The double helix of activity and scholarship: building a medical education career with limited resources

CONTEXT: Creating respected scholarship from educational and clinical activities is challenging for medical school faculty members. In the USA and Europe, criteria for 'scholarship' has broadened and enriched. However, in developing countries, promotion systems generally continue to emphasise traditional laboratory or clinical research. OBJECTIVE: This paper sets forth a broad conception of scholarship and provides international distribution venues that reinforce the importance of scholarly activity corresponding to clinical and educational work. METHODS: Information sources about non-traditional scholarship included 50 medical school faculty from 20 economically developing nations plus senior faculty from throughout the USA. Resources for distribution venues were drawn from a citation index search, a literature search and Google. RESULTS: The authors provide resources for faculty advancement, including examples of non-traditional scholarship that meet rigorous criteria, and a comprehensive list of venues for the dissemination of educational materials and studies. They give a relative value process for academic work to assist faculty in developing educational scholarship. Finally, they propose a double helix model for academic advancement, consisting of 2 congruent helices with the same axis, 1 representing educational, service or clinical activity and the other scholarly achievement. CONCLUSIONS: These materials and the double helix model will support faculty and promotion committees, especially those from schools that have not yet broadened their view of scholarship, to envisage a realistic starting point and see how educational and clinical activities can generate internationally recognised, high-quality scholarship.     

A Framework for Promoting Scholarship Productivity in Occupational Therapy Curricula

ABSTRACT

This paper describes a curricular model to support the production of quality research and development of occupational therapy professional students, prepared to become leaders in the production and utilization of evidence for practice. This model is designed for programs with faculty challenged by the dual mandate of program excellence and expectations for scholarly productivity needed for tenure and promotion: typically programs at research universities. The essence of the model is the paralleling of research and competencies for clinical practice where faculty and students participate as a community of scholars. It is based on the literature that addresses the tensions between achieving excellence in research and scholarly productivity, and excellence in teaching. The experience of one university with this model over a five-year period of time is shared with the student-faculty productivity outcomes. These outcomes include dissemination of 55 collaborative peer reviewed products and faculty has generated support for 25 paid graduate assistantships. The combination of student outcomes and faculty support for their research has strengthened the ability of the faculty to excel in meeting the University mandate of scholarship while providing a high quality professional educational program.     

Peer education for advance care planning: volunteers’ perspectives on training and community engagement activities

Background Peer education by volunteers may aid attitudinal change, but there is little understanding of factors assisting the preparation of peer educators. This study contributes to conceptual understandings of how volunteers may be prepared to work as peer educators by drawing on an evaluation of a training programme for peer education for advance care planning (ACP). Objectives To report on volunteers’ perspectives on the peer education training programme, their feelings about assuming the role of volunteer peer educators and the community engagement activities with which they engaged during the year after training. To examine broader implications for peer education. Design Participatory action research employing mixed methods of data collection. Participants Twenty‐four older volunteers and eight health and social care staff. Data collection methods Evaluative data were gathered from information provided during and at the end of training, a follow‐up survey 4 months post‐training; interviews and focus groups 6 and 12 months post‐training. Findings Volunteers’ personal aims ranged from working within their communities to using what they had learnt within their own families. The personal impact of peer education was considerable. Two‐thirds of volunteers reported community peer education activities 1 year after the training. Those who identified strongly with a community group had the most success. Conclusion We reflect on the extent to which the programme aided the development of ‘critical consciousness’ among the volunteers: a key factor in successful peer education programmes. More research is needed about the impact on uptake of ACP in communities.     

Responsible Decision-Making Through Measured Criteria for Faculty Time Use

The demands upon faculty's time use within the three missions of universities have always created shared tensions in many academic settings. However, the move to post-baccalaureate entry in occupational therapy education has added complexity to this mix, with increasing expectations of graduate education and scholarship both for faculty and students. This article will present the development of the EKU-OT Faculty Work Profile, a model for categorizing faculty's time use during an academic year. The model provides a mechanism for faculty exploration of occupational patterns in an academic setting. The need for increased scholarship in occupational therapy education is addressed as an outcome measure for strategic planning. Potential use and implications will be presented as they relate to the complexities of faculty work inherent in higher education settings.     

Charles W. Dohner,PhD: an evaluator and mentor in medical education

As one of the first generation medical education pioneers, Charles W. Dohner, PhD established the ninth office of medical education at the University of Washington (UW) where he served as chairman from 1967–1996. With a background in education and measurement, he focused his work on evaluation of educational programs and faculty development. The Department of Medical Education went through three distinct stages of development: path finding 1967–1972 focused on developing working relationships with the faculty and clarifying identity, integration into academic affairs 1972–1980, and direct leadership by department faculty 1980–1996. Dohner helped to create and evaluate the WAMI program, a regional medical education program for the states of Washington, Alaska, Montana, and Idaho. He served as a consultant to aspecialty board, the founding president of the Society of Directors of Research in Medical Education, and a frequent consultant in international medical education. Dohner identified three important innovations in medical education: educators in academic medicine, simulations and performance assessment, and community-based medical education. Success factors for professional education include technical competence in education, interpersonal communication and collaboration skills, a plan for personal growth, and use of mentors. Future trends in medical education will involve information technology, professionalism, wellness and complementary medicine, and performance assessment. He has been a passionate spokesman for excellence in medical education and most noted for his roles as an evaluator, program developer, and mentor of academic leaders.This revised version was published online in October 2005 with corrections to the Cover Date.     

Bibliometrics: a potential decision making aid in hiring, reappointment, tenure and promotion decisions

The assessment of scholarship assumes a central role in the evaluation of individual faculty, educational programs and academic fields. Because the production and assessment of scholarship is so central to the faculty role, it is incumbent upon decision makers to strive to make assessments of scholarship fair and equitable. This paper will focus on an approach to the assessment of the quantity and impact of the most important subset of an individual's scholarship-peer-reviewed journal articles. The primary goal of this paper is to stimulate discussion regarding scholarship assessment in hiring, reappointment, tenure and promotion decisions.     

Priorities and benchmarks for new faculty in physical therapist education programs: perceptions of program directors

The purpose of this study was to establish development priorities, ideal workload and performance levels, and preferred faculty development activities for new faculty in professional-level physical therapist education programs. A preliminary questionnaire was sent to 183 directors of these programs to identify new faculty and their program directors. Eighty-five new faculty and 79 of their program directors were identified and sent comparable surveys with questions that pertained to the current and ideal teaching, scholarship, and service activities of the new faculty. Results indicated that both new faculty and program directors agreed on ideal workload levels and that workloads for new faculty should shift from teaching to scholarship. New faculty set performance levels that are significantly higher than those identified by their program directors. Development priorities for the new faculty varied from knowledge and skills in instruction as expressed by program directors to scholarship as expressed by new faculty. Individual consultations were the highest preferred faculty development activity reported by both groups. These findings provide direction for the content and delivery method for faculty development activities for new faculty in these and similar education programs.     

Working with our communities: moving from service to scholarship in the health professions

CONTEXT: As faculty at health professionals schools have become increasingly engaged with their communities in partnerships to improve health, new questions have arisen about faculty rewards for such activities. To sustain the community work of their faculty, institutions need to reconceptualize faculty rewards, promotion, and tenure that are relevant to community activities. HISTORICAL PERSPECTIVE: Scholarship has evolved since the 17th century from a focus on character-building to the practical needs of the nation to an emphasis on research. In 1990, Boyer proposed four interrelated dimensions of scholarship: (1) discovery; (2) integration;(3) application; and (4) teaching. The challenge became the development of criteria and innovative and creative ways to assess community scholarship. CURRENT MODELS FOR COMMUNITY SCHOLARSHIP: This paper reviews four evidence-based models to document and evaluate scholarly activities that are applicable to community scholarship. PROPOSED MODEL FOR COMMUNITY SCHOLARSHIP: We propose a new model for community scholarship that focuses on both processes and outcomes, crosses the boundaries of teaching, research, and service, and reshapes and integrates them through community partnership. We hope this model will generate national discussion about community scholarship and provide thought-provoking information that will move the idea of community scholarship to its next stage of development.     

A new vision for health promotion and nutrition education

Increased integration and collaboration of health promotion and nutrition education professionals to effectively engage consumers, debunk nutrition and health information, and mitigate the effect of chronic diseases is the vision presented for success in the future. Current and optimal roles of educators are discussed in relation to societal trends and their inherent opportunities and barriers. Recommendations for strengthening the role of health promotion in settings where nutrition educators work are provided and include the need for strong academic preparation, field-based training, and continual professional development. The overall goal of these recommendations is to enable nutrition educators and health promotion professionals to advance their professions and develop effective strategies that support the achievement of improved health for all.     

HIV / AIDS and STD health promotion in Tanzanian fishing villages

The Tanzania-Netherlands Project to Support AIDS Control (TANESA) conducted rapid appraisals in 14 villages with fishing camps along Lake Victoria to determine needs and resources available for HIV/STD (sexually transmitted disease) prevention. Discussions with village members sparked interest, so TANESA launched a health promotion program. It first set up a pilot project in a village of about 600 persons with an established fishing camp. TANESA trained 6 young women and 8 fishermen during a 4-day workshop as peer educators. The topics included anatomy and biology, STDs, HIV prevention, adult education, counseling, and communication skills. Training techniques used were short lectures, group discussions, role-playing, and exercises from a workbook. The newly trained peer educators helped set up a general education campaign: video shows, exhibition boards, pamphlets, condom distribution, and discussion sessions with peers. Village leaders did not support the idea of official classes, an AIDS information room, or a village health committee. Nevertheless, the peer educators continued their mission. Once a month, the program coordinator visits them and advocates the program to village leaders. TANESA next replicated the program in a larger village (about 6000 population). This time, it first mobilized village leaders to develop the program themselves. The core groups were fishermen, female bar and guesthouse workers, and young unemployed women offering sex for money. Each group chose its own peer educators. Village leaders were responsible for the educational campaign organized by the peer educators. The campaign received a positive response and effected positive attitudes towards condom use. Village leaders organized an AIDS action committee. TANESA now provides technical support, fosters a team spirit among peer educators, and supports monitoring activities. Peer educators express an increase in their self-esteem and self-confidence.     

'I don't have time': issues of fragmentation, prioritisation and motivation for education scholarship among medical faculty

Objectives  Although lack of time has been frequently cited as a barrier to scholarship, there has been little inquiry into what specific factors medical faculty staff perceive as contributing to this dilemma. The purpose of the present study was to explore, in greater detail, lack of time as a barrier for faculty interested in pursuing education scholarship.
Methods  In 2004, as part of a cross-sectional, mixed-methods needs assessment, 73 (67.6%) medical faculty completed a questionnaire probing areas related to education scholarship. Additionally, one year later, 16 respondents (60% of those invited) each participated in one of three focus groups.
Results  Despite their interest and regardless of their background training in education, faculty were able, on average, to devote only negligible amounts of time to education scholarship. The most commonly reported barrier to these pursuits was lack of protected time. Further analysis revealed that the time-related factor appeared to involve three themes: fragmentation (where opportunities to work on education projects are sporadic); prioritisation (where work responsibilities including after-hours work and administrative workload complete for time, and where there is difficulty in securing financially remunerated time), and motivation (where the degree of recognition and support for education work by both the department and colleagues is limited).
Conclusions  With respect to education scholarship, the dilemma caused by lack of time involves a complex, multi-faceted set of issues which extends beyond the number of hours available in a day. Personal interest and having background training in education do not appear to be sufficient to encourage involvement. Multiple institutional support mechanisms are necessary.     

Valuing the scholarship of integration and the scholarship of application in the academy for health sciences scholars: recommended methods

In the landmark 1990 publication Scholarship Reconsidered, Boyer challenged the 'teaching verses research debates' by advocating for the scholarship of discovery, teaching, integration, and application. The scholarship of discovery considers publications and research as the yardstick in the merit, promotion and tenure system the world over. But this narrow view of scholarship does not fully support the obligations of universities to serve global societies and to improve health and health equity. Mechanisms to report the scholarship of teaching have been developed and adopted by some universities. In this article, we contribute to the less developed areas of scholarship, i.e. integration and application. We firstly situate the scholarship of discovery, teaching, integration and application within the interprofessional and knowledge exchange debates. Second, we propose a means for health science scholars to report the process and outcomes of the scholarship of integration and application with other disciplines, decision-makers and communities. We conclude with recommendations for structural and process change in faculty merit, tenure, and promotion systems so that health science scholars with varied academic portfolios are valued and many forms of academic scholarship are sustained. It is vital academic institutions remain relevant in an era when the production of knowledge is increasingly recognized as a social collaborative activity.     

A two-decades-long study of scholarship by clinical laboratory science faculty

To compete successfully in academia, clinical laboratory science (CLS) faculty members must actively engage in research and scholarly activities. Without research, some CLS educators may experience difficulty in the promotion and tenure process or even find their educational programs threatened with closure. Thus began a national study, spanning the years 1985, 1996, and 2008: to compare CLS faculty demographics, their scholarship, and their perceptions of the research environment. Since 1985, faculty members with doctorates have increased from 26% to 52% and senior faculty at the rank of associate and full professors have improved from 38% to 54%. Over time, the data show CLS faculty are providing more refereed publications (in the 2008 study, 19% had 11 or more publications) and more presentations (in the 2008 study, 34% had 11 or more presentations). Grant monies garnered included $62 million in the latest study. On the other hand, there are more faculty in non-tenured track positions. In addition, in both the 1996 and 2008 studies, the average number of faculty per program remained the same (4), as did hours spent each week in teaching (22). For all three studies, faculty perceived the top two research environment characteristics the same: i.e., 1) research is important for promotion and tenure and 2) computer accessibility is present. The lowest ranked characteristic of the research environment for all these studies-time available for research.     

Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools

Objectives. We compared faculty promotion rates by race/ethnicity across US academic medical centers.Methods. We used the Association of American Medical College''s 1983 through 2000 faculty roster data to estimate median institution-specific promotion rates for assistant professor to associate professor and for associate professor to full professor. In unadjusted analyses, we compared medians for Hispanic and Black with White faculty using the Wilcoxon rank sum test. We compared institution-specific promotion rates between racial/ethnic groups with data stratified by institutional characteristic (institution size, proportion racial/ethnic minority faculty, and proportion women faculty) using the χ² test. Our sample included 128 academic medical centers and 88 432 unique faculty.Results. The median institution-specific promotion rates for White, Hispanic, and Black faculty, respectively, were 30.2%, 23.5%, and 18.8% (P < .01) from assistant to associate professor and 31.5%, 25.0%, and 16.7% (P < .01) from associate to full professor.Conclusions. At most academic medical centers, promotion rates for Hispanic and Black were lower than those for White faculty. Equitable faculty promotion rates may reflect institutional climates that support the successful development of racial/ethnic minority trainees, ultimately improving healthcare access and quality for all patients.The racial/ethnic composition of the healthcare workforce does not reflect the diversity in the US general population. Although combined Blacks and Hispanics represent 28.7% of the total US population,1 only 8.4% of all practicing US physicians are Black or Hispanic.2,3 These disparities extend to academic medical center faculty. Historically underrepresented racial/ethnic minorities constitute 7% of all current academic medical center faculty and fewer than 5% of all new academic medical center faculty.2,4The rationale for supporting racial/ethnic diversity across the academic medical center faculty workforce is multifold. Faculty diversity increases the quality of training for all students, and racial/ethnic minority faculty often serve as important professional resources for racial/ethnic minority trainees.5,6 This is a critical role within the social mission of academic medical centers to develop a diverse practicing physician workforce, which is necessary to reduce healthcare discrimination and increase healthcare access and quality.7–9 Racial/ethnic minority faculty also often provide leadership in medical education, health policy, and research scholarship related to racial/ethnic health inequities. Despite these benefits, academic medical centers struggle to retain racial/ethnic diversity across faculty ranks.Institutional discrimination in the promotion process has been suggested as a potential explanation for the persistent lack of diversity at the senior faculty level associate professor and full professor ranks.10 The majority of Black and Hispanic academic medical center faculty are concentrated at the assistant professor level; among all racial/ethnic groups, men are more likely than are women to hold full professor rank.4 Aggregated national data have described lower career satisfaction among racial/ethnic minority academic medical center faculty, lower promotion rates compared with White peers despite adjustment for established measures of productivity, and decreased likelihood of being awarded research grants from the National Institutes of Health after controlling for several key factors.10–14 Other research has concluded that many physician academic medical center faculty, particularly racial/ethnic minorities, experience a poor institutional diversity climate or discrimination at work.15–18 Although recent data demonstrate increases in the overall numbers of first time racial/ethnic minority assistant professors and medical students,10,19 national averages that reveal lower and slower promotion rates for racial/ethnic minority faculty raise concerns about the success of organizational efforts to successfully diversify the academic medical center faculty workforce.10,13Despite consistent national data on differential career trajectories for racial/ethnic minority academic medical center faculty, it is unknown whether all academic medical centers face similar challenges in the promotion process. The Association of American Medical College''s Faculty Roster database provided us a unique opportunity to examine in detail the promotion disparities between racial/ethnic faculty at individual academic medical centers in the United States. We hypothesized that Black and Hispanic faculty would have lower rates of promotion to associate professor and full professor than would White faculty at most academic medical centers. We also sought to explore whether larger academic medical centers and academic medical centers with higher proportions of Black, Hispanic, or women faculty would approach promotion rate equity across faculty race/ethnicity.We estimated the median institution-specific faculty promotion rates by race/ethnicity across academic medical centers and described the proportion of academic medical centers with faculty promotion rate gaps by race/ethnicity. We also investigated whether selected institutional characteristics were associated with promotion rates for academic medical center faculty by race/ethnicity.     

Education for Menarche

Educational programs to prepare young women for menarche potentially can affect their self-view, peer interaction, decision-making, and self-care capabilities. A review of literature on menarche and menarcheal education is presented with implications for program development. References that can assist health educators in developing appropriate content and strategies are identified.     

Training outreach workers for AIDS prevention in rural India: is it sustainable?

Through a process of community diagnosis and participation, a non-governmental organization in rural Karnataka state in India selected and trained peer outreach workers to implement and sustain AIDS prevention education activities. This activity was part of a larger AIDS education project that aimed at creating awareness and promoting risk-reducing behaviours in the community. This paper describes efforts of the project to identify and train peer educators during its implementation phase and discusses strategies used to facilitate sustainability. We evaluate the impact of these efforts by conducting an analysis in the project area 2 years after the end of the project. The findings reveal generalized interest among rural communities in HIV prevention issues. The project originally conducted an extensive survey to understand community organization and composition, which helped to identify potential partners and peer educators. Training peer educators was a multi-step process, and one with high attrition. While individual peer educators were an excellent resource during the life of the project, peer educators affiliated with village level institutions had the interest, access to resources and willingness to sustain project efforts. However, the sustainability of their efforts was associated with the quality of interactions with the project implementation team, the strength and leadership of their own institutions, the perceived benefits of implementing AIDS education activities after project life and the gender of the outreach worker. Non-sustainers did not have an organizational structure to backstop their work, were often poor and unemployed persons who later found gainful employment, and overwhelmingly, were female. We present a conceptual model based on these findings to help future projects plan for and achieve sustainability.     

Understanding peer education: insights from a process evaluation

In the UK, peer education has become an increasingly popular way of carrying out health promotion work with young people but evaluations of its effectiveness remain largely unpublished. In particular, illuminative evaluations using qualitative methods are rarely reported both in the UK and other countries. This paper presents insights from the process evaluation of a peer education project in Fife, Scotland which was funded to explore new ways of working with young people in the areas of sexual health, HIV/AIDS and drugs. The interactive approach of the evaluation and its responsiveness to the development of the project are outlined. Factors influencing the peer education process, such as recruitment, setting, organizational context and personal development of participants, are described. Aspects of the formal and informal work carried out by the peer educators are discussed. It is hoped that the paper may provide a starting point for developing more reflective understandings about the processes involved when peers educate peers.     

A descriptive analysis of patient education courses in undergraduate and graduate health education programs

Patient education is a necessary component of quality health care, yet little attention has been given to the preparation of health educators to work in that setting. This study seeks to determine the status of and content in patient education courses offered in professional preparation programs. Results show that 9% of respondents offered a patient education course in their academic unit, whereas 18% indicated that such a course was offered in another unit on campus. It appears there is not agreement between university faculty members and practicing patient educators on what should be taught in such a course. In addition, no significant relationship is found between (a) programs with accreditation or approval and offering a patient education course and (b) programs that prepared students for the Certified Health Education Specialist examination and offering a patient education course. Recommendations are offered for improving the preparation of health educators for the medical care setting.     

Peer-led sex education--characteristics of peer educators and their perceptions of the impact on them of participation in a peer education programme

The RIPPLE study is a randomized controlled trial of peer-led sex education in English secondary schools. In 1997, 27 schools were recruited and randomly allocated to a programme of peer-led sex education or to act as control schools. In experimental schools peer educators in Year 12 (aged 16/17 years) were recruited in two successive cohorts and, having received a standardized training programme, delivered classroom-based sex education sessions to Year 9 students (aged 13/14 years). This paper is the first of two focusing on data gathered from these peer educators. Through analysis of pre-(n = 505) and post- (n = 331) programme questionnaire data, the paper describes the profile of peer educators and examines the impact on them of their involvement. Compared to the students receiving the peer-led sex education, more peer educators were female, white, high academic achievers and less socially disadvantaged. Peer educators reported positive changes in sexual knowledge and changes towards more liberal attitudes, and believed the programme would have a positive impact on their confidence in relationships and on their sexual behaviour. There was an increase in confidence about communication and interaction in groups. The paper discusses the methodological difficulties of assessing how involvement in such a programme impacts on peer educators.     

It's good to talk: adolescent perspectives of an informal, peer-led intervention to reduce smoking

Although peer education has enjoyed considerable popularity as a health promotion approach with young people, there is mixed evidence about its effectiveness. Furthermore, accounts of what young people actually do as peer educators are scarce, especially in informal settings. In this paper, we examine the activities of the young people recruited as 'peer supporters' for A Stop Smoking in Schools Trial (ASSIST) which involved 10,730 students at baseline in 59 secondary schools in south-east Wales and the west of England. Influential Year 8 students, nominated by their peers, were trained to intervene informally to reduce smoking levels in their year group. The ASSIST peer nomination procedure was successful in recruiting and retaining peer supporters of both genders with a wide range of abilities. Outcome data at 1-year follow-up indicate that the risk of students who were occasional or experimental smokers at baseline going on to report weekly smoking at 1-year follow-up was 18.2% lower in intervention schools. This promising result was supported by analysis of salivary cotinine. Qualitative data from the process evaluation indicate that the majority of peer supporters adopted a pragmatic approach, concentrating their attentions on friends and peers whom they felt could be persuaded not to take up smoking, rather than those they considered to be already 'addicted' or who were members of smoking cliques. ASSIST demonstrated that a variety of school-based peer educators, who are asked to work informally rather than under the supervision of teaching staff, will engage with the task they have been asked to undertake and can be effective in diffusing health-promotion messages. Given the serious concerns about young people's smoking behaviour, we argue that this approach is worth pursuing and could be adapted for other health promotion messages.