Teaching medical education principles and methods to faculty using an active learning approach: the University of Michigan Medical Education Scholars Program.

The Medical Education Scholars Program (MESP) at the University of Michigan Medical School was established in 1998 to develop educational leadership, improve teaching skills, and promote educational scholarship among medical school faculty. The Department of Medical Education designed and implemented the program. Eighty-one scholars have completed the MESP, with 15 more currently enrolled. While most scholars have been clinical faculty, some have been basic science faculty or from other allied health fields. The selection process emphasizes potential for contributing to the educational mission of the medical school. Each cohort is limited to two participants per department. The curriculum of the MESP is designed to provide an overview of a wide range of topics in education. It is divided into five broad domains: principles and theories of education, teaching methods, educational research methods, assessment and evaluation, and educational leadership. During the sessions, active learning of content is expected and encouraged. For instance, scholars share responsibility with the session presenters for planning and evaluating individual program sessions. To graduate, scholars are expected to attend the sessions regularly, and to make a final presentation of their project, which demonstrates near-completion or substantial progress toward that goal. Over its eight years, the MESP has evolved in response to environmental changes and ongoing evaluation of the program. Overall, the Medical Education Scholars Program has proven effective in developing faculty skills and educational leadership locally at the University of Michigan Medical School and nationally.     

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 participant's 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 master's 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.     

The UCSF Academy of Medical Educators.

The Academy of Medical Educators at the University of California, San Francisco (UCSF), was established in 2000 to (1) foster excellence in teaching, (2) support teachers of medicine, and (3) promote curricular innovation. A membership organization, it recognizes five categories of educational activity: direct teaching, curriculum development and assessment of learner performance, advising and mentoring, educational administration and leadership, and educational research. Excellent medical student teaching and outstanding accomplishment in one or more areas of educational activity qualify a teacher for membership. Candidates prepare a portfolio that is reviewed internally and by national experts in medical education. Currently 37 faculty members, 3% of the entire school of medicine faculty, belong to the academy. The academy's innovations funding program disburses one-year grants to support curricular development and comparisons of pedagogical approaches; through this mechanism, the academy has funded 20 projects at a total cost of $442,300. Three fourths of expended funds support faculty release time. Faculty development efforts include promotion of the use of an educator's portfolio and the establishment of a mentoring program for junior faculty members built around observation of teaching. The Academy of Medical Educators vigorously supports expanded scholarship in education; the academy-sponsored Education Day is an opportunity for educators to present their work locally. Recipients of innovations-funding program grants are expected to present their work in an appropriate national forum and are assisted in doing this through quarterly scholarship clinics. The Academy of Medical Educators has been well received at UCSF and is enhancing the status of medical education and teachers.     

From novice to informed educator: the teaching scholars program for educators in the health sciences.

The Teaching Scholars Program for Educators in the Health Sciences at McGill University, in Montreal, Quebec, was designed to promote the professional development of health science educators by increasing their expertise in developing and implementing educational programs and taking on leadership roles in education. This program, which was initiated in 1997 and is tailored to the individual needs of the participants, consists of participation in: two university courses; a monthly seminar; a research study or an educational project, consisting of curriculum design and evaluation; and faculty-wide faculty development activities. As of 2006, 34 scholars have completed this program. Outcome data indicate that the majority of teaching scholars have taken on new roles and responsibilities in medical education; maintained the changes implemented in their teaching practices; continued to participate in faculty development activities; and presented their work at educational meetings. A number of scholars have also applied successfully for educationally related grants and have published their educational projects. Five of the scholars have pursued advanced studies. This program, which aims to move beyond the improvement of teaching skills by providing a foundation for educational leadership and scholarship, resembles many others in its emphasis on independent study, peer support, and the maintenance of ongoing responsibilities. It is innovative in that scholars participate in university courses and are encouraged to attend an "outside" conference or course. The overall benefits of this program, as noted by the scholars, include increased knowledge and skills, introduction to a "community of practice," and new career paths and opportunities.     

Promoting academic excellence through leadership development at the University of Washington: the Teaching Scholars Program.

The University of Washington Teaching Scholars Program (TSP) was established in 1995 to prepare faculty for local and national leadership and promote academic excellence by fostering a community of educational leaders to innovate, enliven, and enrich the environment for teaching and learning at the University of Washington (UW). Faculty in the Department of Medical Education and Biomedical Informatics designed and continue to implement the program. Qualified individuals from the UW Health Sciences Professional Schools and foreign scholars who are studying at the UW are eligible to apply for acceptance into the program. To date, 109 faculty and fellows have participated in the program, the majority of whom have been physicians. The program is committed to interprofessional education and seeks to diversify its participants. The curriculum is developed collaboratively with each cohort and comprises topics central to medical education and an emergent set of topics related to the specific interests and teaching responsibilities of the participating scholars. Core sessions cover the history of health professions education, learning theories, educational research methods, assessment, curriculum development, instructional methods, professionalism, and leadership. To graduate, scholars must complete a scholarly project in curriculum development, faculty development, or educational research; demonstrate progress towards construction of a teaching portfolio; and participate regularly and actively in program sessions. The TSP has developed and nurtured an active cadre of supportive colleagues who are transforming educational practice, elevating the status of teaching, and increasing the recognition of teachers. Graduates fill key teaching and leadership positions at the UW and in national and international professional organizations.     

Criteria of the "educators' pyramid" fulfilled by medical school faculty promoted on a teaching pathway.

PURPOSE: To compare the results of academic promotion to associate professor and professor via the teaching pathway at the Wake Forest University School of Medicine (WFUSM) with the criteria of the "educators' pyramid" of Sachdeva et al. METHOD: Data on all candidates promoted to associate professor and professor in the academic years 1995-2000 at WFUSM were collected from candidates' portfolios and compared with the criteria for educator (level three) and master educator (level four) from a modified version of the educators' pyramid. RESULTS: Of 186 faculty promoted, 38 were on the teaching pathway. Everyone promoted on the pathway fulfilled all teacher and master teacher criteria. All educator criteria were found among the associate professors, and all but one of the master educator criteria were found among professors. More than 75% of associate professors demonstrated "sustained participation in significant amounts of effective teaching in more than one modality" and "service as a medical student clerkship, course, or residency director." Less than 30% demonstrated "service as assistant dean of education or student affairs" or "service as the chair of departmental education committees." Most associate professors had not regularly participated in national education meetings. For professors, more than 50% demonstrated "achievement of leadership positions in national organizations, committees, and medical school education"; "recognition as a national leader in specialty education"; and "mentorship of other faculty members locally and nationally." Less than 30% demonstrated "pursuit of further training in education through workshops, faculty development programs, or educational fellowship programs" or "development and implementation of nationally-recognized (in education) innovative curricula or teaching programs." No one promoted to professor on the teaching pathway had made what was considered to be a landmark contribution to educational research and development. CONCLUSION: The findings suggest that the educators' pyramid is generalizable to medical faculty being promoted on a teaching pathway at WFUSM. Documentation of achievement in teaching criteria is essential and faculty should be encouraged to maintain records of accomplishment before becoming candidates for promotion.     

Faculty development for educational leadership and scholarship.

The Medical Education Scholars Program (MESP) at the University of Michigan Medical School is designed to develop leaders in medical education. The program's goals are to enable faculty to provide curriculum direction, improved teaching, educational research, and development, and institutional leadership at all levels of medical education. This one-year program uses a variety of educational methods and provides a broad curriculum in educational theory, assessment and evaluation, research design and methods, teaching-skills development, and educational leadership. Faculty are admitted on a competitive basis and one half-day per week of release time is funded as part of the program. Salient outcomes of the program (promotions, educational research and development, curriculum leadership, and educational scholarship) were measured in a pre- and post-program design in which each scholar acted as his or her own control. There were major increases in promotions and educational awards, new educational responsibilities, and new educational programs. A particularly important outcome was the emergence of educational scholarship in the professional portfolios of the program scholars in the form of peer-reviewed presentations and publications and educational grant funding. A cost-outcome analysis indicates that these multi-year outcomes were obtained from a one-time investment of approximately $21,000 per graduating scholar. This evaluation indicates that intensive faculty development programs can have measurable impacts on the careers of the participants and the institutional environment.     

Increasing departmental and college-wide faculty development opportunities through a teaching scholars program.

The University of Iowa Teaching Scholars Program was initiated in 1999 at the University of Iowa Carver College of Medicine (CCOM) with the overall goal of promoting leadership in faculty development related to teaching skills. Specific goals of this program are (1) to promote the development of a cadre of faculty members who have the skills to implement faculty development within their departments and the CCOM; (2) to increase departmental involvement in faculty development efforts; (3) to increase resources available for dissemination of college-wide faculty development efforts; and (4) to acknowledge the extra effort faculty put into developing their skills and knowledge in medical education and in providing continuing education to their faculty colleagues. All clinical and basic science departments in the CCOM are given the opportunity to have a faculty member participate in the program. Unlike other programs reported in the literature, competitive decisions for program participation are made at the departmental level. The three-year program combines monthly meetings and other activities to train faculty to provide faculty development in teaching skills. Each scholar develops and implements a project to address departmental faculty development needs as well as needs of other departments in the CCOM. To date (2006), 50 faculty members from 19 different departments have participated in the program with an average of 12 scholars per class. The program has resulted in a substantial increase in departmental and college-wide faculty development programming and has had a positive impact on individual scholars' teaching skills and leadership roles.     

The role of nonphysician consultants as health-care educators in postgraduate programs of anesthesiology

Many physicians believe that the tasks of postgraduate medical education and faculty development are best carried out by senior physicians trained in the appropriate specialty. However, many also will admit that, as physicians, they have received too little training for such an educational role, and that the practical demands of medical practice, scientific research, and administration make it difficult if not impossible to allocate time to continuing medical education program development, curriculum design for residency training, teacher training, and other key aspects of postgraduate medical education. Many medical disciplines have attempted to alleviate this problem by using nonphysician health-care educational consultants in their training programs. However, little attention has been paid to the possibilities of using such consultants in anesthesiology residency education and faculty development. Such consultants in postgraduate medical education and training programs in anesthesiology could perform a wide variety of functions and roles because they possess skills and technical expertise in teaching, training, curriculum design, evaluation, program planning, and interpersonal communications that faculty members often lack. The successful use of a nonphysician consultant in the Department of Anesthesiology at Hahnemann University in Philadelphia, Pennsylvania, is described.     

Evaluation of a faculty development program in managing care.

PURPOSE. To evaluate a faculty development program that teaches quality improvement and cost-effectiveness. METHOD. From October 2000 to February 2001, a two-part faculty development program was offered to 39 physicians from 19 U.S. medical schools supported by grants from the Partnerships for Quality Education (PQE) and Undergraduate Medical Education in the 21st Century (UME-21). Special features of the program included partnerships between academic and community physicians from each school, development of an educational innovation of interest to the participants, concurrent development of teaching skills and new medical knowledge, learning leadership skills (e.g., how to train colleagues to teach), and practice periods. The program focused on quality improvement and cost-effectiveness, but included other "managing care" topics. Prior to and after the course, participants assessed their knowledge of and competence to teach these topics, as well as other managing care topics. They also assessed their competence as medical educators and leaders. After the course, they indicated their progress in implementing their proposed educational innovations. RESULTS. Thirty-two of the 39 physicians completed evaluations both before and after the program. Self-assessed knowledge and competence to teach quality improvement and cost-effectiveness were significantly higher at the end of the course, as were all self-assessed teaching and leadership skills. The largest change scores occurred in assessments of competency to teach the new topics and to teach in new ways. Participants who implemented their innovations rated their competencies to teach quality improvement and cost-effectiveness higher than did non-implementers. CONCLUSION. Opportunities for faculty to learn how to teach a topic of stated importance to them, to practice what they have learned, and to work collaboratively with partners improved teaching skills.     

A consortium-based research education program for residents.

With growing pressures to consolidate and reorganize health care delivery systems, graduate medical education (GME) consortia can draw faculty from affiliated members to assemble educational programs. The authors report on consortium-based research education seminars of a quality that many residency programs would be unable to develop and support on their own. Drawing a diverse faculty from consortium members and area universities, the OHEP Center for Medical Education's annual Research Workshop Series focuses on the design of research projects; data analysis and hypothesis testing; and written and oral presentation of scientific research. Each spring, OHEP sponsors a research forum in which the best research projects from consortium members are presented by the resident-researchers, who compete for recognition and prize money. Further, of the 128 presentations made thus far at the annual OHEP Research Forum, 25% were subsequently published. The consortium's research education program has been well received by residents, is cost-effective, and is an integral component of the research curricula of many area residency programs. Including research training in GME provides residents an opportunity to become more competitive for fellowship, faculty, and leadership positions.     

The Academy at Harvard Medical School: nurturing teaching and stimulating innovation.

The Academy at Harvard Medical School, established in 2001, was formed at a critical moment for medical schools in this country. Several decades of enormous growth in the biomedical research and clinical care activities of medical school faculty have resulted in great societal benefit. The unintended consequence has been a decline in faculty time and reward for the educational mission that is unique to a medical school. The impact of this decline is particularly felt now because the explosive growth in the science and technology relevant to medical practice, coupled with dramatic changes in the health care delivery system, calls for new models for the education of the next generation of physicians. The mission of the academy is to renew and reinvigorate the educational mission of Harvard Medical School (HMS). By bringing together a select group of some of the school's most talented and dedicated faculty and providing direct support for their work related to education, the academy has created a unique mechanism for increasing the recognition of teaching contributions of both academy members and the teaching faculty at large, fostering educational innovation, and providing a forum for the exchange of ideas related to medical education that cross departmental and institutional lines. The authors describe the academy's membership criteria, structure, governance, activities, institutional impact, and plans for long-term evaluation, and indicate challenges the academy will face in the future.     

How do medical schools use measurement systems to track faculty activity and productivity in teaching?

The authors describe their findings from a study that (1) identified 41 medical schools or medical school departments that used metric systems to quantify faculty activity and productivity in teaching and (2) analyzed the purposes and progress of those systems. Among the reasons articulated for developing these systems, the most common was to identify a "rational" method for distributing funds to departments. More generally, institutions wanted to emphasize the importance of the school's educational mission. The schools varied in the types of information they tracked, ranging from a selective focus on medical school education to a comprehensive assessment of teaching activity and educational administration, committee work, and advising. Schools were almost evenly split between those that used a relative-value-unit method of tracking activity and those that used a contact-hour method. This study also identified six challenges that the institutions encountered with these metric systems: (1) the lack of a culture of data in management; (2) skepticism of faculty and chairs; (3) the misguided search for one perfect metric; (4) the expectation that a metric system will erase ambiguity regarding faculty teaching contributions; (5) the lack of, and difficulty with developing, measures of quality; and (6) the tendency to become overly complex. Because of the concern about the teaching mission at medical schools, the number of institutions developing educational metric systems will likely increase in the coming years. By documenting and accounting financially for teaching, medical schools can ensure that the educational mission is valued and appropriately supported.     

Fifteen years of aligning faculty development with primary care clinician-educator roles and academic advancement at the Medical College of Wisconsin.

Starting in 1991, the Medical College of Wisconsin's (MCW) primary care-focused faculty development programs have continuously evolved in order to sustain tight alignment among faculty members' needs, institutional priorities, and academic reward structures. Informed by literature on the essential competencies associated with academic success and using educational methods demonstrated to achieve targeted objectives, MCW's initial 1.5-day per month comprehensive faculty development programs prepared faculty as clinician-researchers, leaders, and educators. As institutional priorities and faculty roles shifted, a half-day per month advanced education program was added, and the comprehensive faculty development program transitioned to its current half-day per month program. Using a modular approach, this program focuses exclusively on clinician-educator competencies in curriculum, teaching, leadership, evaluation, and learner assessment. Instructional methods combine interactive, face-to-face sessions modeling a range of instructional strategies with between-session assignments now supported through an e-learning platform. All participants complete a required project, which addresses a divisional or departmental need, meets standards associated with scholarship, and is submitted to a peer-reviewed forum. To date, over 115 faculty members have enrolled in MCW's faculty development programs. Program evaluation over the 15-year span has served to guide program revision and to provide clear evidence of program impact. A longitudinal evaluation of comprehensive program graduates from 1993 to 1999 showed that 88% of graduates' educational projects were implemented and sustained more than one year after program completion. Since 2001, each participant, on average, attributes more than two peer-reviewed presentations and one peer-reviewed publication to program participation. Based on 15 years of evaluation data, five tenets associated with program success are outlined.     

Promoting fundamental clinical skills: a competency-based college approach at the University of Washington.

The focus on fundamental clinical skills in undergraduate medical education has declined over the last several decades. Dramatic growth in the number of faculty involved in teaching and increasing clinical and research commitments have contributed to depersonalization and declining individual attention to students. In contrast to the close teaching and mentoring relationship between faculty and students 50 years ago, today's medical students may interact with hundreds of faculty members without the benefit of a focused program of teaching and evaluating clinical skills to form the core of their four-year curriculum. Bedside teaching has also declined, which may negatively affect clinical skills development. In response to these and other concerns, the University of Washington School of Medicine has created an integrated developmental curriculum that emphasizes bedside teaching and role modeling, focuses on enhancing fundamental clinical skills and professionalism, and implements these goals via a new administrative structure, the College system, which consists of a core of clinical teachers who spend substantial time teaching and mentoring medical students. Each medical student is assigned a faculty mentor within a College for the duration of his or her medical school career. Mentors continuously teach and reflect with students on clinical skills development and professionalism and, during the second year, work intensively with them at the bedside. They also provide an ongoing personal faculty contact. Competency domains and benchmarks define skill areas in which deepening, progressive attention is focused throughout medical school. This educational model places primary focus on the student.     

Enhancing behavioral science education at the Ohio State University College of Medicine.

The social and behavioral sciences play key roles in patient health outcomes. Given this reality, successful development of social and behavioral science curricula in medical education is critically important to the quality of patients' lives and the effectiveness of health care delivery systems. The Institute of Medicine, in a recent report, recommended that medical schools enhance their curricula in these areas and identified four institutions as "exemplars" of social and behavioral science education. The authors describe an ongoing curriculum development and improvement process that produced one such exemplary program at The Ohio State University College of Medicine.The authors provide a historical perspective on behavioral science education, discuss issues that led to curricular change, and describe the principles and processes used to implement reform. Critical factors underlying positive change are addressed: increase active learning, recruit a core group of small-group facilitators who are primary care physicians, diversify teaching methods, support student-directed educational initiatives, enhance student-teacher relationships, centralize course administration, obtain funding, implement a faculty development program, and apply curriculum quality improvement methods. Outcome data from evaluations completed by both students and small-group physician faculty are presented, and future directions regarding further revision are outlined. The authors believe that the strategies they describe can be applied at other institutions and assist behavioral science educators who may experience the challenges typically encountered in this important field of medical education.     

A communication assessment and skill-building exercise (CASE) for first-year residents.

OBJECTIVE: Good communication skills are essential for residents entering postgraduate education programs. However, these skills vary widely among medical school graduates. This pilot program was designed to create opportunities for (1) teaching essential interviewing and communication skills to trainees at the beginning of residency, (2) assessing resident skills and confidence with specific types of interview situations, (3) developing faculty teaching and assessment skills, (4) encouraging collegial interaction between faculty and new trainees, and (5) guiding residency curricular development. DESCRIPTION: During residency orientation, all first-year internal medicine residents (n = 26) at the University of Minnesota participated in the communication assessment and skill-building exercise (CASE). CASE consisted of four ten-minute stations in which residents demonstrated their communication skills in encounters with standardized patients (SPs) while faculty members observed for specific skills. Faculty and SPs were oriented to the educational purposes and goals of their stations, and received instructions on methods of providing feedback to residents. With each station, residents were provided one and a half minutes of direct feedback by the faculty observer and the SP. The residents were asked to deal with an angry family member, to counsel for smoking cessation, to set a patient-encounter agenda, and to deliver bad news. A resident's performance was analyzed for each station, and individual profiles were created. All residents and faculty completed evaluations of the exercise, assessing the benefits and areas for improvement. DISCUSSION: Evaluations and feedback from residents and faculty showed that most of our objectives were accomplished. Residents reported learning important skills, receiving valuable feedback, and increasing their confidence in dealing with certain types of stressful communication situations in residency. The activity was also perceived as an excellent way to meet and interact with faculty. Evaluators found the experience rewarding, an effective method for assessing and teaching clinical skills, a faculty development experience for themselves in learning about structured practical skills exercises, and a good way to meet new interns. The residency program director found individual resident performance profiles valuable for identifying learning issues and for guiding curricular development. Time constraints were the most frequently cited area for improvement. The exercise became feasible by collaborating with the medical school Office of Education-Educational Development and Research, whose mission is to collaborate with faculty across the continuum of medical education to improve the quality of instruction and evaluation. The residency program saved considerable time, effort, and expense by using portions of the medical school's existing student skills-assessment programs and by using chief residents and faculty as evaluators. We plan to use CASE next year with a wider variety of physician-patient scenarios for interns, and to expand the program to include beginning second- and third-year residents. Also, since this type of exercise creates powerful feedback and assessment opportunities for instructors and course directors, and because feedback was so favorable from evaluators, we will encourage participation in CASE as part of our faculty educational development program.     

Implementing a mission-based reporting system at an academic health center: a method for mission enhancement.

PURPOSE: To describe the utility of school-wide use of mission-based reporting (MBR) for medical school deans and department chairs. METHOD: All faculty members in the University of California, Davis, School of Medicine reported their clinical, creative, teaching, and service activities for 2000-2001 to the MBR system. The authors report on school-wide and department MBR profiles, and profiles by rank and academic series. They validate MBR by comparing individual results with actual merit actions reviewed independently by the school's academic personnel committee. RESULTS: A total of 419 faculty members (85%) completed their MBR reports. The average faculty member spent considerably more than 50 hours per week fulfilling the missions of the school, and full professors and faculty members in academic series supported by state funds were the most productive in investigative and creative work. The teaching load was shared equally by all the academic ranks, although the clinician-scholars taught more than did faculty members in the other series. There was an inverse relationship between clinical load and academic rank, with the majority of the clinical work performed by junior faculty members. MBR results compared favorably with the merit review process, although MBR is not expected to replace the traditional peer review system. CONCLUSION: The creation of these graphic profiles and summaries is a valuable feature of MBR that would not have been possible without such quantitative data. The profiles allow monitoring to ensure that workload conforms to established objectives for individuals, departments, academic ranks and series. Finally, the authors discuss future directions for their MBR system.     

Global health in Canadian medical education: current practices and opportunities.

PURPOSE: Globalization is altering health and health care. At the same time, prospective and current medical students are increasingly requesting global health training and creating opportunities when these are not provided by medical schools. To understand the type and amount of global health activities provided in Canadian medical schools, the authors undertook a survey of global health educational opportunities available at all 17 medical schools during the 2005-2006 academic year. METHOD: Using a structured questionnaire, information was collected from deans' offices, institutional representatives, faculty, students, and medical school Web sites. RESULTS: All 17 medical schools participated. Canadian medical schools vary widely in their approach to global health education, ranging from neither required nor elective courses in global health to well-developed, two-year electives that include didactic and overseas training. There is no consensus on the educational content covered, the year in which global health issues are taught, whether materials should be elective or required, or how much training is needed. Of the 16 Canadian medical schools that allow students to participate in international electives, 44% allow these electives to occur without clear faculty oversight or input. CONCLUSIONS: Despite both the strong, growing demand from medical students and the changing societal forces that call for better global health training, Canadian medical school curricula are not well positioned to address these needs. Improving global health opportunities in Canadian medical school curricula will likely require national leadership from governing academic bodies.