L. Randol Barker

Faculty Development in Teaching Skills: An Intensive Longitudinal Model

Although reflection contributes to the personal growth of clinician–educators and is important for effective teaching, few teaching skills programs report its use. The Johns Hopkins Faculty Development Program in Teaching Skills, first implemented in 1987 as a theoretically grounded, longitudinal model for faculty development of clinician–educators, comprises a set of conditions intended to promote reflective learning. This paper describes the program and reports evaluation results for 98 participants and a comparison group of 112 nonparticipants between 1988 and 1996. Participants met with facilitators weekly for nine months for 3.5 hours, in stable groups of four to six individuals. Educational methods used across seven content areas emphasized relationships and collaboration, and included information provision, experiential learning with reflection, and personal awareness sessions. A pre–post evaluation design with comparison group measured changes in self-assessed teaching and professional skills, teaching enjoyment, and learning effectiveness. A post-only evaluation design appraised overall program quality, educational methods, facilitation, learning environment, and perceived impact of participation. Program participants had significantly greater pre–post-change scores than nonparticipants for all 14 outcomes (p < .05). Multiple regression modeling indicated that program participation was associated with pre–post improvement in all outcomes except administration skills, controlling for all participant and nonparticipant baseline characteristics (p < .05). All measured programmatic characteristics were highly rated by participants. Experiential methods with reflection were rated significantly higher than information-provision and personal awareness sessions (p < .001). Evaluation results demonstrate a positive impact of this alternative approach to faculty development on clinician–educator perceptions of their attitudes and behaviors towards learners and colleagues.

An evaluation of residency training in interviewing skills and the psychosocial domain of medical practice

Competent use of interviewing skills is important for the care of all patients but is especially critical, and frequently deficient, in meeting the needs of patients experiencing emotional distress. This study presents an evaluation of a curriculum in communication and psychosocial skills taught to first-year medical residents. A randomized experimental design compared trained and untrained residents’ (n=48) performances with a simulated patient presenting with atypical cbest pain and psychosocial distress. Evaluation was based on analysis of videotapes, simulated patient report of residents’ behaviors, and cbart notation. Trained compared with untrained residents asked more open-ended questions and fewer leading questions, summarized main points more frequently, did more psychosocial counseling, and were rated as baving better communication skills by the simulated patient. The use of more focused and psychosocially directed questions, and fewer leading and grab-bag questions, was associated with more accurate diagnoses and management recorded in the medical chart. However, no significant difference was found in the charting practices of trained versus untrained residents.

Long-Term Follow-Up of a Longitudinal Faculty Development Program in Teaching Skills

BACKGROUND: The long-term impact of longitudinal faculty development programs (FDPs) is not well understood.OBJECTIVE: To follow up past participants in the Johns Hopkins Faculty Development Program in Teaching Skills and members of a comparison group in an effort to describe the long-term impact of the program.DESIGN AND PARTICIPANTS: In July 2002, we surveyed all 242 participants in the program from 1987 through 2000, and 121 members of a comparison group selected by participants as they entered the program from 1988 through 1995.MEASUREMENTS: Professional characteristics, scholarly activity, teaching activity, teaching proficiency, and teaching behaviors.RESULTS: Two hundred participants (83%) and 99 nonparticipants (82%) responded. When participants and nonparticipants from 1988 to 1995 were compared, participants were more likely to have taught medical students and house officers in the last year (both P<.05). Participants rated their proficiency for giving feedback more highly (P<.05). Participants scored higher than nonparticipants for 14 out of 15 behaviors related to being learner centered, building a supportive learning environment, giving and receiving feedback, and being effective leaders, half of which were statistically significant (P<.05). When remote and recent participants from 1987 through 2000 were compared with each other, few differences were found.CONCLUSIONS: Participation in the longitudinal FDP was associated with continued teaching activities, desirable teaching behaviors, and higher self-assessments related to giving feedback and learner centeredness. Institutions should consider supporting faculty wishing to participate in FDPs in teaching skills.

Curriculum for ambulatory care training in medical residency - Rationale, attitudes, and generic proficiencies

This paper provides a foundation for establishing curricula to train medical residents in ambulatory care. To do so, it first presents reasons that curricula are needed in this area. It then delineates attitudes and proficiencies (knowledge and skills) that such curricula should be designed to instill. Finally, it briefly discusses implications for curriculum development. Extensive tables are provided, including detailed lists of generic proficiencies that residents should attain. Among realms in which these proficiencies lie are organizing the ambulatory care encounter, using interpersonal skills, gathering information through physical examination and other means, obtaining and employing clinically useful knowledge, documenting the encounter, and planning and coordinating care. The paper notes that planning for the discharge of patients from the hospital can contribute to obtaining proficiencies important in ambulatory care.This paper provides a foundation for establishing curricula to train medical residents in ambulatory care. To do so, it first presents reasons that curricula are needed in this area. It then delineates attitudes and proficiencies (knowledge and skills) that such curricula should be designed to instill. Finally, it briefly discusses implications for curriculum development. Extensive tables are provided, including detailed lists of generic proficiencies that residents should attain. Among realms in which these proficiencies lie are organizing the ambulatory care encounter, using interpersonal skills, gathering information through physical examination and other means, obtaining and employing clinically useful knowledge, documenting the encounter, and planning and coordinating care. The paper notes that planning for the discharge of patients from the hospital can contribute to obtaining proficiencies important in ambulatory care.

Continuing medical education for European general practitioners in doctor‐patient relationship skills and psychosocial issues

&NA; The objective of this study was to identify the types of continuing medical education (CME) available to European general practitioners in doctor‐patient relationship skills and in the psychosocial content of practice. Two methods were used: (1) a questionnaire, mailed to the 26 council members of the European Association of Teachers of General Practice (EURACT) and (2) observation and inquiry during visits to CME coordinators in several countries. Sixteen of 23 responding EURACT members reported CME activities in the areas of interest. Most reported programs that address both doctor‐patient relationship skills and psychosocial content. Programs studied in three countries illustrated in detail the types of CME that were reported elsewhere: small‐group workshops, intensive learning by one or more physicians over a prolonged time period, and national‐level CME activities. The activities identified in this study represent potential resources for CME planners throughout Europe. The findings suggest several challenges that have also been identified in the U.S.: (1) to make this type of CME more available to primary care practitioners; (2) to structure general practice visits so that there is sufficient time to develop doctor‐patient relationships and to address psychosocial problems; and (3) to develop processes for sharing educational ideas in these two areas.

Promoting humanistic care in the house staff continuity clinic.

Context and setting Mission Statement Day (MSD) is an experiential exercise for Year 1 medical students. It was designed to help students begin developing their professional values and attitudes, as well as explore the personal values they bring to medical school. The MSD was introduced in September 1994 to the graduating class of 1998 at Schulich School of Medicine, University of Western Ontario. Why the idea was necessary The development of professional values is a frequently discussed topic in the medical literature. Many authors express concern that the medical profession addresses the matter inadequately and has lost sight of its core values and ethical principles. Professionalism is often introduced to medical students through special activities such as white coat ceremonies and the swearing of oaths or other special declarations. While these are excellent exercises, they tend to be passive activities. Engaging medical students in writing their own mission statements was felt to be an ideal way to begin the process of self-reflection and the exploration of personal values. What was done The MSD is scheduled at the end of the first week for each new medical class. The morning begins with several patients speaking about their personal experiences with a major health problem. They speak freely, expressing their own positive or negative opinions and answering questions. The class is then divided into small groups with a facilitator assigned to each group. The groups spend approximately 90 mins identifying the characteristics they feel are important in a future doctor, defining the roles they feel a doctor should fulfil in the health care system, and creating a mission statement. The entire class reassembles and each group shares its mission statement with the class. Later, representatives of each group create a composite class mission statement. The mission statement is engraved on a plaque in the student lounge, a copy is presented to the dean, and it is printed in the clinical skills handbooks. Finally, each class recites their mission statement at graduation. Evaluation of results and impact Using qualitative methodology we explored the impact of MSD through focus groups and key informant interviews with students from Years 1)4. The process of creating a mission statement was more important to the students than the mission statement they created. Three themes were identified: the central role of patients; bonding and group formation, and student ownership and valuing of the mission statement. Patient involvement was critical to exploring the disease and illness experience, and to stimulating discussion about compassion and professional relationships. Mission Statement Day represented the first opportunity for students to share ideas in an academic setting. They spoke eloquently of the class diversity and differing value systems, as well as the support of peers. Faculty role-modelling highlighted the value placed on MSD by the medical school. Students had vivid and easily recalled recollections of the day. The experience was very powerful, prompting the students to reflect on their future professional role and reinforcing their decisions to enter medical school. Mission Statement Day is an excellent exercise to introduce medical students to their future professional role.