Strategic Approaches for the Health Science Educator: Understanding Strategic Planning, Strategic Thinking, and Continuous Process Improvement and Their Impact

ABSTRACT

With continued demand for health science institutions to find solutions to deliver on heightened student expectations despite smaller budgets and fewer resources, the utilization of organizational improvement techniques is pervasive. Academic health care leaders are seeking effective modalities to overcome obstacles, modernize, and become more efficient. Three of the commonly used approaches for improvement are strategic planning, strategic thinking, and continuous process improvement (CPI), and these concepts have been used in a variety of forms throughout industry, higher education, and health care. However, their definitions are often not well understood, and their processes are misconstrued in practice. With the increased expectation of health care institutions with undergraduate, graduate, and continuing education to consider strategic processes in organizational improvement, it is important for leadership to understand the differences in these three approaches. In this article, we explain the concepts of strategic planning, strategic thinking, and CPI through an overview of their history, definitions, and the benefits and pitfalls as observed by researchers. Furthermore, we reduce the noise in the existing literature into three concise definitions for each approach. And finally, for those seeking where to begin, we explain one tool in each category recommended for the novice strategist: the Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis for strategic planning, the Goals, Objectives, Strategies, and Tactics (GOST) framework for strategic thinking, and the Pareto Chart for CPI.

Twelve tips for developing, implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization's educational mission and participants' career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population's health.

The design and utility of institutional teaching awards: a literature review

BACKGROUND

Institutional teaching awards have been used widely in higher education since the 1970s. Nevertheless, a comprehensive review of the literature on such awards has not been published since 1997.

AIM

We conducted a literature review to learn as much as possible about the design (e.g., formats, selection processes) and utility (e.g., impact on individuals and institutions) of teaching awards in order to provide information for use in designing, implementing, or evaluating award programs.

METHODS

We searched electronic databases for English-language publications on awards for exemplary teaching. Targeted publications included descriptions and/or investigations of award programs, their impact, and theoretical or conceptual models for awards programs. Screening was conducted by dual review; a third reviewer was assigned for disagreements. Data were analyzed qualitatively. Results were summarized descriptively.

RESULTS

We identified 1302 publications for initial relevancy screening by title and abstract. We identified an additional 23 publications in a follow-up search. The full text of 126 publications was reviewed for further relevance. A total of 62 publications were identified as relevant, and of these 43 met our criteria for inclusion. Of the 43, 19 described the design features of 24 awards; 20 reports discussed award utility. Nomination and selection processes and benefits (e.g., plaques) varied as did perceived impact on individuals and institutions.

CONCLUSION

Limited evidence exists regarding design and utility of teaching awards. Awards are perceived as having potential for positive impact, including promotions, but may also have unintended negative consequences. Future research should investigate the impact of awards on personal and professional development, and how promotion and tenure committees perceive awards.

Perspective: Guidelines for reporting team-based learning activities in the medical and health sciences education literature

Medical and health sciences educators are increasingly employing team-based learning (TBL) in their teaching activities. TBL is a comprehensive strategy for developing and using self-managed learning teams that has created a fertile area for medical education scholarship. However, because this method can be implemented in a variety of ways, published reports about TBL may be difficult to understand, critique, replicate, or compare unless authors fully describe their interventions.The authors of this article offer a conceptual model and propose a set of guidelines for standardizing the way that the results of TBL implementations are reported and critiqued. They identify and articulate the seven core design elements that underlie the TBL method and relate them to educational principles that maximize student engagement and learning within teams. The guidelines underscore important principles relevant to many forms of small-group learning. The authors suggest that following these guidelines when writing articles about TBL implementations should help standardize descriptive information in the medical and health sciences education literature about the essential aspects of TBL activities and allow authors and reviewers to successfully replicate TBL implementations and draw meaningful conclusions about observed outcomes.

The educational attributes and responsibilities of effective medical educators

Of the many roles that the academic-educator may fulfill, that of teacher is particularly challenging. Building on prior recommendations from the literature, this article identifies the skill set of teachers across the medical education continuum-characteristics of attitude and attributes, knowledge, and pedagogic skills that permit effective teaching to be linked with effective learning and understanding. This examination which characterizes teachers' attitudes, knowledge, and skills serves to reemphasize the centrality of teaching within medical education, provides direction for faculty and institutions alike in the discharge of academic responsibilities, and makes educational accountability clear. This listing of teacher attitudes and responsibilities was vetted in 2009 by medical education leaders from across North America during a national conference on faculty development.A set of recommendations concerning faculty development issues for medical teachers is offered. The recommendations are intended to establish an academic culture in medical education that values and rewards-academically and fiscally-those centrally committed to the role of teacher. The challenges of defining skills, developing and funding programs, and ongoing evaluation must be faced to achieve success in teaching throughout medical education, now and in the future. Faculty members, fellow learners, and patients deserve no less.

Quality of standardised patient research reports in the medical education literature: review and recommendations

CONTEXT

In order to assess or replicate the research findings of published reports, authors must provide adequate and transparent descriptions of their methods. We conducted 2 consecutive studies, the first to define reporting standards relating to the use of standardised patients (SPs) in research, and the second to evaluate the current literature according to these standards.

METHODS

Standards for reporting SPs in research were established by representatives of the Grants and Research Committee of the Association of Standardized Patient Educators (ASPE). An extensive literature search yielded 177 relevant English-language articles published between 1993 and 2005. Search terms included: 'standardised patient(s)'; 'simulated patient(s)'; 'objective structured clinical examination (OSCE)', and 'clinical skills assessment'. Articles were limited to those reporting the use of SPs as an outcome measure and published in 1 of 5 prominent health sciences education journals. Data regarding the SP encounter, SP characteristics, training and behavioural measure(s) were gathered.

RESULTS

A random selection of 121 articles was evaluated according to 29 standards. Reviewers judged that few authors provided sufficient details regarding the encounter (21%, n = 25), SPs (16%, n = 19), training (15%, n = 15), and behavioural measures (38%, n = 44). Authors rarely reported SP gender (27%, n = 33) and age range (22%, n = 26), whether training was provided for the SPs (39%, n = 47) or other raters (24%, n = 29), and psychometric evidence to support the behavioural measure (23%, n = 25).

CONCLUSIONS

The findings suggest that there is a need for increased rigor in reporting research involving SPs. In order to support the validity of research findings, journal editors, reviewers and authors are encouraged to provide adequate detail when describing SP methodology.

Why invest in an educational fellowship program?

Expanding and refining the repertoire of medical school teaching faculty is required by the many current and changing demands of medical education. To meet this challenge academic medical institutions have begun to establish programs--including educational fellowship programs--to improve the teaching toolboxes of faculty and to empower them to assume leadership roles within both institutional and educational arenas. In this article, the authors (1) provide historical background on educational fellowship programs; (2) describe the prevalence and focus of these programs in North American medical schools, based on data from a recent (2005) survey; and (3) give a brief overview of the nine fellowship programs that are discussed fully in other articles in this issue of Academic Medicine. These articles describe very different types of educational fellowships that, nevertheless, share common features: a cohort of faculty members who are selected to participate in a longitudinal set of faculty development activities to improve participants' teaching skills and to build a cadre of educational leaders for the institution. Evaluation of educational fellowships remains a challenging issue, but the authors contend that one way to evaluate the programs' effectiveness is to look at the educational improvements that have been instigated by program graduates. The authors hope that the various program descriptions will help readers to improve their existing programs and/or to initiate new programs.

The relationship between preceptor expectations and student performance on 2 pediatric objective structured clinical examination stations

BACKGROUND

We designed 2 pediatric objective structured clinical examination stations, 1 anemia case associated with lead exposure and 1 failure-to-gain-weight case associated with extended breast-feeding, to evaluate third-year medical students who had studied in pediatric community preceptors' offices as part of a 12-week multidisciplinary ambulatory clerkship rotation.

OBJECTIVE

To examine the relationship between preceptor expectations and student performance on these 2 objective structured clinical examination stations.

METHODS

To elicit community preceptors' expectations of student performance, we constructed a 46-item survey replicating checklists filled out by simulated patients evaluating student performance on the objective structured clinical examination stations. The percentage agreement among preceptors for each checklist item as well as the percentage agreement between preceptor responses and student responses on each checklist item were calculated. A summary score of preceptor responses across all checklist items and a summary score for student responses across all checklist items on each station were calculated. The correlation coefficients between preceptor and student summary scores were then examined.

RESULTS

Fifty-nine preceptor surveys were mailed and 38 were returned (64% response rate). Data were usable from 37 surveys. Eighty-nine percent (33 of 37)of the preceptors agreed that a third-year clerkship student should have the knowledge to care for the patient with anemia and 92% (34 of 37)of the preceptors agreed similarly for the growth-delay case. Agreement among preceptors on individual checklist items varied widely for both cases. Fifty-seven students studied at the anemia station and 34 students studied at the growth-delay station. The mean+/-SD agreement across the 26 items on the anemia case between preceptor responses and student responses was 62%+/-23% and, for the 21 items on the growth-delay case, 60%+/-17%. The mean+/-SD preceptor summary score for the anemia case was 17.4+/-3.8 (maximum, 26) and 16.0+/-3.6 (maximum, 21) for the growth-delay case. The mean student score on the anemia case was 15.5+/-3.7 (maximum, 26) and, for the growth-delay case, 10.0+/-4.5 (maximum, 21). The Pearson correlation coefficient between the preceptor and student scores on the anemia case was 0.19 (P=.15), and for the growth-delay case,-0.41 (P=.06).

CONCLUSIONS

These data suggest community preceptors agree on topic areas in which students should be clinically competent. There was, however, considerable variation in agreement among preceptors about what preceptors believe students should be able to do and how the students actually perform. The overall percentage agreement between preceptor expectations and student performance appears to be no better than chance.