Mark H. Gelula

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.

Using standardised students in faculty development workshops to improve clinical teaching skills

Purpose  We describe the use of standardised students (SSs) in interdisciplinary faculty development programmes to improve clinical teaching skills. Standardised students are actual health professions students who are trained to portray a prototypical teaching challenge consistently across many encounters with different faculty participants.

Effective lecture presentation skills

Lectures are the most popular form of teaching in medical education. As much as preparation and organization are key to the lectures success, the actual presentation also depends upon the presenters ability to reach the audience. Teaching is a lively activity. It calls for more than just offering ideas and data to an audience. It calls for direct contact with the audience, effective use of language, capability to use limited time effectively, and the ability to be entertaining. This article offers a structure to effective lecturing by highlighting the importance of voice clarity and speaking speed, approaches to using audiovisual aids, effectively using the audience to the lecture, and ways to be entertaining.

A Web-Based Course on Complementary Medicine for Medical Students and Residents Improves Knowledge and Changes Attitudes

Background: There is a growing need to educate physicians about complementary and alternative medicine (CAM). Few introductory courses in CAM have been described. Purpose: To develop and evaluate an introductory course in CAM for medical students and residents. Method: We conducted a controlled study evaluating a case-based, Web-based course in CAM, making comparison to no intervention. Participants were 123 internal medicine residents, family medicine residents, and 3rd- and 4th-year medical students at academic residency programs in internal medicine and family medicine and two U.S. medical schools. Outcomes included knowledge of CAM, attitudes toward CAM, and course evaluation information. Results: Eighty-nine learners completed the course. Test scores among a subset of these (n = 57) were higher (M ± SD = 78.7 ± 10.1) than scores (50.9 ± 8.5, p < .001) among a no-intervention control group (n = 34), and remained higher (64.9 ± 11.4) 3 months later. After the course participants felt more comfortable discussing CAM with patients, recognized a greater role for CAM, and knew better where to find information on CAM (ps < .001 compared to baseline). Course ratings were high, although 26% of learners desired greater feedback. Conclusions: This brief course in CAM improved knowledge, changed attitudes, and was well received.

CLINICAL DISCUSSION SESSIONS AND SMALL GROUPS

Because most adults learn more efficiently and what they learn is retained longer when they are able to engage in active learning, discussion groups are at the center of medical education. Group discussion is an active learning process. Active learning supports participant interchange through structured and supportive educational procedures. Small group discussions provide opportunities for identification of new areas of knowledge acquisition by students. They also can be used to formally integrate previous knowledge though active integrating discussion. The clinical instructor who uses small group discussions effectively will find that his role as information provider is diminished, but that his role as facilitator is greatly enhanced. The paper focuses on purposes for discussion groups, the role of the clinical instructor, and offers specific suggestions for techniques to enhance small group discussions.

Preparing and organizing for a lecture

In a lecture, developing a strong organization assures strong delivery and a clear message. In this article preparation steps that will support the lecture are identified and described. These steps include: understanding the background and needs of the audience, establishing a clear purpose for the presentation, and being cognizant of the program planners expectations of you. To assure a flawless lecture, several organizational imperatives are recommended.

Addiction medicine: a place for faculty development.

Addiction medicine must fight for its space in the undergraduate, graduate and continuing medical education curricula, as do most other clinical domains. Often curriculum time is provided to specialty areas when a clear relevance to the overall curriculum is made obvious. Increasing the awareness of addiction medicine through institutionalized faculty development programs can serve to foster the integration of this specialized curriculum. Institutionalizing faculty development is proposed in a description of a four-phase model. Specific recommendations of goals, processes, and critical steps in the faculty development process supporting scholarship leading to curricular change are described.

Working with slides and transparencies for presentations

Abstract This article provides ideas that support visual aids. Good visuals will enhance and complement any presentation. Yet, as much as good visuals can strengthen a presentation, so too may ineffective visuals undermine it. “Visuals belong to your audience. They exist to synthesize your main points and to give your listeners a road map of where you are going [1].” Careful attention in planning the visual complement to an oral presentation will assure ones audience is able to absorb a greater part of the intended message … and use it.

Does early clinical practice in community settings change the perception and performance of students on preventive skills

After successful utilization of Lance Armstrong’s autobiography to teach clinical pharmacology to a small group of nursing students (Mathibe 2007), we assessed its usefulness among a larger group of medical students. The research took place over the period of two successive years (2006 and 2007), involving third-year medical students enrolled for the Bachelor of Medicine and Surgery (MBChB) degree at the University of KwaZulu-Natal (Nelson R Mandela School of Medicine, South Africa). General learning objectives as well as copies of selected chapters (4, 5 and 6) of the autobiography were given to the students at the beginning of the lectures. During the first 45 min of the lecture; willing students were requested to read certain sections of the autobiography, for the whole class, to draw attention to the names and regimens of cytotoxic drugs; side effects; investigation procedures; the role of team work in cancer management; health related quality of life and holistic health care. For the remaining 45 min the lecturer used a didactic teaching method (prepared using scientific therapeutics literature) to explain and expand on issues discussed during the autobiography-reading sessions. Self-administered originally constructed questionnaires with statements graded on 5-point Likert scale (11⁄4 strongly disagree; 21⁄4 disagree; 31⁄4 neutral; 41⁄4 agree and 51⁄4 strongly agree) and open-ended questions (qualitative measures) were used to assess students’ perceptions. Ethical permission, as well as copyright for making copies from the autobiography, was obtained from the University’s Bio-Ethics committee. Total of 259 (91% response) students completed and returned the questionnaires. Majority (90%) of participants ‘agreed’ that the exercise stimulated their interest in cancer drugs and 85% felt that the exercise was a valuable use of their time. Ninety-one percent of female and 78% of males ‘agreed’ that the ‘exercise was a valuable use’ of their time and difference (13%) was statistically significant (p < 0.008). Younger students ( 21 years old) were in favour of the use of the autobiography more (p1⁄4 0.035) than other age groups (21–25 and 26 years old). There were statistically significant (p1⁄4 0.03) results between males and females regarding their preference of the use of a popular autobiography over the ‘didactic’ teaching method; with females preferring the use of a popular autobiography over the ‘didactic’ teaching method than males. The autobiography, as a teaching method, was more appealing to younger (<21 years old) students as compared to the older ones. This discovery augurs well for implementation of this teaching method in early years of medical education.