Susan Starr

Development and implementation of an objective structured teaching exercise (OSTE) to evaluate improvement in feedback skills following a faculty development workshop

Background: Faculty development programs focusing on teaching have become widespread. Purpose: Despite the popularity of such programs, evidence as to their effectiveness is limited. This article reports on the development of an objective structured teaching exercise (OSTE) and its pilot implementation in an evaluation of a faculty development program module. A written test intended to measure feedback skills was also developed and pilot tested. Methods: A separate-sample, pretest-posttest design was used to pilot test both instruments. Results: The results showed some evidence of significant differences between groups tested preworkshop and postworkshop. Higher scores were observed for the posttest group compared to the pretest group only for OSTE items focusing on prioritizing and limiting the amount of feedback given at one time and on action planning. Conclusions: Results suggest that an OSTE may be sensitive to changes in preceptor skill level for skills that are relatively easy to incorporate immediately into practice. Lack of differences in other skill areas may be due to lack of sensitivity of the measure or to need for practice and reflection before changes in performance on other feedback skills are evident.

Community preceptors' views of their identities as teachers

Purpose Community physicians are increasingly being recruited to teach medical students and residents, yet there has been little research about how they think of themselves as teachers or what factors contribute to “teacher identity.” Physicians who think of themselves as teachers may be more likely to enjoy teaching, to teach more, and to be recognized by students and other faculty as good teachers. Identifying factors that enhance teacher identity may be helpful for the recruitment and retention of high-quality community faculty. Method Thirty-five experienced community preceptors were audiotaped in five structured focus groups in April 2001, answering a series of questions about their teacher identity. Responses were qualitatively analyzed for evidence of themes. Results “Feeling intrinsic satisfaction” was the most common theme that emerged from the tapes. Preceptors also identified that “having knowledge and skill about teaching” and “belonging to a group of teacher” enhanced their roles as teachers. “Being a physician means being a teacher,” “feeling a responsibility to teach medicine,” and “sharing clinical expertise” also emerged as important themes. Although a group of participants were interested in “receiving rewards for teaching,” rewards did not need to be financial compensation. For some, genuine recognition for their efforts by the medical school, particularly in the form of faculty development opportunities, constituted reward and recognition for teaching. Conclusions Community physicians described a variety of factors that contribute to their identity as teachers. Faculty development programs offer opportunities to strengthen teacher identity and foster relationships between teaching programs and community-based faculty.

A Human Factors Curriculum for Surgical Clerkship Students

HYPOTHESIS Early introduction of a full-day human factors training experience into the surgical clerkship curriculum will teach effective communication skills and strategies to gain professional satisfaction from a career in surgery. DESIGN In pilot 1, which took place between July 1, 2007, and December 31, 2008, 50 students received training and 50 did not; all received testing at the end of the rotation for comparison of control vs intervention group performance. In pilot 2, a total of 50 students were trained and received testing before and after rotation to examine individual change over time. SETTING University of Massachusetts Medical School. PARTICIPANTS A total of 148 third-year medical students in required 12-week surgical clerkship rotations. INTERVENTIONS Full-day training with lecture and small-group exercises, cotaught by surgeons and educators, with focus on empathetic communication, time management, and teamwork skills. MAIN OUTCOME MEASURES Empathetic communication skill, teamwork, and patient safety attitudes and self-reported use of time management strategies. RESULTS Empathy scores were not higher for trained vs untrained groups in pilot 1 but improved from 2.32 to 3.45 on a 5-point scale (P < .001) in pilot 2. Students also were more likely to ask for the nurses perspective and to seek agreement on an action plan after team communication training (pilot 1, f = 7.52, P = .007; pilot 2, t = 2.65, P = .01). Results were mixed for work-life balance, with some trained groups scoring significantly lower than untrained groups in pilot 1 and no significant improvement shown in pilot 2. CONCLUSIONS The significant increase in student-patient communication scores suggests that a brief focused presentation followed by simulation of difficult patient encounters can be successful. A video demonstration can improve interdisciplinary teamwork.

Initial testing of an instrument to measure teacher identity in physicians

Background: A previous study described 7 elements of teacher identity: intrinsic satisfaction from teaching, knowledge and skill about teaching, belonging to a community of teachers, receiving rewards for teaching, believing that being a doctor means being a teacher, feeling a responsibility to teach, and sharing clinical expertise. Purpose: To conduct the initial testing of an instrument to measure the 7 elements of teacher identity in clinical educators and to consider the potential applications of such an instrument. Methods: A 37-item questionnaire was mailed to 153 preceptors of preclinical students. Categories reflected the elements of teacher identity listed here. Demographic data were collected. Means, alphas, ANOVAs, and paired t tests were calculated. Results: Of 153 preceptors, 127 (83%) completed the questionnaire. Cronbachs alpha for the overall scale and several subscales were high. Salaried physicians and those who had completed a faculty development program scored significantly higher on several subscales than physicians who volunteered to teach or who did not have faculty development. Conclusions: This study provides preliminary evidence that teacher identity can be measured and that preceptors do not respond as a homogeneous group. Assessing teacher identity may be helpful to medical schools looking to identify and support physicians who teach.

Resident Preparedness for Practice: A Longitudinal Cohort Study

OBJECTIVE To determine whether the perception of preparedness for practice changes over time. DESIGN Questionnaire survey of University of Massachusetts residents 5 years after an initial survey. Responses to individual questions in the 2 surveys were compared for each graduate and the Wilcoxon rank sum test applied. A supplementary questionnaire addressed current confidence in areas with relatively low scores in both surveys. RESULTS All 24 eligible graduates responded. The high rating of overall sense of preparedness was identical in the 2 surveys. Differences were statistically significant in only 3 categories: common illnesses, office gastroenterology, and office gynecology-all from a lower estimate of preparedness initially to a higher estimate in retrospect. Six areas continued to receive relatively low scores: nutrition, patient scheduling, cost-effectiveness, telephone management, office gynecology, and office orthopedics. Respondents feel more confident currently with nutrition, patient scheduling, and telephone management but not with cost-effectiveness, gynecology, or orthopedics. CONCLUSIONS Residents paired with office-based practitioners for their continuity experience report feeling well prepared for practice both on practice entry and 5 to 9 years later. In the 6 areas of relatively low preparedness, experience improved confidence with nutrition, patient scheduling, and telephone management, but not cost-effectiveness, gynecology, or orthopedics. The hypothesis that clinical areas of relative weakness at the end of residency may remain so years later deserves to be tested.

Educating pediatric residents in community settings.

Pediatric training programs have recently witnessed a renewed emphasis on community-based experiences. This change can be attributed partly to the need for a more appropriate foundation for careers in general pediatrics and partly to a call for more generalist physicians as a result of health care reform. Community experiences provide optimal sites for residents to learn community-based primary care, practice management, collaboration with patient care teams, and advocacy on behalf of childrens issues. The literature of the past year has focused on the theoretical issues, curricular components, and practical demands of implementing such experiences.