The geriatrics excellence in teaching series: an integrated educational skills curriculum for faculty and fellows development

Geriatricians need to acquire skills in teaching and curriculum development to educate physicians caring for the growing population of adults aged 65 and older. To meet this challenge, educators in the Duke University Center for the Study of Aging and Human Development introduced a monthly seminar series to promote the development of geriatrics faculty and fellows as clinician educators. Ten educational skills development seminars were incorporated into geriatrics grand rounds in the first year of the program. These sessions were implemented using a variety of active learning strategies to expose participants to innovative adult learning-centered approaches for enhancing learning and instruction in medical education. Participants assessed all sessions using a feedback form and were surveyed at the end of the series to measure their overall satisfaction with the program and ascertain its effect on their roles as educators. Participants rated individual sessions highly, and respondents to the survey at the end of the course agreed that the Geriatrics Excellence in Teaching Series provided them with resources for use in their teaching practices and attested to having already applied knowledge and skills learned in the series in their teaching practices. Key elements for the program's success included an upfront needs assessment to prioritize topics, interactive sessions promoting skill development through actual practice of various strategies, open discussions to identify challenges and solutions, and a convenient and customary time slot. This format can be replicated with other geriatrics programs, providing a needed opportunity for faculty and fellows to learn about education principles.     

Academic incentives for faculty participation in community-based participatory research

Recognizing the need to overcome the obstacles of traditional university- and discipline-oriented research approaches, a variety of incentives to promote community-based participatory research (CBPR) are presented. Experiences of existing CBPR researchers are used in outlining how this methodological approach can appeal to faculty: the common ground shared by faculty and community leaders in challenging the status quo; opportunities to have an impact on local, regional, and national policy; and opening doors for new research and funding opportunities. Strategies for promoting CBPR in universities are provided in getting CBPR started, changing institutional practices currently inhibiting CBPR, and institutionalizing CBPR. Among the specific strategies are: development of faculty research networks; team approaches to CBPR; mentoring faculty and students; using existing national CBPR networks; modifying tenure and promotion guidelines; development of appropriate measures of CBPR scholarship; earmarking university resources to support CBPR; using Institutional Review Boards to promote CBPR; making CBPR-oriented faculty appointments; and creating CBPR centers.     

Practicing physician education in geriatrics: lessons learned from a train-the-trainer model

Evidence of poor performance in the evaluation and management of common geriatric conditions suggests the need for changing physician behavior in these areas. Traditional lecture-style continuing medical education (CME) has not been shown to be effective. Expert faculty initially trained 60 nonexpert peer educators to conduct small-group, learner-centered CME using tool kits on memory loss, incontinence, and depression. Peer educators presented 109 community-based sessions to 1,309 medical practitioners. Surveys were administered to community participants immediately and 6 months after a session. Evidence of effectiveness included statistically significant increases in self-reported knowledge, attitudes, and office-based practices on the target topics at the time of training and at the 6-month follow-up (P<.001) and two-thirds of respondents reporting continued use of three or more tools at 6 months. Participants reported that the interactive presentation aided their understanding of and ability to use the tool kits more than an off-the-shelf review (mean rating+/-standard deviation 4.1+/-0.71, with 1 = not at all and 5 = significantly). After the formal evaluation period, additional information about the project dynamics and tool kits was obtained through a small interview sample and an on-line survey, respectively. Receiving copies of the tool kits was an important factor in enabling educators to offer sessions. Barriers to offering sessions included finding time, an audience, and space. Findings suggest that modest positive changes in practice in relation to common geriatric problems can be achieved through peer-led, community-based sessions using principles of knowledge translation and evidence-based tool kits with materials for providers and patients.     

Faculty development in geriatrics for clinician educators: a unique model for skills acquisition and academic achievement

As the size of the aged American population increases, so too does the shortage of trained providers in geriatrics. Educational strategies to train physicians at all levels of experience within adult medical and surgical disciplines are needed to complement fellowship training, given the small size of most academic faculties in geriatrics. This article describes a unique faculty development program that creates geriatrically oriented faculty in multiple disciplines. The Boston University Center of Excellence in Geriatrics (COE), funded by the John A. Hartford Foundation, has trained 25 faculty members. Four to six scholars enter the program each year and participate in the COE 1 day per week. Nine months are spent in four content modules-Geriatrics Content, Clinical Teaching, Evidence-based Medicine, and Health Care Systems; 3 months are spent in supervised scholarly activities and clinical settings. A self-report questionnaire and a structured interview were used to evaluate the outcomes of participation in the COE. The results from the first 4 years of the program are reported. The response rate was 83% for the self-report questionnaire and 75% for the structured interview. The results indicate that the COE is effective in improving scholars' assessment and management of older patients. The structured interview revealed that the COE program promotes the integration of geriatrics into clinical teaching at the medical student and resident level. Participants also completed scholarly projects in geriatrics. This program effectively trains faculty scholars to better care for older adults and to teach others to do likewise.     

Evaluation of a faculty development program in substance abuse education

Objective: To determine whether a faculty development program was effective in increasing clinical skills and the amount of substance abuse teaching of individual general medical faculty. Design: Program participants were evaluated with a structured assessment before and several months after participating in a faculty development program in substance abuse education. Participants: Eighty percent were general internal medicine faculty, who on average devoted 25% of their time to teaching. The remainder of the participants were family medicine, psychiatry, or other internal medicine faculty and nonphysician teachers. Intervention: The participants attended a learner-centered, largely experiential faculty development program in substance abuse education to improve their clinical and teaching skills relevant to substance abuse among patients in the general medical setting. Measurements and main results: Eighty-six percent of the participants completed the evaluation. The participants reported increased confidence in their clinical skills in recognizing substance abuse, presenting the problem to the patient, and referring the patient for treatment. The participants also reported improved attitudes toward patients and increased teaching about the management of the primary problem of substance abuse, but not at the expense of teaching about medical complications. Conclusions: Clinically oriented, interactive faculty development courses in substance abuse education can contribute to increased confidence in clinical skills in substance abuse as well as teaching about substance abuse. Received from the Departments of Medicine, Harvard Medical School, Boston, Brigham and Women’s Hospital, Boston, and the Cambridge Hospital, Cambridge, and the Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts. Presented at the annual meeting of the Society of General Internal Medicine, May 1–3, 1991, Seattle, Washington. Supported by funds to the Society of General Internal Medicine from the J.M. Foundation and the Pew Memorial Trusts.     

Brief report: Utilizing an audiotape for outpatient preceptor faculty development

BACKGROUND: Faculty development for busy and geographically dispersed ambulatory preceptors is a difficult task for course directors. PURPOSE: A faculty development audiotape intended for playing in the preceptor's car was created. The feasibility of this form of faculty development was tested in this pilot study. METHODS: A short audiotape, focusing on strategies for the provision of independence to students in the office setting, was made and distributed to all preceptors of students taking a fourth-year required clerkship in ambulatory medicine. Preceptor behavior was reported by students on postclerkship evaluations before and after tape distribution. RESULTS: In the year before tape distribution, 21% of evaluations indicated a lack of independence on the part of the student, compared with 14% in the year following the intervention (P=.03). There was no regression of behavior among preceptors already providing independence. Among the preceptors initially identified as not following recommendations for student independence, the percentage of evaluations indicating a lack of independence went from 72% preintervention to 42% postintervention (P<.001). CONCLUSIONS: A short audiotape is a novel form of faculty development, which was acceptable to preceptors and may influence teaching behavior in the desired manner.     

Academic geriatrics in Singapore

Singapore is one of the fastest-aging countries in the world. The proportion of adults aged 65 and older is projected to increase from 8.7% to 20% over the next 20 years. The country has developed various strategies to meet the needs of this increase in older adults. There is an acute shortage of geriatricians and a need to train more healthcare workers to care for older adults. Geriatric medicine is a relatively new specialty, and a small number of geriatricians have been tasked with providing an increasing load of clinical service, education, and research. Hence, there is a need to develop a cohesive structure of support for faculty development and retention, advanced specialty trainee recruitment, leadership in medical education, research, and clinical service to care for the rapidly aging population. In addition, geriatric medicine is primarily a hospital-based specialty in Singapore. There is still opportunity to collaborate and improve the academic and practice integration of geriatric medicine into primary care and intermediate and long-term care where it is most needed.     

The impact of the stanford faculty development program on ambulatory teaching behavior

CONTEXT: Faculty development has received considerable investment of resources from medical institutions, though the impact of these efforts has been infrequently studied. OBJECTIVE: To measure the impact of the Stanford Faculty Development Program in Clinical Teaching on ambulatory teaching behavior. DESIGN: Pre-post. SETTING AND PARTICIPANTS: Eight internal medicine faculty participating in local faculty development. INTERVENTION: Participants received 7 2-hour sessions of faculty development. Each session included didactic, role-play, and videotaped performance evaluation. MAIN OUTCOME MEASURE: Before and after the intervention, faculty were video-taped during a case presentation from a standardized learner, who had been trained to portray 3 levels of learners: a third-year medical student, an intern, and a senior medical resident. Teacher and learner utterances (i.e, phrases) were blindly and randomly coded, using the Teacher Learner Interaction Analysis System, into categories that capture both the nature and intent of the utterances. We measured change in teaching behavior as detected through analysis of the coded utterances. RESULTS: Among the 48 videotaped encounters, there were a total of 7,119 utterances, with 3,203 (45%) by the teacher. Examining only the teacher, the total number of questions asked declined (714 vs 426, P=.02) with an increase in the proportion of higher-level, analytic questions (44% vs 55%, P<.0001). The quality of feedback also improved, with less "minimal" feedback (87% vs 76%, P<.0005) and more specific feedback (13% vs 22%) provided. CONCLUSIONS: Teaching behaviors improved after participation in this faculty development program, specifically in the quality of questions asked and feedback provided.     

Implementing a mandatory geriatrics clerkship

Due to the rapid growth in the proportion of U.S. citizens aged 65 and older (20% by 2030) it is imperative that U.S. medical schools train students who can provide quality care to the older population. Consequently, the objective of this paper is to report the experience of creating a 4-week, mandatory geriatrics clerkship for junior medical students. Funded by a grant from the Donald W. Reynolds Foundation, the University of Arkansas for Medical Sciences developed a mandatory, third-year clerkship in geriatric medicine.The clerkship included clinical experiences in outpatient clinics, transitional care units, nursing homes, hospice programs, and core didactic sessions. The sites for the clerkship were the University of Arkansas for Medical Sciences Hospital, the Central Arkansas Veterans Healthcare System Hospital, community nursing homes, and community hospice programs in Little Rock, Arkansas. The entire junior class of 135 students participated in the new clerkship.Students were assessed through a three-station Objective Structured Clinical Examination followed by a brief post- encounter examination and faculty preceptor evaluations collected from each clinical site. Students evaluated the clerkship through written evaluations and focus group discussions. This paper demonstrates that students acquired sufficient cognitive knowledge to satisfactorily complete the clerkship but did not highly value the experience.     

Measuring outcomes of a one-minute preceptor faculty development workshop

BACKGROUND: Measuring outcomes of faculty development programs is difficult and infrequently attempted beyond measuring participant satisfaction with the program. Few studies have validated evaluation tools to assess the effectiveness of faculty development programs, and learners have rarely participated in assessing improvement of faculty who participate in such programs. OBJECTIVE: To develop a questionnaire to measure the effectiveness of an enhanced 1-minute preceptor (OMP) faculty development workshop via faculty self-assessment and resident assessment of faculty, and to use the questionnaire to assess an OMP faculty development workshop. DESIGN AND MEASUREMENTS: We developed and tested a questionnaire to assess the 5 "microskills" of a OMP faculty development program, and performed faculty self-assessment and resident assessment using the questionnaire 6 to 18 months before and 6 to 18 months after our experiential skills improvement workshop. PARTICIPANTS: Sixty-eight internal medicine continuity clinic preceptors (44 control and 24 intervention faculty) at a university, a veteran's affairs hospital, and 2 community internal medicine training sites. RESULTS: Twenty-two participants (92%) completed pre- and postintervention questionnaires. Residents completed 94 preintervention questionnaires and 58 postintervention questionnaires on participant faculty. Faculty reported improvement in behavior following the intervention. Residents reported no significant improvements in faculty teaching behaviors following the intervention. CONCLUSION: We attempted to rigorously evaluate a faculty development program based on the OMP. Although the intervention did not show statistically significant changes in teaching behavior, we believe that this study is an important step in extending assessment of faculty development to include resident evaluation of participating faculty.     

Outcomes of a national faculty development program in teaching skills

BACKGROUND: Awareness of the need for ambulatory care teaching skills training for clinician-educators is increasing. A recent Health Resources and Services Administration (HRSA)-funded national initiative trained 110 teams from U.S. teaching hospitals to implement local faculty development (FD) in teaching skills. OBJECTIVE: To assess the rate of successful implementation of local FD initiatives by these teams. METHODS: A prospective observational study followed the 110 teams for up to 24 months. Self-reported implementation, our outcome, was defined as the time from the training conference until the team reported that implementation of their FD project was completely accomplished. Factors associated with success were assessed using Kaplan-Meier analysis. RESULTS: The median follow-up was 18 months. Fifty-nine of the teams (54%) implemented their local FD project and subsequently trained over 1,400 faculty, of whom over 500 were community based. Teams that implemented their FD projects were more likely than those that did not to have the following attributes: met more frequently (P=.001), had less turnover (P=.01), had protected time (P=.01), rated their likelihood of success high (P=.03), had some project or institutional funding for FD (P=.03), and came from institutions with more than 75 department of medicine faculty (P=.03). The cost to the HRSA was $22,033 per successful team and $533 per faculty member trained. CONCLUSIONS: This national initiative was able to disseminate teaching skills training to large numbers of faculty at modest cost. Smaller teaching hospitals may have limited success without additional support or targeted funding.     

Integrating teaching skills and clinical content in a faculty development workshop

Incorporating clinical content into medical education faculty development programs has been proposed as a strategy to consolidate faculty continuing medical education time and enhance learning. We developed a faculty development program for ambulatory internal medicine preceptors that integrated primary care genetics with ambulatory precepting. The instructional strategies addressed both areas simultaneously and included facilitated discussions, mini-lectures, trigger tapes, and role plays. To evaluate the program, we conducted a pre-post trial. Skills were measured by retrospective pre-post self-reported ratings and behaviors by self-reported implementation of commitment to change (CTC) statements. Participants' (N = 26) ambulatory precepting and primary care genetics skill ratings improved after the intervention. They listed an average of 2.4 clinical teaching CTC statements and 2.0 clinical practice CTC statements. By 3 months after the workshop, preceptors, as a group, fully implemented 32 (38%), partially implemented 35 (41%), and failed to implement 18 (21%) CTC statements. The most common barrier to clinical teaching change was insufficient skills (8 of 25; 32%) and to clinical practice change was lack of a suitable patient (15 of 25; 60%). Integrating clinical content with clinical teaching in a faculty development workshop is feasible, can improve clinical and teaching skills, and can facilitate behavior change.     

Faculty rewards for the generalist clinician — Teacher

Historically, medicine has regarded itself as a profession of great breadth, encompassing the total range of human activity: biological, behavioral, social and organizational. In the last several decades, however, it has become increasingly reductionist, fragmented, and specialized. Recent developments, as exemplified by the return of the generalist clinician-educator to the academic community, portend a reversal of this trend. Manifestations of a change in the orientation of medicine and medical education toward holism and humanism include a movement toward improved compensation for “cognitive” services, development of new promotion tracks for clinician-teachers, and increased support and recognition of applied clinical research. Generalist faculty are in a position to benefit from these trends, but obstacles remain; vigilism and activism are required to maintain momentum.     

Geriatrics training and education for nongeriatrician faculty: the Dean's Faculty Scholars in Aging Program

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.     

Interactive faculty development seminars improve the quality of written feedback in ambulatory teaching

We performed a pre-post study of the impact of three 90-minute faculty development workshops on written feedback from encounters during an ambulatory internal medicine clerkship. We coded 47 encounters before and 43 after the workshops, involving 9 preceptors and 44 third-year students, using qualitative and semiquantitative methods. Postworkshop, the mean number of feedback statements increased from 2.8 to 3.6 statements (P =.06); specific (P =.04), formative (P =.03), and student skills feedback (P =.01) increased, but attitudinal (P =.13) and corrective feedback did not (P =.41). Brief, interactive, faculty development workshops may refine written feedback, resulting in more formative specific written feedback comments.     

Long-term follow-up of a longitudinal faculty development program in teaching skills

BACKGROUND: The long-term impact of longitudinal faculty development programs (FDPs) is not well understood. OBJECTIVE: To follow up past participants in the Johns Hopkins Faculty Development Program in Teaching Skills and members of a comparison group in an effort to describe the long-term impact of the program. DESIGN AND PARTICIPANTS: In July 2002, we surveyed all 242 participants in the program from 1987 through 2000, and 121 members of a comparison group selected by participants as they entered the program from 1988 through 1995. MEASUREMENTS: Professional characteristics, scholarly activity, teaching activity, teaching proficiency, and teaching behaviors. RESULTS: Two hundred participants (83%) and 99 nonparticipants (82%) responded. When participants and nonparticipants from 1988 to 1995 were compared, participants were more likely to have taught medical students and house officers in the last year (both P<.05). Participants rated their proficiency for giving feedback more highly (P<.05). Participants scored higher than nonparticipants for 14 out of 15 behaviors related to being learner centered, building a supportive learning environment, giving and receiving feedback, and being effective leaders, half of which were statistically significant (P<.05). When remote and recent participants from 1987 through 2000 were compared with each other, few differences were found. CONCLUSIONS: Participation in the longitudinal FDP was associated with continued teaching activities, desirable teaching behaviors, and higher self-assessments related to giving feedback and learner centeredness. Institutions should consider supporting faculty wishing to participate in FDPs in teaching skills.     

Cadaver treasure hunt: introducing geriatrics concepts in the anatomy class

The objective of this study was to develop an educational program introducing geriatrics to medical students during anatomy. Observational study of an educational intervention in medical school was the design utilized. First-year medical students in an anatomy laboratory were participants. The program consists of a lecture and a workshop. First, a geriatrics lecture early in the course presents demographic data on the cadavers, followed by comparison with national data on leading causes of death. Second, there is a "treasure hunt" in the anatomy laboratory conducted by geriatricians. Each geriatrician spends 45 minutes with one-four-student cadaver group at a time, reviewing anatomical findings and facilitating a discussion of clinical correlations and implications. A list of common anatomical findings, aging- and disease-related, is distributed to the students as an aid in identifying findings of interest. Students have been surprised to learn that the mean age of the 24 cadavers exceeded 80 years (mean 81, median 85 for 2 years), and that causes of death mirrored national data. The students begin understanding aging and appreciate the valuable resource of cadavers. The students acquire a new holistic perspective regarding their cadavers that is not apparent during the dissections. Students and faculty find the experience valuable in understanding the interplay of disease and aging. Evaluations have been mostly positive (82-87% positive responses). The anatomy lecture and "treasure hunt" experience are unique strategies for using cadavers to introduce geriatrics principles into the medical school.     

The effect of the geriatrics education for emergency medical services training program in a rural community

The Geriatrics Education for Emergency Medical Service (EMS) (GEMS) course provides continuing education for EMS providers. This study evaluated the effect of the course on EMS providers in a rural county by performing a prospective cohort study using a pre-postsurvey design. The Geriatric Attitude Scale, the GEMS knowledge posttest, a class satisfaction survey, and a survey evaluating EMS providers' comfort in caring for older adults were used to measure the classes' effect. Eighty-eight EMS providers participated. All passed the course and were very satisfied with it. Follow-up was completed with 77 (80%). No significant change in attitude score was identified ( P =.09). Median comfort scores significantly increased for the domains of communications, medical care, abuse evaluation, and falls evaluation. Providing the GEMS course to EMS providers in a rural community resulted in students passing a posttest evaluating their knowledge regarding caring for older adults and resulted in an increase in their comfort level for the care of older adults. The effect of the training on patient outcomes needs to be identified.      

Geriatrics attitudes and knowledge among surgical and medical subspecialty house officers

OBJECTIVES: To examine geriatrics knowledge and attitudes of non-primary care house officers (HOs) before and after a multidisciplinary faculty development program.
DESIGN: Serial cross-sectional surveys.
PARTICIPANTS: HOs.
SETTING: A large midwestern academic medical center.
INTERVENTION: Faculty from seven surgical and six medical subspecialties participated in weekly seminars for 9 months and implemented geriatrics curricula in their HO programs.
MEASUREMENTS: HO geriatrics attitudes and knowledge were measured using the University of California at Los Angeles Geriatrics Attitudes Scale (GAS; 14 items), two scales of the Maxwell Sullivan test (Therapeutic Potential and Time/Energy; six items each; lower scores denote more-favorable attitudes), and the Geriatrics Clinical Knowledge Assessment (20 multiple choice items; range 0–100%). Repeat surveys were administered in seven disciplines after geriatrics curriculum implementation.
RESULTS: Baseline (n=175) geriatrics attitudes were favorable (e.g., 3.7 for GAS; 2.1 for Time/Energy), with more-favorable attitudes among medical subspecialty than surgical HOs (e.g., mean GAS 3.8 and 3.6, respectively; P =.001), and with advanced training. Mean baseline knowledge scores were 65.1% among all HOs. No differences in attitudes or knowledge were observed between the first (n=100) and second (n=90) cohorts in the seven disciplines that administered subsequent tests.
CONCLUSION: Geriatrics attitudes of non-primary care HOs are positive, and knowledge is moderate, suggesting need for and potential effect of geriatrics curricula. Demonstrating effects on learner outcomes of faculty development programs may require more than one faculty member per discipline and measures that are curriculum-specific and detailed rather than general and brief.