Yvonne Steinert

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.

Role modelling--making the most of a powerful teaching strategy.

Teachers need to be aware of the conscious and unconscious components of learning from role modelling, so that the net effect of the process is positive

Interactive lecturing: strategies for increasing participation in large group presentations

SUMMARY Interactive lecturing involves an increased interchange between teachers, students and the lecture content.The use of interactive lectures can promote active learning, heighten attention and motivation, give feedback to the teacher and the student, and increase satisfaction for both.This article describes a number of interactive techniques that can be used in large group presentations as well as general strategies that can promote interactivity during lectures. Have you ever given or attended an interactive lecture? What was it that made it interactive?What were your impressions of this method of teaching? Whereas much has been written about effective lecturing and presentation skills in medical education (Cox & Ewan, 1988; Laidlaw, 1988; Newble & Cannon, 1994), little has been written about the bene® ts and strategies of interactive lecturing for medical teachers.The goals of this article are to describe the advantages and indications for interactive lectures, to discuss common fears and concerns about using this method of teaching, to outline a number of interactive techniques that can be incorporated into medical teaching at all levels, and to highlight general guidelines for successful interaction and audience participation.

Student perceptions of effective small group teaching

Purpose  The goal of this study was to assess student perceptions of effective small group teaching during preclinical training in a medical school that promotes an integrated, systems‐based undergraduate curriculum. In particular, students were asked to comment on small group goals, effective tutor behaviours, pedagogical materials and methods of evaluation.

Faculty development for teaching and evaluating professionalism: from programme design to curriculum change.

Introduction  The recent emphasis on the teaching and evaluation of professionalism for medical students and residents has placed significant demands on medicines educational institutions. The traditional method of transmitting professional values by role modelling is no longer adequate, and professionalism must be taught explicitly and evaluated effectively. However, many faculty members do not possess the requisite knowledge and skills to teach this content area and faculty development is therefore required.

Learning together to teach together: Interprofessional education and faculty development

Interprofessional education for collaborative patient-centered practice has been identified as a key mechanism to address health care needs and priorities. Faculty development can play a unique role in promoting interprofessional education (IPE) by addressing some of the barriers to teaching and learning that exist at both the individual and the organizational level, and by providing individuals with the knowledge and skills needed to design and facilitate IPE. This article highlights a number of approaches and strategies that can facilitate IPE. In particular, it is recommended that faculty development initiatives aim to bring about change at the individual and the organizational level; target diverse stakeholders; address three main content areas, notably interprofessional education and collaborative patient-centred practice, teaching and learning, and leadership and organizational change; take place in a variety of settings, using diverse formats and educational strategies; model the principles and premises of interprofessional education and collaborative practice; incorporate principles of effective educational design; and consider the adoption of a dissemination model to implementation. Clearly, faculty members play a critical role in the teaching and learning of IPE and they must be prepared to meet this challenge.

Faculty development initiatives designed to promote leadership in medical education. A BEME systematic review: BEME Guide No. 19.

Background: Due to the increasing complexity of medical education and practice, the preparation of healthcare professionals for leadership roles and responsibilities has become increasingly important. To date, the literature on faculty development designed to promote leadership in medical education has not been reviewed in a systematic fashion. Aim: The objective of this review is to synthesize the existing evidence that addresses the following question: ‘What are the effects of faculty development interventions designed to improve leadership abilities on the knowledge, attitudes, and skills of faculty members in medicine and on the institutions in which they work?’ Methods: Search strategy: The search, which covered the period 1980–2009, included six databases (Medline, EMBASE, CINAHL, Web of Science, ERIC, and ABI/Inform) and used the following keywords: faculty development; in-service training; doctor; medic; physician; faculty; leadership; management; administration; executive; and change agent. Hand searches were also conducted, and expert recommendations were solicited. Inclusion and exclusion criteria: Articles with a focus on faculty development to improve leadership, targeting basic science and clinical faculty members, were reviewed. All study designs that included outcome data beyond participant satisfaction were examined. From an initial 687 unique records, 48 articles met the review criteria in three broad categories: (1) reports in which leadership was the primary focus of the intervention; (2) reports in which leadership was a component of a broader focus on educational development; and (3) reports in which leadership was a component of a broader focus on academic career development. Data extraction: Data were extracted by three coders using the standardized Best Evidence Medical Education coding sheet adapted for our use. One reviewer coded all of the articles, and two reviewers each coded half of the dataset. Coding differences were resolved through discussion. Data synthesis: Data were synthesized using Kirkpatricks four levels of educational outcomes. Findings were grouped by intervention type and level of outcome. Results: Forty-eight articles described 41 studies of 35 different interventions. The majority of the interventions targeted clinical faculty members and included workshops, short courses, fellowships, and other longitudinal programs. The majority of studies were quantitative in nature, though five studies used a qualitative design, and 12 studies used mixed methods. All quantitative studies were quasi-experimental and most employed a single group design; only two studies had a comparison group. Qualitative study designs were typically not specified. The majority of evaluation data, primarily collected post-intervention, consisted of participants’ responses to questionnaires and interviews. Key points and summary of outcomes: Despite methodological limitations, the faculty development literature tends to support the following outcomes: ▪ High satisfaction with faculty development programs. Participants consistently found programs to be useful and of both personal and professional benefit. They also valued the practical relevance and applicability of the instructional methods used. ▪ A change in attitudes toward organizational contexts and leadership roles. Participants reported positive changes in attitudes toward their own organizations as well as their leadership capabilities. Some reported an increased awareness of – and commitment to – their institutions vision and challenges, whereas others reported greater self-awareness of personal strengths and limitations, increased motivation, and confidence in their leadership roles. A greater sense of community and appreciation of the benefits of networking were also identified. ▪ Gains in knowledge and skills. Participants reported increased knowledge of leadership concepts, principles, and strategies (e.g., leadership styles and strategic planning), gains in specific leadership skills (e.g., personal effectiveness and conflict resolution), and increased awareness of leadership roles in academic settings. ▪ Changes in leadership behavior. Self-perceived changes in leadership behavior were consistently reported and included a change in leadership styles, the application of new skills to the workplace (e.g., departmental reorganization and team building), the adoption of new leadership roles and responsibilities, and the creation of new collaborations and networks. Observed changes primarily suggested new leadership positions. ▪ Limited changes in organizational practice. Although not frequently examined, changes in organizational practice included the implementation of specific educational innovations, an increased emphasis on educational scholarship, and the establishment of collegial networks. ▪ Key features of faculty development. Features contributing to positive outcomes included the use of: multiple instructional methods within single interventions; experiential learning and reflective practice; individual and group projects; peer support and the development of communities of practice; mentorship; and institutional support. ▪ Avenues for future development: Moving forward, faculty development programs should: ground their work in a theoretical framework; articulate their definition of leadership; consider the role of context; explore the value of extended programs and follow-up sessions; and promote the use of alternative practices including narrative approaches, peer coaching, and team development. Methodological issues: More rigorous and diverse research designs are needed to capture the complexity of interventions in this area. Varied methods of assessment, utilizing multiple data sources to tap changes at the interpersonal and organizational level should be explored, as should the maintenance of change over time. Process-oriented studies, comparing different faculty development strategies and clarifying the process of change through faculty development, should also become a priority. Conclusion: Participants value leadership development activities and report changes in attitudes, knowledge, skills and behavior. Moreover, despite methodological limitations, certain program characteristics seem to be associated with positive outcomes. Further research is required to explore these associations and document changes at both the individual and organizational level.

The Professionalism Mini-evaluation Exercise: a preliminary investigation.

Background As the evaluation of professional behaviors has been identified as an area for development, the Professionalism Mini-Evaluation Exercise (P-MEX) was developed using the mini-Clinical Examination Exercise (mini-CEX) format. Method From a set of 142 observable behaviors reflective of professionalism identified at a McGill workshop, 24 were converted into an evaluation instrument modeled on the mini-CEX. This instrument, designed for use in multiple settings, was tested on clinical clerks in medicine, surgery, obstetrics and gynecology, psychiatry, and pediatrics. In all, 211 forms were completed on 74 students by 47 evaluators. Results Results indicate content and construct validity. Exploratory factor analysis yielded 4 factors: doctor–patient relationship skills, reflective skills, time management, and interprofessional relationship skills. A decision study showed confidence intervals sufficiently narrow for many measurement purposes with as few as 8 observations. Four items frequently marked below expectations may be identifiers for “problem” students. Conclusion This preliminary study suggests that the P-MEX is a feasible format for evaluating professionalism in clinical training.

A teaching scholars program to develop leaders in medical education.

The authors describe a year-long faculty development initiative to develop leaders in medical education. The Teaching Scholars Program for Educators in the Health Sciences at McGill University enables faculty to improve their educational knowledge and skills while maintaining their clinical, teaching, and research responsibilities. The program, tailored to the participants individual needs, consists of five main components: two university courses; independent study; participation in faculty-wide faculty development workshops and medical education rounds; a monthly seminar; and attendance at a national or international conference or course. Since its inception in 1997, 22 faculty members have completed the program; four are currently participating in it. This report discusses the experience of 15 scholars who completed the program by September 2000. Evaluations indicate that the scholars achieved most of their stated objectives. The university courses provided a foundation in educational principles and methodology; independent study allowed them to work on educational projects relevant to their disciplines; and the monthly seminars, faculty development workshops, and outside courses offered opportunities for skill acquisition and reflection. Participants also appreciated the opportunity to meet others interested in medical education and to become aware of available educational resources. A year after completing the program, many had joined new educational committees, taken on new leadership roles in medical education, and developed new courses for students and residents. Some of their projects had been presented at national meetings and were being prepared for publication. Two scholars had pursued further study at a masters level. Despite the ongoing challenge of protecting time for educational pursuits, this program has been beneficial in helping to develop educational leaders in the Faculty of Medicine.

Faculty development: from workshops to communities of practice.

Participating in a faculty development workshop gives me a sense of community, self-awareness, motivation and validation of current practices and beliefs ….Steinert (2008)Faculty development, or st...