John Spencer

A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8

Background: Preparing healthcare professionals for teaching is regarded as essential to enhancing teaching effectiveness. Although many reports describe various faculty development interventions, there is a paucity of research demonstrating their effectiveness. Objective: To synthesize the existing evidence that addresses the question: “What are the effects of faculty development interventions on the knowledge, attitudes and skills of teachers in medical education, and on the institutions in which they work?” Methods: The search, covering the period 1980–2002, included three databases (Medline, ERIC and EMBASE) and used the keywords: staff development; in-service training; medical faculty; faculty training/development; continuing medical education. Manual searches were also conducted. Articles with a focus on faculty development to improve teaching effectiveness, targeting basic and clinical scientists, were reviewed. All study designs that included outcome data beyond participant satisfaction were accepted. From an initial 2777 abstracts, 53 papers met the review criteria. Data were extracted by six coders, using the standardized BEME coding sheet, adapted for our use. Two reviewers coded each study and coding differences were resolved through discussion. Data were synthesized using Kirkpatricks four levels of educational outcomes. Findings were grouped by type of intervention and described according to levels of outcome. In addition, 8 high-quality studies were analysed in a ‘focused picture’. Results: The majority of the interventions targeted practicing clinicians. All of the reports focused on teaching improvement and the interventions included workshops, seminar series, short courses, longitudinal programs and ‘other interventions’. The study designs included 6 randomized controlled trials and 47 quasi-experimental studies, of which 31 used a pre-test–post-test design. Key points: Despite methodological limitations, the faculty development literature tends to support the following outcomes: Overall satisfaction with faculty development programs was high. Participants consistently found programs acceptable, useful and relevant to their objectives. Participants reported positive changes in attitudes toward faculty development and teaching. Participants reported increased knowledge of educational principles and gains in teaching skills. Where formal tests of knowledge were used, significant gains were shown. Changes in teaching behavior were consistently reported by participants and were also detected by students. Changes in organizational practice and student learning were not frequently investigated. However, reported changes included greater educational involvement and establishment of collegiate networks. Key features of effective faculty development contributing to effectiveness included the use of experiential learning, provision of feedback, effective peer and colleague relationships, well-designed interventions following principles of teaching and learning, and the use of a diversity of educational methods within single interventions.Methodological issues: More rigorous designs and a greater use of qualitative and mixed methods are needed to capture the complexity of the interventions. Newer methods of performance-based assessment, utilizing diverse data sources, should be explored, and reliable and valid outcome measures should be developed. The maintenance of change over time should also be considered, as should process-oriented studies comparing different faculty development strategies. Conclusions: Faculty development activities appear highly valued by participants, who also report changes in learning and behavior. Notwithstanding the methodological limitations in the literature, certain program characteristics appear to be consistently associated with effectiveness. Further research to explore these associations and document outcomes, at the individual and organizational level, is required.

Learner centred approaches in medical education

Medical education is a lifelong process embracing premedical experience, undergraduate education, general clinical training, specialist or vocational training, subspecialty training, and continuing medical education. Although medical education was once seen as the province of medical schools and teaching hospitals, large and increasing numbers of practitioners now provide teaching and promotion of learning outside the traditional environment. Over the past decade both the university sector and the NHS have seen considerable change and increased accountability for their activities, and all the signs suggest that the next 10 years will be no different. Simultaneously, medical schools are having to acknowledge the implementation of new curricula, the consequences of new health service priorities, an increase in the number of medical students, and the implications of the report from the National Committee of Enquiry into Higher Education, chaired by Sir Ron Dearing.1 The most recent recommendations of the General Medical Councils education committee were intended to promote an approach to undergraduate medical education and to give a perspective on its aims, which differ substantially from those of traditional curricula.2 Although the 13 principal recommendations are now well known, at the core is the promotion of the merits of learner centred and problem oriented approaches to learning, which aim to produce doctors better equipped with the adult learning skills necessary for them to adapt to, and meet, the changing needs of the community they serve. The pedagogic shift from the traditional teacher centred approach, in which the emphasis is on teachers and what they teach, to a student centred approach, in which the emphasis is on students and what they learn, requires a fundamental change in the role of the educator from that of a didactic teacher to that of a facilitator of learning.3 Our aim was to explore some of the …

Clarifying the concepts of confidence and competence to produce appropriate self-evaluation measurement scales.

This paper reviews the literature on self‐evaluation and discusses the findings of a small‐scale qualitative study which explored the terms ‘confidence’ and ‘competence’ as useful measures in a self‐evaluation scale. Four pre‐registration house officers took part in interviews and completed a provisional instrument to assess their perceived competence.

Identifying appropriate tasks for the preregistration year: modified Delphi technique

Abstract Objectives: To identify the tasks that should constitute the work of preregistration house officers to provide the basis for the development of a self evaluation instrument. Design: Literature review and modified Delphi technique. Setting: Northern Deanery within the Northern and Yorkshire office NHS executive. Subjects: 67 educational supervisors of preregistration house officers. Main outcome measures: Percentage of agreement by educational supervisors to tasks identified from the literature. Results: Over 61% of communication items, 70% of on call patient care items, 75% of routine patient care items, 45% of practical procedure items, and over 63% of self management items achieved over 95% agreement that they should be part of the house job of preregistration house officers. Poor agreement was found for the laboratory and clinical investigations that house officers could perform with or without supervision. Conclusions: The tasks of house officers were identified but issues in using this method and in devising a universally acceptable list of tasks for preregistration house officers were apparent. Key messages More than 100 activities were identified as potential tasks for house officers, and 11 personal abilities were identified as self management skills The ability of preregistration house officers to perform all of the tasks independently would be restricted by their experiences and therefore may depend on the specialty in which they work The deliberation over what are and are not “shared tasks” was evident; some educational supervisors wanted the house officer to be capable of, but not practise, some tasks whereas others did not believe these tasks were within the remit of the house officer The Delphi technique is a useful method for gaining the autonomous opinions of individuals from a large group of geographically distant members

A survey of medical students’ views about the purposes and fairness of assessment

Objective  To survey medical students’ views about the purposes and fairness of assessment procedures.

Decline in empathy in medical education: how can we stop the rot?

It is hard to reconcile the fresh faced idealism and altruistic aspirations of candidates at interview for medical school, or the optimism shown by junior medical students in their early discussions about the role of the doctor, with the scepticism and apparent detachment of at least some of the world weary graduates who stagger off the end of the production line. This decline in idealism during training will be familiar (and perplexing) to most medical educators and has long been recognised, indeed is enshrined in the old catchphrase that describes the two traditional phases of medical education as precynical and cynical. Waning of idealism is thought to be associated with a decline in empathy, and two papers in this edition explore this important area.

What has changed in the evidence for early experience? Update of a BEME systematic review

Background: We previously reviewed evidence published from 1992 to 2001 concerning early experience for healthcare undergraduates (Dornan T, Littlewood S, Margolis S, Scherpbier A, Spencer J, Ypinazar V. 2006. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach 28:3–18). This subsequent study reviews evidence published from 2002 to 2008. Aims: Identify changes in the evidence base; determine the value of re-reviewing; set a future research agenda. Methods: The same search strategy as in the original review was repeated. Newly identified publications were critically appraised against the same benchmarks of strength and educational importance. Results: Twenty-four new empirical studies of early authentic experience in education of health professionals met our inclusion criteria, yielding 96 outcomes. Sixty five outcomes (from 22 studies) were both educationally important and based on strong evidence. A new significant theme was found: the use of early experience to help students understand and align themselves with patient and community perspectives on illness and healthcare. More publications were now from outside Europe and North America. Conclusions: In addition to supporting the findings of our original review, this update shows an expansion in research sources, and a shift in research content focus. There are still questions, however, about how early authentic experience leads to particular learning outcomes and what will make it most educationally effective.

Preparedness for practice : the perceptions of medical graduates and clinical teams

Background: Earlier research indicated that medical graduates feel unprepared to start work, and that this varies with medical school. Aims: To examine the extent to which graduates from different UK medical schools differed in their perceptions of preparedness for practice, and compare their perceptions with those of clinical team members. Method: An anonymous questionnaire assessing perceptions of 53 aspects of preparedness was devised, and administered to the graduating cohorts of three medical schools: Newcastle (systems-based, integrated curriculum); Warwick (graduate-entry) and Glasgow (problem-based learning). In addition, a triangulating questionnaire was cascaded via ward managers to doctors, nurses and pharmacists who worked with new graduates in their first posts. Results: The response rate for the cohort questionnaire was 69% (479/698). The overall mean preparedness score was 3.5 (on a five-point scale), with no significant difference between schools. On individual items, there were large differences within each site, but smaller differences between sites. Graduates felt most prepared for aspects of working with patients and colleagues, history taking and examination. They felt least prepared for completing a cremation form, some aspects of prescribing, complex practical procedures and for applying knowledge of alternative and complementary therapies, and of the NHS. A total of 80 clinical team questionnaires were completed, similarly showing substantial variation within each site, but smaller differences between sites. Conclusions: New doctors feel relatively unprepared for a number of aspects of practice, a perception shared by their colleagues. Although medical school has some effect on preparedness, greater differences are common across sites. Differences may reflect hidden influences common to all the schools, unintended consequences of national curriculum guidance or common traits in the graduate populations sampled. Further research is needed to identify the causes.

A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40

Abstract Background: This review, which focused on faculty development initiatives designed to improve teaching effectiveness, synthesized findings related to intervention types, study characteristics, individual and organizational outcomes, key features, and community building. Methods: This review included 111 studies (between 2002 and 2012) that met the review criteria. Findings: Overall satisfaction with faculty development programs was high. Participants reported increased confidence, enthusiasm, and awareness of effective educational practices. Gains in knowledge and skills, and self-reported changes in teaching behaviors, were frequently noted. Observed behavior changes included enhanced teaching practices, new educational initiatives, new leadership positions, and increased academic output. Organizational changes were infrequently explored. Key features included evidence-informed educational design, relevant content, experiential learning, feedback and reflection, educational projects, intentional community building, longitudinal program design, and institutional support. Conclusion: This review holds implications for practice and research. Moving forward, we should build on current success, broaden the focus beyond individual teaching effectiveness, develop programs that extend over time, promote workplace learning, foster community development, and secure institutional support. We should also embed studies in a theoretical framework, conduct more qualitative and mixed methods studies, assess behavioral and organizational change, evaluate transfer to practice, analyse key features, and explore the role of faculty development within the larger organizational context.

Does the presence of medical students affect quality in general practice consultations

Context  Previous studies have suggested that the patient’s experience of a consultation with a doctor is not affected by the presence of medical students. However, no study has looked at the effect of student presence on conventional UK general practice consultations.