Georgette A. Stratos

Faculty Development: A Resource for Clinical Teachers

Clinical teachers have the challenging and profound responsibility to convey the art and science of current medical practice. Fortunately, over the past four decades, a variety of programs have been developed to help them play this difficult role. Starting with the initial work of Miller and colleagues in the mid 1950s,1 faculty-development programs to enhance instructional skills have been created for the large cadre of clinician-educators in this country. Since 1978, the Department of Health and Human Services and foundations such as the Kaiser Family Foundation, the Macy Foundation, and the Robert Wood Johnson Foundation have supported programs that emphasize teaching. Such initiatives have resulted in a wide variety of faculty-development programs operating at the institutional, regional, and national levels. The rationale for providing support for clinician-educators can be found in both the task of clinical teaching itself and the empirical studies of faculty-development programs. The task of teaching in general is complex and difficult.2 Clinical teaching can be especially difficult. First, its intended outcome—the effective training of medical practitioners—imposes a ponderous responsibility on the clinical teacher. In the short term, effective clinical teaching is necessary to provide society with excellent care for patients currently in teaching hospitals. Over the long term, effective clinical teaching provides the underpinnings for the high quality of care given patients away from the academic center, who are treated long after physicians finish their formal training. Second, clinical teaching is laden with many educational challenges requiring a breadth of skills. Clinical teachers are expected to address a wide range of educational goals (knowledge, attitudes, and skills); to work with learners who vary greatly in their experience and abilities (students through fellows); to use a variety of teaching methods (lecturing, small–group discussion, and one-on-one teaching); and to teach in different settings (inpatient, outpatient, and lecture hall).3–5 Moreover, clinical teaching is commonly compounded by the simultaneous requirement to deliver patient care. Given this complexity, clinical teachers need to be prepared with as many teaching skills as possible. Empirical studies provide further evidence for the value of faculty development. First, in evaluating many faculty-development programs, clinical teachers rate the experience as useful, and they recommend their experience to colleagues.6,7 Second, evaluation measures show that such programs can improve teachers’ knowledge, skills, and attitudes. These measures include improvements in the following: self–reported knowledge and the use of educational terms before and after training,8 retrospective ratings of knowledge and skills,9,10 teacher ratings of self-efficacy in teaching specific content,11 teacher behavior during problem-based tutorials,12 teacher beliefs regarding problem-based methods,13 ratings from videotapes of participants’ teaching,3 and attitudes toward collaboration between community faculty and university programs.14 Other unpublished data describe improvements in student ratings,15 participants’ self-report 3 to 6 months after training regarding the concepts and skills taught in the program (T. A. DeWitt and M. Quirk, unpublished results),16 and participants’ ability to use educational concepts when analyzing videotaped teaching scenarios (K. M. Skeff and G. A. Stratos, unpublished results).17 In summary, the difficulty of clinical teaching coupled with the evidence that clinician-educators can improve in this role indicates the value of faculty-development programs. Although this rationale for using faculty-development methods is forceful, most medical faculty still have not participated in programs to improve teaching skills. Possible reasons include barriers to faculty participation and lack of knowledge about resources. To help more faculty benefit from available methods, we shall discuss potential barriers to participation in faculty-development programs, provide a summary of the types of available programs in primary care fields, describe characteristics of effective teaching-improvement methods, and recommend how to choose among teaching-improvement methods.

Evaluation of the seminar method to improve clinical teaching

The effects of a seminar method to improve the teaching of ward attending physicians were evaluated. Forty-six attending physicians from four institutions were randomly assigned to experimental and control groups. The method was evaluated to assess its effects on attending physicians’ performances and attitudes, and impact on learners. Evaluation methods included ratings of videotapes of ward rounds, teachers’ subjective assessments of both their teaching performances and their experiences in the study, and trainee ratings. Videotape ratings, the teachers’ own assessments, and the trainees’ assessments of the attending physicians’ impact on learning were significantly different, favoring the experimental group (p<0.05). It is concluded that the seminar method can provide the basis for effective and feasible approaches for improving clinical teaching by attending physicians.

The Stanford faculty development program: A dissemination approach to faculty development for medical teachers

The Stanford Faculty Development Program, designed to improve the instructional skills of clinical teachers, uses a dissemination model to provide faculty development activities for medical schools across the country. Selected clinical faculty attend a month‐long training program at Stanford University Medical Center and then return to their home institutions to conduct seminars for their fellow faculty and for residents in one of three content areas: (a) principles and skills of clinical teaching, (b) the teaching of medical decision making, or (c) the teaching of clinical preventive medicine. Faculty from institutions affiliated with over one quarter of U.S. medical schools have participated in the program. From 1986 through 1991, the program has trained 67 seminar facilitators from 47 institutions who have then conducted training for over 500 faculty and 200 residents. The extent of dissemination indicates that this approach provides a feasible mechanism for delivering faculty development in a wide var...

Practicing Physician Education in Geriatrics: Lessons Learned from a Train‐the‐Trainer Model

Evidence of poor performance in the evaluation and management of common geriatric conditions suggests the need for changing physician behavior in these areas. Traditional lecture‐style continuing medical education (CME) has not been shown to be effective. Expert faculty initially trained 60 nonexpert peer educators to conduct small‐group, learner‐centered CME using tool kits on memory loss, incontinence, and depression. Peer educators presented 109 community‐based sessions to 1,309 medical practitioners. Surveys were administered to community participants immediately and 6 months after a session. Evidence of effectiveness included statistically significant increases in self‐reported knowledge, attitudes, and office‐based practices on the target topics at the time of training and at the 6‐month follow‐up (P<.001) and two‐thirds of respondents reporting continued use of three or more tools at 6 months. Participants reported that the interactive presentation aided their understanding of and ability to use the tool kits more than an off‐the‐shelf review (mean rating±standard deviation 4.1±0.71, with 1=not at all and 5=significantly). After the formal evaluation period, additional information about the project dynamics and tool kits was obtained through a small interview sample and an on‐line survey, respectively. Receiving copies of the tool kits was an important factor in enabling educators to offer sessions. Barriers to offering sessions included finding time, an audience, and space. Findings suggest that modest positive changes in practice in relation to common geriatric problems can be achieved through peer‐led, community‐based sessions using principles of knowledge translation and evidence‐based tool kits with materials for providers and patients.

The effect of a clinical teaching retreat on residents’ teaching skills

No abstract available.

Impact of a clinical preventive medicine curriculum for primary care faculty: Results of a dissemination model

BACKGROUND This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States. METHODS The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise. RESULTS Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics. CONCLUSIONS The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.

Clinical teaching improvement: The transportability of the Stanford Faculty Development Program.

Background: The Stanford Faculty Development Center (SFDC) at Stanford University developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model. We were curious to see if cultural factors might influence the applicability and impact of the course when delivered to non-American participants by a facilitator from that culture. Methods: A Swedish anaesthesiologist at Uppsala University Hospital, Sweden, was trained in October 2004 at Stanford University. From January 2005 to March 2007 he delivered five faculty development seminar series at Uppsala University Hospital to 40 physicians from different departments. Participants rated the usefulness of the seminar series and retrospective pre- and post-seminar ratings were used to assess effects on participants’ teaching skills and behaviours. Results: Participants rated the seminars as highly useful (M = 4.8, SD = 0.4). Participants’ ratings of their teaching ability indicated significant increases across a variety of clinical and non-clinical teaching settings (p < 0.001), and positive changes in teaching behaviours were found for all seven educational categories assessed (p < 0.001). Conclusions: This faculty development model is highly transportable to medical teachers in Sweden, and capable of producing positive results, consistent with those found in the United States.

Medical students’ needs for feedback from residents during the clinical clerkship year

Feedback from residents may be an important component of the learning process for medical students in the clerkship year. In this study, we investigated what kind of feedback medical students in the clerkship year desired from residents and whether these needs changed over the course of the clerkship year. Over the course of 1 year, 69 students from one medical school class participated in meetings in which the nominal group technique was used to identify their feedback needs. Six students were also individually interviewed. Feedback needs early in the clerkship year were closely linked with students’ needs for goals clarification. As the year progressed, students required less communication from residents regarding expectations and more feedback on specific skills, notably physical examination skills, clinical skills, or both and written communication. Feedback either early or at a midpoint in the clerkship appeared to be an important need. Both positive and negative feedback were frequently mentioned. T...

Prioritizing areas for faculty development of clinical teachers by using student evaluations for evidence-based decisions

No abstract available.

A randomised controlled study of role play in a faculty development programme.

Background: The Stanford Faculty Development Center at Stanford University has developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model. Aims: This study was designed to investigate the relative impact of role playing as an instructional technique within that course for facilitating change in teaching behaviours. Method: From January 2009 to April 2010, six faculty development courses were delivered at Uppsala University Hospital to 48 physicians from different departments. The standard course presentation includes a range of instructional methods including short lectures, small group discussion, review of video re-enactments, role-play exercises and personal goal setting. For this study, participants were randomised to participate in (1) a ‘standard’ course with role play or (2) an ‘alternative’ course with no role play. The effects of the course on teaching performance were assessed with retrospective pre- and post-course self-ratings of 29 specific teaching behaviours. Results: Self-assessment ratings indicated significantly greater positive changes in teaching behaviour among faculty who attended the standard course (with role play) as compared to those in the alternative course (p = 0.015). Conclusions: This study validates the commonly held view that role play is a useful instructional method for improving teaching.