Francine P. Hekelman

Professional Networks: The Influence of Colleagues on the Academic Success of Faculty

Background Successful higher education faculty, those who get promoted and tenured, who get recognized for contributions, who produce more and significant research, frequently consult colleagues. This article summarizes what is known about colleague relationships with the hope of stimulating further research to extend current conclusions to medical school faculty. Method In the spring of 1992, a systematic literature review was conducted using database searches and author review of 137 selected books and articles using a standard protocol; preference was given to articles that were data-oriented, used quality designs, and related directly to the topic. Results Forty-seven “best” sources, published between 1963 and 1991, were included in the review of (1) types and configurations of colleague relationships, (2) forming and maintaining colleague relationships, (3) colleague effects on faculty success, (4) functions of colleague relationships, (5) changes in colleague relationships over a career, and (6) effects on methods, size, and configuration of colleague relationships. Conclusion Among the conclusions reached are that (1) there are a variety of types or configurations of colleague relationships, all with different functions and effects on faculty performance; (2) dyadic conceptions of colleague relationships are insufficient to explain the functions of colleague relationships; and (3) the most important source for developing colleague relationships is professional associations, while the least important source is ones own institution.ABSTRACTBackgroundAlthough national figures for medical student withdrawal and extended leave have long been reported, similar data have not been available for residents in training.MethodData for this study came from the American Medical Association survey of the 1991–92 residency year, in which pr

Continuous self-improvement: systems thinking in a personal context.

BACKGROUND Continuous quality improvement (CQI) thinking and tools have broad applicability to improving peoples lives--in continuous self-improvement (CSI). Examples include weight loss, weight gain, increasing exercise time, and improving relationship with spouse. In addition, change agents, who support and facilitate organizational efforts, can use CSI to help employees understand steps in CQI. A STEP-BY-STEP APPROACH: Team members should be involved in both the definition of the problem and the search for the solution. How do everyday processes and routines affect the habit that needs to change? What are the precursors of the event? Clients list possible solutions, prioritize them, and pilot test the items selected. One needs to change the daily routines until the desired behavior is accomplished habitually and with little external decision. DISCUSSION CSI is successful because of its emphasis on habits embedded in personal processes. CSI organizes support from process owners, buddies, and coaches, and encourages regular measurement, multiple small improvement cycles, and public reporting.

Characteristics of Family Physicians' Clinical Teaching Behaviors in the Ambulatory Setting: A Descriptive Study.

The one‐on‐one encounter between the physician teacher and the learner is the major clinical teaching vehicle in the ambulatory setting. Few medical educators have observed the encounter for its length; frequency and types of physician teaching behaviors; or the pattern of the encounter—relying instead on perceptions of the outcomes of the teaching/learning process. The purpose of this study was to describe the instructional activities occurring in physician‐learner encounters. Sixteen family physicians were observed performing 10 teaching encounters each. A clinical observation instrument captured and categorized 17 clinical teaching and nonteaching behaviors. The results of the study suggest that the encounter is driven by the patient and that little attention is focused on traditional elements of instruction such as setting expectations and giving feedback.

Excellence in clinical teaching: the core of the mission

The core of clinical education is the dialogue between physician teachers and their students and residents. Several years ago the authors began to examine the nature of the “talk” in one-on-one ambulatory clinical teaching encounters. Discourse analysis, a qualitative method for examining communication, can identify patterns of interaction and can highlight the factors that impede useful teaching conversation and learning in the contexts of clinical education. Further, it can identify the microskills that physician-teachers need to teach effectively and humanistically. Having faculty members coach each other is an effective institutional approach to teaching these microskills, and it is especially valuable to have teachers examine the language they use in clinical teaching, so that they can understand the different impacts that different kinds of language can have on learners. Physicians are responsible for cultivating humanistic attitudes in their students. When a physician is humanistic in helping a student learn, the student can, in turn, use the same attributes with the patient. The humanistic behaviors that are valuable parts of the physician-patient relationship are the same ones that must also characterize the relationship between physicians and their students. Excellent one-on-one teaching in clinical settings requires two major things: first, medical educators must understand the special communication skills that create effective and humanistic teaching; and second, administrators must re-recognize that teaching is the true heart of our medical schools and teaching hospitals, and therefore support the faculty professional development needed to foster excellent teaching.

Rapid improvement teams.

BACKGROUND Suggestions, most of which are supported by empirical studies, are provided on how total quality management (TQM) teams can be used to bring about faster organizationwide improvements. SUGGESTIONS Ideas are offered on how to identify the right problem, have rapid meetings, plan rapidly, collect data rapidly, and make rapid whole-system changes. Suggestions for identifying the right problem include (1) postpone benchmarking when problems are obvious, (2) define the problem in terms of customer experience so as not to blame employees nor embed a solution in the problem statement, (3) communicate with the rest of the organization from the start, (4) state the problem from different perspectives, and (5) break large problems into smaller units. Suggestions for having rapid meetings include (1) choose a nonparticipating facilitator to expedite meetings, (2) meet with each team member before the team meeting, (3) postpone evaluation of ideas, and (4) rethink conclusions of a meeting before acting on them. Suggestions for rapid planning include reducing time spent on flowcharting by focusing on the future, not the present. Suggestions for rapid data collection include (1) sample patients for surveys, (2) rely on numerical estimates by process owners, and (3) plan for rapid data collection. Suggestions for rapid organizationwide implementation include (1) change membership on cross-functional teams, (2) get outside perspectives, (3) use unfolding storyboards, and (4) go beyond self-interest to motivate lasting change in the organization. CONCLUSIONS Additional empirical investigations of time saved as a consequence of the strategies provided are needed. If organizations solve their problems rapidly, fewer unresolved problems may remain.

Successful and less-successful research performance of junior faculty

In academic medical centers, there is increasing concern about the diminishing supply of clinical investigators and the amount of clinical investigation being conducted. This study developed and evaluated an instrument designed to measure characteristics of a successful researcher. All assistant professor faculty in the tenure track at this research university were sent a two-page survey. Analyses revealed that 50 percent of the items significantly discriminated successful and less-successful researchers. A factor analysis of these items produced four stable factors: research activities, mentoring, local networks, and scholarly habits. A backward stepwise discriminant analysis revealed that only two of the four factors were needed to effectively identify successful researchers. These two factors were research activities and scholarly habits. The rate of correct classification of the two-factor equation was such that 92 percent of the successful researchers were correctly identified. Testing this instrument in other academic settings would help to determine its generalizability.

Humanistic teaching attributes of primary care physicians

Little research exists on the humanistic qualities of the physician as teacher. This study examined the humanistic teaching attributes used by 30 primary care physicians when teaching medical students in the ambulatory setting. Three research questions were addressed: What humanistic teaching behaviors are demonstrated by physician‐teachers? How do these observed behaviors compare with medical students’ perceptions of physician behavior? How do these observed behaviors compare with the physician‐teachers’ perceptions of their own behaviors? Data from direct observation of the clinical teaching encounter between the physician‐teacher and medical student were compared with students’ perceptions of the humanistic behaviors demonstrated by the teacher and the teachers perception of the frequency with which these behaviors were used. Humanistic teaching attributes were observed to occur with moderate to high frequency. Findings are consistent with other studies suggesting little correlation between self‐repor...

Preceptors' use of reflection to teach in ambulatory settings: An exploratory study.

Purpose Reflection on ones teaching behavior is a means to question teaching events to bring teaching actions to a conscious level, to interpret the consequences of those actions, and to conceptualize alternative teaching actions. Ambulatory teaching settings are variable, unpredictable, and discontinuous, often resulting in lessfocused teaching. The authors sought to measure the level of reflection on teaching used by preceptors to plan teaching in these settings. Method Three preceptors who had participated in the Case Western Reserve Universitys peer-coaching program each answered four questions about how they planned to respond to two teaching case studies. The questions were posed by a medical educator who, for three of the four questions, also prompted the preceptors to stimulate their reflection. The audiotaped responses were assessed using Sparks-Langer and Coltons framework for reflective thinking. Results The levels of reflective thinking increased after prompting, but they did not exceed the rather low technical and practical levels, particularly for the more complex of the two cases. Conclusion This exploratory intervention suggests that faculty rely more on external and non-reflective levels of thought when planning to teach in the ambulatory setting. The authors recommend further research to foster discussions about the cognitive processes involved in planning for teaching in this setting.

Use of Patient Encounter Documentation (Log) Systems at Three Medical Schools.

This article describes uses and limitations of patient encounter documentation (log) systems in four programs at three medical schools. Curricular, psychometric, and administrative issues affecting their successful implementation are discussed, and recommendations to facilitate their use in program evaluation are offered.

Using PDSA To Establish Academic-Community Partnerships: The Cleveland Experience

The Schools of Medicine and Nursing at Case Western Reserve University and the Program in Health Administration at Cleveland State University have created an interdisciplinary course in continuous improvement that emphasizes learning through experience, accommodates a large number of students, and has created new partnerships with Cleveland area health care organizations. An approach that respects these partners as customers and refines the relationships with serial tests of change (e.g., PDSA) has contributed significantly to this programs success.