Reaching and teaching preceptors: limited success from a multifaceted faculty development program

We conducted a six-pronged preceptor faculty development program that included a listserve and interactive Web-based teaching scenarios. A total of 144 preceptors in a required preceptorship program were offered traditional continuing medical education (CME), a preceptor listserve, an electronic clinical teaching discussion group, an orientation videotape, a CD-ROM on teaching skills, and technology support. On Web-based evaluation, 31% of participants responded. Eighty percent of preceptors allowed us to subscribe them to the listserve, and most agreed it was useful. One third of preceptors responded to an electronic clinical teaching case discussion, most rating it useful to their precepting. The listserve and electronic teaching cases hold promise for preceptor faculty development.     

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. METHODS: The faculty development programmes described focused on the skills of providing feedback and brief clinical teaching. At the beginning of each session, each participant was videotaped in encounters with 2 different SSs. Using microteaching (an instructional method in which learners view short segments of their own videotaped performance and discuss the tapes with a facilitator, consultant or other workshop participants), each group of participants and instructors reviewed the tapes and reflected on the encounters, providing immediate feedback to participants and modelling different approaches to the same teaching problem. The same process was repeated with more complicated scenarios after 2 weeks and again after 6 months offering reinforcement, further practice and more sophisticated development of the strategies learned. Participants completed post-session evaluations and a follow-up telephone survey. RESULTS: A total of 36 faculty members from the colleges of medicine, dentistry, pharmacy and nursing participated in workshops in 2000-01. The workshops were rated as highly relevant to participants' teaching, and most participants reported that they had learned a great deal. Participants most appreciated reviewing the videotaped interactions, the feedback they received, the interactions with their colleagues, the interdisciplinary nature of the groups and the practical focus of the workshops. CONCLUSIONS: Standardised students provide a high fidelity, low risk, simulated environment in which faculty can reflect on and experiment with new teaching behaviours. Such encounters can enhance the effectiveness and impact of faculty development programmes to improve clinical teaching skills.     

Learning is in the facilitation: faculty perspectives with facilitated teaching and learning-recommendations from informal discussions

Small group learning is an interactive activity that requires a skilled teacher with the ability to facilitate and debrief. Approximately 250 students from seven health professions were enrolled in a first year interprofessional education course that focused on the importance of communication and collaboration. Weekly faculty debrief sessions were conducted and were utilized to share the teachers perspectives with facilitative teaching as well as for feedback and improvement strategies. Recommendations included linking the learning within the small group sessions back to clinical and professional practice in order to validate the course content and thereby increase student engagement; creation of facilitator guides with specific debrief instructions for the given objectives in order to encourage effective learning dialogue among all participants; and providing faculty with formalized facilitator training as well as debrief strategies in order to attain the skills to better guide student learning.     

Dietetic preceptor educational needs from the preceptor, student, and faculty perspectives

Quality dietetic education relies on strong preceptors to encourage, motivate, and teach dietetic students so that they can excel as practitioners. The purpose of this study was to examine the needs of dietetic preceptors, determine how those needs should be met, and suggest who can best address those needs. Grounded theory methodology was used to design this study of preceptor needs. Focus groups and one-on-one interviews were conducted with 22 preceptors, 5 former students, and 4 faculty members of a clinical dietetic training program. Data were analyzed using open, axial, and selective coding. The central category/ factor that influenced preceptor participation and effectiveness was determined to be lack of time. Preceptors felt they did not have sufficient time to devote to precepting students. Other categories found to be important for successful precepting included student-preceptor orientation, the teaching-learning environment, views of dietetic professionalism, and the responsibilities and rewards of precepting. Based on the themes that emerged with this grounded theory methodology, this study suggests that preceptors should be trained in the following five areas: 1) basic teaching skills, 2) time management strategies, 3) methods for coaching students, 4) adult learning styles, and 5) methods for providing constructive feedback. This training should increase the likelihood that the experience will be both time-efficient and successful for the preceptor, student, and faculty involved. This should improve the effectiveness of preceptors as educators, which should consequently facilitate recruitment and retention of dietetic preceptors.     

Teaching colposcopy and androscopy in family practice residencies

Addressing the widespread human papillomavirus and genital epithelial dysplasia epidemic requires mastery of colposcopy, androscopy, and cryotherapy. Implementing a family medicine residency training program for these skills requires identifying a faculty facilitator to consider the issues of time, cost, caseload, reimbursement, specialist support, personal training, and office impact related to this training. Experience with teaching these skills in a community-based family practice residency indicates that startup costs range from $10,000 to $20,000. Residents will initially require from 30 to 60 minutes to provide a complete examination. All procedures require precepting by trained faculty and adherence to established protocol. The most frequent indications for these procedures include evaluating the abnormal Papanicolaou smear, visible cervical abnormalities, or evidence of clinical papillomavirus infection in either sex. Experience suggests that over 90% of cervical dysplasia can be managed entirely in the residency outpatient setting. These procedures have become the most common outpatient procedures performed, surpassing all others combined. Referrals to the residency for these procedures are readily available. Strategies for developing curriculum, literature review, learning materials, and training workshops are presented. Colposcopy, androscopy, and cryotherapy are appropriate additions to the training curriculum of family practice residencies.     

Effectiveness of a training program in supervisors’ ability to provide feedback on residents’ communication skills

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents’ CS in clinical practice. The authors designed a pretest–posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6–9 months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents’ needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents’ communication skills was successful in improving clinical supervisors’ feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approach.     

Observed versus reported precepting skills: teaching behaviours in a community ambulatory clerkship

PURPOSE: Community-based doctors are increasingly utilised for the clinical education of medical students. Faculty development programmes are frequently provided. However, data about the community faculty-student teaching interaction and the longterm impact of such programmes are limited. This study observes community faculty-student teaching interactions and assesses the use of clinical teaching methods taught during faculty development workshops. METHODS: Between March and August 2002, 13 rural, urban and suburban community-based faculty who completed at least 1 faculty development workshop were observed during faculty-student-patient encounters and interviewed. Observer-interviewers utilised a checklist to record teaching styles, methods and skills, and administered a questionnaire to obtain community faculty's self-perceptions. RESULTS: On observation, the assertive precepting style and didactic teaching predominated in 90% and 86% of teaching encounters, respectively. Interactive discussion and direct observation occurred less often, in 71% and 18% of encounters, respectively. Feedback was provided in 25% of encounters. On interview, community faculty reported that faculty development workshops resulted in improved precepting effectiveness and professional satisfaction with moderate to considerable improvement in feedback, interactive teaching and use of multiple precepting styles for 100%, 77% and 77% of community faculty, respectively. Community faculty reported that their skills in addressing problem students, direct observation and didactic teaching improved moderately. There was little statistical correlation between self-assessed and observed skills. CONCLUSIONS: Community-based faculty rate their teaching skills as improved following faculty development. Observation reveals that interactive discussion, direct observation, feedback and problem management skills are still lacking.     

The Rural Physician Associate Program: new directions in education for competency

The Rural Physician Associate Program (RPAP) has 34 years experience in training 1097 medical students as independent distance learners in a 36 week, community-based continuity primary care experience. This program has been successful in preparing competitive students who select primary care residencies and return to rural practice. The RPAP program has been based on traditional apprentice-style clinical teaching with the support of computer-based resources to enhance distance learning. However while the clinical exposure and development of medical skills was strong, there were weaknesses in evidence-based medicine and managing healthcare, and inconsistencies in community or population health learning. New directions in the educational program for RPAP are described that have been or are being developed to address the competencies as outlined by the Accreditation Council on Graduate Medical Education. They include online and other resources, preceptor education and support, interactive journaling and cases, electronic portfolios, community projects, observed structured clinical exams and examinations. Ongoing challenges to competency-based education include developing meaningful measures and tools to assess competence for areas such as professionalism or systems-based practice; providing faculty development toward being able to practice, teach and evaluate students with an understanding of the competencies; and to build in ways of practicing, learning and improving care that involve effective teams of health-care professionals.     

Teaching physicians to teach: a three-year report.

To meet the needs for an expanded preceptor faculty, the Department of Family Medicine at the College of Medicine and Dentistry of New Jersey-Rutgers Medical School has for three years conducted yearly training programs designed to prepare practicing family physicians for the teaching role. Thirty-six physicians have completed the program, which consists of four group seminars and three individual learning site visits spent in the office of an experienced preceptor while a fourth year student is present. Many lessons were learned in the course of these yearly programs which may be useful to others who plan to undertake similar faculty development activities. Therefore, detailed, practical, experiential information is presented regarding recruitment, orientation, the educational program of seminars and individual learning experiences, evaluation, and required resources. Some problems proved to be particularly difficult, such as the uneven quality of the individual learning visits and the attrition of some participants from the program. Feedback from participating physicians has been extremely positive.     

The rural physician associate program: new directions in education for competency

The Rural Physician Associate Program (RPAP) has 34 years experience in training 1097 medical students as independent distance learners in a 36-week, community-based continuity primary care experience. This program has been successful in preparing competitive students who select primary care residencies and return to rural practice. The RPAP program has been based on traditional apprentice-style clinical teaching with the support of computer-based resources to enhance distance learning. However while the clinical exposure and development of medical skills was strong, there were weaknesses in evidence-based medicine and managing healthcare, and inconsistencies in community or population health learning. New directions in the educational program for RPAP are described that have been or are being developed to address the competencies as outlined by the Accreditation Council on Graduate Medical Education. They include online and other resources, preceptor education and support, interactive journaling and cases, electronic portfolios, community projects, observed structured clinical exams and examinations. Ongoing challenges to competency-based education include developing meaningful measures and tools to assess competence for areas such as professionalism or systems-based practice; providing faculty development toward being able to practice, teach and evaluate students with an understanding of the competencies; and to build in ways of practicing, learning and improving care that involve effective teams of health-care professionals.     

Impact of patient feedback on the interpersonal skills of general practice registrars: results of a longitudinal study

CONTEXT: A general practice vocational training program. OBJECTIVES: To examine the impacts and implications of different models of systematic patient feedback on the development of general practice (GP) registrars' interpersonal skills as they progressed through a GP vocational training program. DESIGN: A longitudinal study in which GP registrars were randomly assigned to three models of patient feedback: a control group and two intervention groups. The major source of data gathering was through the Doctors' Interpersonal Skills Questionnaire (DISQ) which was administered to patients immediately after their consultation. SUBJECTS: 210 GP registrars, 104 GP supervisors and 28 156 patients. RESULTS: Multivariate analysis techniques (including repeated-measures analysis) tested the effectiveness of the interventions. Findings showed that systematic patient feedback at regular intervals throughout GP training resulted in sustained levels of interpersonal skills. The most significant gains in interpersonal skills for both intervention groups occurred in the earlier stages of general practice training. Most registrars found the experience of patient feedback useful for gaining a better understanding of their interpersonal skills and for identifying areas in which they needed to improve. GP supervisors valued the opportunity to receive patient feedback themselves and found the activity a useful adjunct to their preceptor role. CONCLUSIONS: Patients, by providing feedback on doctors' interpersonal skills, have been able to contribute to improving the quality of the patient-doctor interaction. GP registrars and their supervisors value highly the role of patient feedback in interpersonal skill development.     

Primary care resident,faculty, and patient views of barriers to cultural competence,and the skills needed to overcome them

INTRODUCTION: Primary care residencies are expected to provide training in cultural competence. However, we have insufficient information about the perceptions of stakeholders actually involved in healthcare (i.e. residents, faculty and patients) regarding commonly encountered cross-cultural barriers and the skills required to overcome them. METHOD: This study used a total of 10 focus groups to explore resident, faculty and patient attitudes and beliefs about what culturally competent doctor-patient communication means, what obstacles impede or prevent culturally competent communication, and what kinds of skills are helpful in achieving cultural competence. A content analysis was performed to identify major themes. RESULTS: Residents and faculty defined culturally competent communication in terms of both generic and culture-specific elements, however, patients tended to emphasize only generic attitudes and skills. Residents and patients were liable to blame each other in explaining barriers; faculty were more likely to consider systemic influences contributing to resident-patient difficulties. All groups emphasized appropriate skill and attitude development in learners as the key to successful communication. However, residents were sceptical of sensitivity and communication skills training, and worried that didactic presentations would result in cultural stereotyping. DISCUSSION: All stakeholders recognized the importance of effective doctor-patient communication. Of concern was the tendency of various stakeholders to engage in person-blame models.     

Can brief workshops improve clinical instruction?

CONTEXT: The impact of faculty development activities aimed at improving the teaching skills of clinical instructors requires elucidation. Since 2003, all instructors at our school of medicine have been required to undertake a brief workshop in basic clinical instructional skills as a prerequisite for promotion and tenure. The impact of this has, so far, remained unknown.OBJECTIVE: This study aimed to examine to what extent participation in a brief workshop can improve clinical instructors' performance in the long run, and which particular dimensions of performance are improved.METHODS: The study included a sample of 149 faculty members who undertook a required workshop in basic instructional skills. The teaching performance of these faculty members was measured by student feedback a year after the workshop. The study used pre- and post-test design, with a comparison group of 121 faculty members.RESULTS: Student ratings for 5 dimensions of clinical instruction increased significantly, but only for the study group who had participated in a workshop. The comparison group's ratings were unchanged. The highest improvement in the instructors' performance related to availability of teachers to students.CONCLUSIONS: The study supports previous findings about the added value gained by longterm improvement of instructional skills after participation in even a brief workshop. The meaningful improvement in instructor availability to students is associated with the workshops' emphasis on a learner-centred approach and the need to provide continuous feedback.     

A departmental approach for improving lecture skills of medical teachers

The programme described here concentrated on improving the lecture skills of medical teaching staff in a single department. The training format for this programme included videotaping faculty lectures, providing written feedback, and formal training sessions. As a result of participating in this programme members of teaching staff felt that their lecture skills had improved and wanted additional training in other areas of education. The significance of the programme rests not only with its impact on the staff of this specific department but in its being a pilot of an approach to teacher development utilizing an exclusively self-instructional format.     

What's in store for medical students? Awareness and utilization of expert nutrition guidelines among medical school preceptors

BACKGROUND: Instruction of physicians and other health professionals in medical nutrition sciences is among the expert recommendations to promote population health and reduce risks for cancer and other major causes of morbidity and mortality in the population. However, formal training in nutrition in United States medical schools is still lacking compared to the gains in basic and applied medical nutrition sciences. We sought to understand the awareness and current utilization of expert nutrition recommendations and practice guidelines among medical student faculty preceptors. METHODS: We surveyed the teaching faculty who precept for first-, second-, and third-year medical students in two required courses at Boston University. The instrument queried preceptor awareness and current utilization of expert nutrition recommendations, nutritional management practice guidelines, as well as faculty-student interactions regarding patient nutritional education and counseling. RESULTS: Of 187 faculty surveyed, 139 (74%) responded. Faculty reported using 2.3 expert guideline sources (N = 111; SD = 1.8; range = 0-8) but 83% had considered only one or no sources or did not remember what guidelines they had used. Eighty-four percent of preceptors expected students to routinely discuss nutritional practices with patients and/or their families; however, less than half of preceptors routinely provided feedback to students on patient nutritional education or counseling strategies. CONCLUSION: Our findings suggest gaps in faculty awareness and utilization of expert nutrition recommendations and practice guidelines relating to cancer and other chronic disease-risk reduction and population health promotion, underscoring the need for improvements in faculty and medical student training in basic and applied medical nutrition sciences.     

Assessing facilitator competence in a comprehensive communication skills training programme

Objectives  Evidence suggests that the most important component of communication skills training (CST) is experiential learning through role-play sessions that rely on facilitators to guide learners. However, there is little published evidence about processes of assessing facilitator competence in CST. This paper reports on the development and application of procedures to assess facilitator competence in a large-scale CST programme.
Methods  Thirty-two novice facilitators in a large CST programme were audio-recorded while facilitating small-group CST training sessions in order to explore whether the training they had received had prepared them to competently facilitate. Audio-recordings were assessed using the Comskil facilitator assessment coding system. Facilitators were rated as having achieved basic competence, advanced competence or expert competence.
Results  Facilitation tasks that were most frequently coded as being used always included inviting the learner to give feedback first and inviting all group members to give feedback. The facilitation task coded least frequently as being used always was involving group members in solving problems. Of the 32 facilitators, 18 reached at least a basic level of competence. Psychosocially trained facilitators and MD facilitators differed in their use of five facilitation tasks.
Conclusions  Modest training and minimal practice does not result in complete facilitator competence. Some facilitation skills appear to be more easily acquired than others. These findings highlight which skills should be prioritised in the further training of novice facilitators. A long-term project currently underway will study whether facilitator competence improves with practice and regular feedback.     

Teaching dietetic students in the clinical setting

On the basis of requests from dietitians who function as student preceptors, faculty members for a coordinated undergraduate program developed guidelines for their inservice training. It was anticipated that the dietitian as a clinical instructor would need to be able to establish, clarify, and guide the student in achieving goals; aid the student's learning process by helping him/her recall information and knowledge from previous course work; direct the student's attention to focus on priorities; identify factors that will contribute to effective communication skills; provide opportunities for the student to apply knowledge and practice dietetics; identify motivational possibilities; use evaluation feedback to help students improve their clinical practice; and assist the student in facilitating the transfer of knowledge and skills to new problems and situations.