BACKGROUND

Faculty members rely on residents' feedback about their teaching performance. The influence of residents' characteristics on evaluations of faculty is relatively unexplored. We aimed to evaluate the levels of work engagement and empathy among residents and the association of both characteristics with their evaluation of the faculty's teaching performance.

METHODS

A multicenter questionnaire study among 271 surgery and gynecology residents was performed from September 2012 to February 2013. Residents' ratings of the faculty's teaching performance were collected using the system for evaluation of teaching quality (SETQ). Residents were also invited to fill out standardized measures of work engagement and empathy using the short Utrecht Work Engagement Scale and the Jefferson Scale of Physician Empathy, respectively. Linear regression analysis using generalized estimating equations to evaluate the association of residents' engagement and empathy with residents' evaluations of teaching performance.

RESULTS

Overall, 204 (75.3 %) residents completed 1814 SETQ evaluations of 302 faculty, and 143 (52.8 %) and 140 (51.7 %) residents, respectively, completed the engagement and empathy measurements. The median scores of residents' engagement and empathy were 4.56 (scale 0-6) and 5.55 (scale 1-7), respectively. Higher levels of residents' engagement (regression coefficient b = 0.128; 95 % confidence interval (CI) 0.072-0.184; p < 0.001) and empathy (b = 0.113; 95 % CI 0.063-0.164; p < 0.001) were associated with higher faculty teaching performance scores.

CONCLUSIONS

Residents' engagement and empathy appear to be positively associated with their evaluation of the faculty's performance. A possible explanation is that residents who are more engaged and can understand and share others' perspectives stimulate and experience faculty's teaching better than others.

In the eyes of residents good supervisors need to be more than engaged physicians: the relevance of teacher work engagement in residency training

During their development into competent medical specialists, residents benefit from their attending physicians' excellence in teaching and role modelling. Work engagement increases overall job performance, but it is unknown whether this also applies to attending physicians' teaching performance and role modelling. Attending physicians in clinical teaching practice take on roles as doctors and teachers. Therefore, this study (a) examined levels of attending physicians' work engagement in both roles, and (b) quantified the relationships of both work engagement roles to their teaching performance and role model status. In this multicenter survey, residents evaluated attending physicians' teaching performance and role model status using the validated System for Evaluation of Teaching Qualities. Attending physicians self-reported their work engagement on a 7-point scale, separately for their roles as doctors and teachers, using the validated 9-item Utrecht Work Engagement Scale. In total, 549 (68 %) residents filled out 4,305 attending physician evaluations and 627 (78 %) attending physicians participated. Attending physicians reported higher work engagement in their doctor than in their teacher roles (mean difference: 0.95; 95 % CI 0.86-1.04; p < 0.001). Teacher work engagement was positively related to teaching performance (regression coefficient, B: 0.11; 95 % CI 0.08-0.14; p < 0.001), which in turn was positively associated to role model status (B: 1.08; 95 % CI 0.10-1.18; p < 0.001). In the eyes of residents, good supervisors need to be more than engaged physicians, as attending physicians with high teacher work engagement were evaluated as better teachers.

Determinants of academics' job satisfaction: empirical evidence from private universities in Bangladesh

The job satisfaction of academics is related to a number of variables of complex function such as demographic characters, the work itself, pay, work responsibilities, variety of tasks, promotional opportunities, relationship with co-workers and others. Academics may be simultaneously satisfied with some facets of the job and dissatisfied with others. This paper aims at determining the influential factors that contribute to the enhancement or reduction of academics' job satisfaction among private universities in Bangladesh with special reference to Dhaka, the capital city of Bangladesh. A total of 346 respondents are considered from ten private universities using non-probability sampling. A pre-tested and closed-ended questionnaire using a seven-point Likert scale is used for data collection. In this study, descriptive statistics, Pearson product moment correlation, multiple regression, and factor analysis are exercised as statistical tools. A conceptual model of job satisfaction is developed and applied for academics' job satisfaction. The results reveal that compensation package, supervisory support, job security, training and development opportunities, team cohesion, career growth, working conditions, and organizational culture and policies are positively associated with the academics' job satisfaction. Amongst them, three factors stood out as significant contributors for job satisfaction of academics i.e. compensation package, job security, and working conditions. Therefore, the management of private universities should focus their effort on these areas of human resource management for maintaining academics' job satisfaction and employee retention. The study will be useful for university management in improving overall job satisfaction as it suggests some strategies for employee satisfaction practices.

[Prevalence of anxiety disorders and depression among junior doctors and their links with their work]

The caregivers are exposed to several occupational hazards, including psychosocial risks. Among these occupational groups, junior doctors have been little studied. The aim of this study was to evaluate the prevalence of depression and anxiety among junior doctors and their links with their work.

METHODS

This is a prospective study using an anonymous online questionnaire between October 2011 and June 2012. Every junior doctor of Brest medical school was included without exclusion criteria. The questionnaire asked about demographic and health data. It included four validated scales: the Center for Epidemiologic Studies Depression Scale (CES-D), the Spielberger anxiety questionnaire, the Quality of Life Questionnaire of WHO (WHO-QOL) and the Job Content Questionnaire of Karasek.

RESULTS

One hundred and ninety-two junior doctors were included; 68.2 % of them were women. They were 13.0 % suffering from depression; 28.7 % from anxiety; 32.8 % of junior doctors were in job strain and 29.7 % in iso strain. Depression was correlated with high psychological demands and anxiety. The lack of organizational support from senior doctors and competition between junior doctors increased the junior doctors' anxiety.

CONCLUSION

A part of junior doctors is anxious and depressed, somehow due to the psychological demands of work and relationships with other junior doctors and with senior doctors.

Beyond limitations: Improving how we handle uncertainty in health professions education research

The researchers' assumptions invariably influence research outcomes. This is true for both qualitative and quantitative studies. Assumptions or choices regarding underlying theories, causal relations, study setting and population, sampling strategies, participant non-response, data collection, data analysis, and researchers' perceptions and interpretations of results are among factors that can induce uncertainty in research findings. Researchers tend to treat these factors as potential study limitations, but how they may impact research findings is rarely explicated and, therefore, mostly unknown. In this article, we approach uncertainty as unavoidable in research and argue that communicating about uncertainty can inform researchers, policy makers and practitioners about the validity and applicability of the study findings for their interests and contexts. We illustrate approaches to address, interpret, and explicate uncertainty in medical education research in both qualitative and quantitative paradigms. Across research paradigms, we call on researchers to consider the uncertainty in their research findings, employ appropriate methods to explore its extent and effects in their work, and communicate it explicitly in their research papers. This will help to advance our understanding of the nature and implications of the emerging knowledge in our field.

Effect of the learning climate of residency programs on faculty's teaching performance as evaluated by residents

Background

To understand teaching performance of individual faculty, the climate in which residents’ learning takes place, the learning climate, may be important. There is emerging evidence that specific climates do predict specific outcomes. Until now, the effect of learning climate on the performance of the individual faculty who actually do the teaching was unknown.

Objectives

This study: (i) tested the hypothesis that a positive learning climate was associated with better teaching performance of individual faculty as evaluated by residents, and (ii) explored which dimensions of learning climate were associated with faculty’s teaching performance.

Methods and Materials

We conducted two cross-sectional questionnaire surveys amongst residents from 45 residency training programs and multiple specialties in 17 hospitals in the Netherlands. Residents evaluated the teaching performance of individual faculty using the robust System for Evaluating Teaching Qualities (SETQ) and evaluated the learning climate of residency programs using the Dutch Residency Educational Climate Test (D-RECT). The validated D-RECT questionnaire consisted of 11 subscales of learning climate. Main outcome measure was faculty’s overall teaching (SETQ) score. We used multivariable adjusted linear mixed models to estimate the separate associations of overall learning climate and each of its subscales with faculty’s teaching performance.

Results

In total 451 residents completed 3569 SETQ evaluations of 502 faculty. Residents also evaluated the learning climate of 45 residency programs in 17 hospitals in the Netherlands. Overall learning climate was positively associated with faculty’s teaching performance (regression coefficient 0.54, 95% confidence interval: 0.37 to 0.71; P<0.001). Three out of 11 learning climate subscales were substantially associated with better teaching performance: ‘coaching and assessment’, ‘work is adapted to residents’ competence’, and ‘formal education’.

Conclusions

Individual faculty’s teaching performance evaluations are positively affected by better learning climate of residency programs.

The teacher, the physician and the person: exploring causal connections between teaching performance and role model types using directed acyclic graphs

Background

In fledgling areas of research, evidence supporting causal assumptions is often scarce due to the small number of empirical studies conducted. In many studies it remains unclear what impact explicit and implicit causal assumptions have on the research findings; only the primary assumptions of the researchers are often presented. This is particularly true for research on the effect of faculty’s teaching performance on their role modeling. Therefore, there is a need for robust frameworks and methods for transparent formal presentation of the underlying causal assumptions used in assessing the causal effects of teaching performance on role modeling. This study explores the effects of different (plausible) causal assumptions on research outcomes.

Methods

This study revisits a previously published study about the influence of faculty’s teaching performance on their role modeling (as teacher-supervisor, physician and person). We drew eight directed acyclic graphs (DAGs) to visually represent different plausible causal relationships between the variables under study. These DAGs were subsequently translated into corresponding statistical models, and regression analyses were performed to estimate the associations between teaching performance and role modeling.

Results

The different causal models were compatible with major differences in the magnitude of the relationship between faculty’s teaching performance and their role modeling. Odds ratios for the associations between teaching performance and the three role model types ranged from 31.1 to 73.6 for the teacher-supervisor role, from 3.7 to 15.5 for the physician role, and from 2.8 to 13.8 for the person role.

Conclusions

Different sets of assumptions about causal relationships in role modeling research can be visually depicted using DAGs, which are then used to guide both statistical analysis and interpretation of results. Since study conclusions can be sensitive to different causal assumptions, results should be interpreted in the light of causal assumptions made in each study.

Qualitative study about the ways teachers react to feedback from resident evaluations

BACKGROUND

Currently, one of the main interventions that are widely expected to contribute to teachers' professional development is confronting teachers with feedback from resident evaluations of their teaching performance. Receiving feedback, however, is a double edged sword. Teachers see themselves confronted with information about themselves and are, at the same time, expected to be role models in the way they respond to feedback. Knowledge about the teachers' responses could be not only of benefit for their professional development, but also for supporting their role modeling. Therefore, research about professional development should include the way teachers respond to feedback.

METHOD

We designed a qualitative study with semi-structured individual conversations about feedback reports, gained from resident evaluations. Two researchers carried out a systematic analysis using qualitative research software. The analysis focused on what happened in the conversations and structured the data in three main themes: conversation process, acceptance and coping strategies.

RESULTS

The result section describes the conversation patterns and atmosphere. Teachers accepted their results calmly, stating that, although they recognised some points of interest, they could not meet with every standard. Most used coping strategies were explaining the results from their personal beliefs about good teaching and attributing poor results to external factors and good results to themselves. However, some teachers admitted that they had poor results because of the fact that they were not "sharp enough" in their resident group, implying that they did not do their best.

CONCLUSIONS

Our study not only confirms that the effects of feedback depend first and foremost on the recipient but also enlightens the meaning and role of acceptance and being a role model. We think that the results justify the conclusion that teachers who are responsible for the day release programmes in the three departments tend to respond to the evaluation results just like human beings do and, at the time of the conversation, are initially not aware of the fact that they are role models in the way they respond to feedback.