An innovative program to augment community preceptors' practice and teaching skills.

Medical students currently interface more and more with community-based physicians, many of whom have little training or experience as educators. They also start their ambulatory experiences from the beginning of their medical school training, not just at the clerkship year. This has prompted substantial literature on the need for improved faculty development for community preceptors, which is widely believed to be inadequate at present. The authors describe a novel program, designed to augment community preceptor teaching skills and practice behaviors, focusing on topics relating to humanism, communication, and psychosocial issues common in primary care. The program was conducted for four years beginning in 1999 and organized around acknowledged attributes of successful adult learning, and used case-based, small-group sessions, where individual community preceptors were each asked to "teach" a series of standardized students, in front of the group, regarding issues raised by a number of hypothetical patient cases. The standardized students had in turn been trained by the authors to interact with the participating faculty in a defined manner. The small-group sessions were led by community "opinion leaders" who had been chosen for this role by the participants, and who themselves first underwent training by the authors to familiarize them with core concepts felt to be essential to the program. At the conclusion of the entire process, surveys of the opinion leaders, the other community preceptor participants, and the standardized students suggested that the program did stimulate significant changes in attitude and behavior, although further research is needed to confirm this.     

Faculty development in communication skills instruction: insights from a longitudinal program with "real-time feedback".

Responsibility for teaching communication skills often falls to a multidisciplinary group of faculty who lack both a common model for teaching and prior experience teaching communication in small groups. This article describes East Tennessee State University's multifaceted faculty development program in teaching communication skills. The program was developed and implemented in three phases. First, a two-step Delphi approach helped identify core communication skills. Phase two gave faculty the opportunity to practice identifying communication teaching issues and effective strategies for working with small groups. The third phase involved the videotaping of faculty teaching small groups of students. These tapes were reviewed both individually and in faculty groups. The tapes were also reviewed by students, who provided realtime, moment-to-moment feedback to the faculty. Implementation and review of the program has helped to identify new strategies for effectively facilitating small-group teaching of communication skills.     

Faculty development in teaching skills: an intensive longitudinal model.

Although reflection contributes to the personal growth of clinician-educators and is important for effective teaching, few teaching skills programs report its use. The Johns Hopkins Faculty Development Program in Teaching Skills, first implemented in 1987 as a theoretically grounded, longitudinal model for faculty development of clinician-educators, comprises a set of conditions intended to promote reflective learning. This paper describes the program and reports evaluation results for 98 participants and a comparison group of 112 nonparticipants between 1988 and 1996. Participants met with facilitators weekly for nine months for 3.5 hours, in stable groups of four to six individuals. Educational methods used across seven content areas emphasized relationships and collaboration, and included information provision, experiential learning with reflection, and personal awareness sessions. A pre-post evaluation design with comparison group measured changes in self-assessed teaching and professional skills, teaching enjoyment, and learning effectiveness. A post-only evaluation design appraised overall program quality, educational methods, facilitation, learning environment, and perceived impact of participation. Program participants had significantly greater pre-post-change scores than nonparticipants for all 14 outcomes (p <.05). Multiple regression modeling indicated that program participation was associated with pre-post improvement in all outcomes except administration skills, controlling for all participant and nonparticipant baseline characteristics (p <.05). All measured programmatic characteristics were highly rated by participants. Experiential methods with reflection were rated significantly higher than information-provision and personal awareness sessions (p <.001). Evaluation results demonstrate a positive impact of this alternative approach to faculty development on clinician-educator perceptions of their attitudes and behaviors towards learners and colleagues.     

A multidisciplinary program to improve the teaching skills of incoming housestaff

Residents at the School of Medicine and Biomedical Sciences at the State University of New York at Buffalo (SUNY at Buffalo) expressed an interest in receiving instruction in teaching skills. In 1988, under sponsorship of the Graduate Medical-Dental Education Consortium, faculty and residents implemented an orientation program for 110 incoming housestaff. Residents received instruction in large-group teaching skills, bedside teaching, small-group discussion, and student evaluation. The program was rated positively by the residents, 5% of whom became instructors in the orientation program for the following year. Because of the program's structure, both faculty and housestaff receiving training in teaching skills, which may lead to an overall improvement in the teaching of SUNY at Buffalo's medical students.     

Reflective writing in the teaching of communication skills for medical students—A systematic review

ObjectiveTo analyse the use, assessment, and measured outcomes of reflective writing (RW) in teaching communication to medical students.MethodsSystematic search of seven electronic databases, focused on using RW in teaching communication skills. Three reviewers selected and prepared the synthesis of the studies. The synthesis was based on thematic analysis using Braun and Clarke’s approach.ResultsWe identified 1325 studies, reviewed 101 full-text articles, and included 12 articles in the analysis. The four themes identified showed that RW is not a stand-alone practice. RW is blended with other teaching strategies. Through RW, students identified structural, emotional, and relational aspects and challenges of communication. Only a few studies found a positive correlation between reflective ability and communication skillsConclusionRW can be integrated with various teaching methods, at all stages of learning, to stimulate discussion of interpersonal and intrapersonal topics. Through RW, students explore theirs and their patient’s emotions, values, behaviours, and needs identifying challenges and practices relevant to communication. Practice implications: RW can address different structural, relational, and emotional issues that are relevant to communication learning. Further educational development and high-quality empirical research on the use of RW and unique outcomes are needed to support communication skills learning.     

Lexicon creation to promote faculty development in medical communication

OBJECTIVE: Most medical educators have little or no training in teaching and assessing medical communication, and they are not consistent in what they teach. The authors set out to reach consensus in our educational community on a lexicon of communication terms for use in teaching physician-patient communication skills to second-year medical students. METHODS: An interdisciplinary medical school physician-patient communication committee assembled 23 important terms and agreed on definitions for each term. Thirty core preclinical faculty representing nine medical specialties reviewed the lexicon. Faculty were surveyed about lexicon definitions, barriers to use, and methods of using during educational encounters. RESULTS: All preclinical faculty members agreed on 19 out of 23 definitions and most respondents agreed on the definitions of the remaining four terms. Sixty-nine percent of respondents said they used the terms during their teaching encounters. CONCLUSION: Implementing a process to create a shared language around physician-patient communication may help unify and enhance faculty educational efforts. We were able to establish that medical educators can agree on the content of a medical communication lexicon for use with students. The use of defined and consistently used terms in multiple venues may reduce ambiguity, standardize teaching, enhance recognition of communication skills, and promote effective reinforcement and remediation by faculty. PRACTICE IMPLICATIONS: Evidence suggests that most medical educators have little or no training in teaching and assessing medical communication and that they are not consistent in what they teach. Asking a community of faculty to share responsibility for creating a communication lexicon may be an efficient and effective way to educate faculty and unify their educational effort.     

Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides.

Communication skills training is now internationally accepted as an essential component of medical education. However, learners and teachers in communication skills programs continue to experience problems integrating communication with other clinical skills, ensuring that clinical faculty support and teach communication beyond the formal communication course, extending communication training coherently into clerkship and residency, and applying communication skills in medical practice at a professional level of competence. One factor contributing to these problems is that learners confront two apparently conflicting models of the medical interview: a communication model describing the process of the interview and the "traditional medical history" describing the content of the interview. The resulting confusion exacerbates the above dilemmas and interferes with learners using communication skills training to advantage in real-life practice. The authors propose a comprehensive clinical method that explicitly integrates traditional clinical method with effective communication skills. To implement this more comprehensive approach, they have modified their own Calgary-Cambridge guides to the medical interview by developing three diagrams that visually and conceptually improve the way communication skills teaching is introduced and that place communication process skills within a comprehensive clinical method; devising a content guide for medical interviewing that is more closely aligned with the structure and process skills used in communication skills training; and incorporating patient-centered medicine into both process and content aspects of the medical interview. These enhancements help resolve ongoing difficulties associated with both teaching communication skills and applying them effectively in medical practice.     

Training faculty to facilitate communication skills training: development and evaluation of a workshop

OBJECTIVE: To develop a workshop for training faculty to facilitate small group role play sessions for a communication skills training program and assess the impact of that workshop on the trainees' self-efficacy about facilitation skills. METHODS: A multi-specialty group of 33 attending physicians at a Comprehensive Cancer Center were trained in a Facilitating Communication Skills Training workshop in order to prepare them to facilitate small group role play with fellows and residents. The workshop curriculum was based on theory and literature on teaching communication skills. RESULTS: The workshop had a significant effect on participants' self-efficacy in facilitating communication skills training. At least 75% of participants reported feeling comfortable facilitating communication skills training small groups. CONCLUSION: This facilitation workshop was successful in providing participants with confidence to successfully facilitate small group role play sessions in communication skills training. PRACTICE IMPLICATIONS: In order to evaluate the effectiveness of communication skills training programs, it is important to have trained facilitators who adhere to a set of facilitation guidelines. Workshops on facilitation skills provide the background and practice time necessary as a first step in the training process.     

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.     

Teachers' perceptions of difficulties in teaching ethics in residencies.

In 1989 the authors surveyed faculty who were teaching medical ethics in residencies in order to obtain information concerning the goals, formats, topics, and settings of such teaching, as well as the difficulties encountered. Of 163 teachers contacted, 94 (58%) responded and 63 (39%), representing 50 institutions, reported participation in formal ethics teaching programs for residents. The 63 teachers reported using a variety of formats, including ethics rounds, lectures, and incorporating ethics teaching into weekly case-management conferences. Frequently mentioned goals of ethics teaching included improving the residents' skills in reasoning about ethical decisions and improving the residents' understanding of the language and concepts of ethics. Thirty-four of the 63 teachers (54%) taught ethics in hospital settings exclusively and 21 (33%) taught both in hospitals and in outpatient clinics or offices. The teachers identified a number of barriers encountered in carrying out such teaching, most of which can be grouped in six categories: (1) time constraints due to residents' heavy schedules; (2) attitudes of residents that pose obstacles; (3) logistical problems associated with teaching in the clinical setting; (4) time demands placed on teachers; (5) lack of reinforcement for teaching ethics from other faculty; and (6) shortcomings in the background and training of faculty for teaching ethics in the clinical setting. The authors conclude that difficulties are commonly encountered and discuss ways to overcome the principal barriers to effective teaching of ethics in the residency years.     

A theory-based faculty development program for clinician-educators.

This essay describes the development, implementation, and evaluation of a theory-based faculty development program for physician-educators in medicine and pediatrics at The Cleveland Clinic. The program comprises a 12-hour course (focused on skills in precepting, bedside teaching, leading small-group discussions, giving lectures, designing curricula, and giving effective feedback); onsite coaching of teaching (on wards, in outpatient clinics, or in formal lectures); and innovative projects in clinical medical education. The program advocates and demonstrates a tailored-teaching approach combined with learner-centered, interactive, experiential, and reflective teaching strategies. The evaluation of the program includes satisfaction ratings, self-assessment of teaching competencies, and independent ratings of teaching effectiveness by the participants' trainees (medical students, residents, and fellows). The program is rated highly, shows significant improvements in teaching skills as measured by both participants' self assessments and independent ratings by participants' trainees, and is ongoing.     

Reflective practice in the teaching of communication skills

Reflective practice is encouraged in medical education in general and in teaching communication skills in particular to develop into a reflective practitioner. However, the term is complex to understand and multidimensional thus challenging to grasp, describe and teach. Furthermore, though used frequently little guidance exists on how to promote reflective ability in teaching communication skills. This paper builds on a keynote address delivered at the International Conference of Communication in Healthcare (ICCH 2019) and is based on the vast literature on reflection and the author’s personal experience as a researcher and educator. It discusses the components of reflective practice as well as exemplifies the importance of reflective practice to student’s capability to learn communication skills.     

Effects of expert and non-expert facilitators on the small-group process and on student performance.

At the University of Michigan Medical School in 1990, the authors investigated the effects of faculty facilitators' levels of content expertise on the educational process and learning outcomes of small-group teaching sessions. The study was conducted in a microbiology course for second-year students in which four small-group sessions were used to replace 38 hours of lecture and laboratory time. The interactions between 11 expert and ten non-expert faculty facilitators and 156 students were observed and coded. The students' levels of knowledge and satisfaction were measured. The results indicate that, although significant differences in faculty-student interactions were not observed, the students in the 11 groups led by the content experts had higher levels of satisfaction and higher examination scores.     

Strengthening clinical microbiology skill acquisition; a nationwide survey of faculty perceptions & practices on teaching & assessment of practical skills to undergraduate students

PurposeNew Competency-Based Medical Education (CBME) curriculum has emphasized on the acquisition of core competencies by an Indian Medical Graduate (IMG). Likewise ability to perform basic microbiological investigations, and diagnose infectious disease is deemed critical for a doctor of first contact. In order to prepare students to achieve these competencies, effective skill training and assessment is paramount. However, microbiology skill training is known to vary across Indian medical schools. This survey has explored faculty perceptions and current practices across the country, to suggest measures for strengthening skill acquisition. Methods: Online survey was conducted through Google form questionnaire. Faculty shared their perceptions and practices on the Likert scale about teaching, learning and assessment of microbiology skills. Results: Sixty faculty members from 58 medical colleges from 17 states of India participated. Majority of the faculty considered interpretational skills as more important than technical skills. Faculty perceptions and practices varied. Although most of the skills are being taught and assessed on one or more occasions, some important clinical microbiology skills were not assessed. Feasibility was an issue for new set of CBME competencies. Blue print and skill laboratory was adopted by 10% and 31.66% colleges respectively. Conclusions: Variation in perceptions and practices in teaching and assessment of microbiology skills in Indian context is now documented. Skill training requires a standardised and robust program with ample opportunities for practice and feedback. Faculty orientation and use of innovative strategies are overriding to augment skill acquisition and thus, successful implementation of new CBME curriculum.     

Using a database to analyze core basic science content in a problem-based curriculum.

As medical schools critically reevaluate their methods of instruction and as the number of innovative programs increases, the content delivered across disciplines must be carefully reviewed. However, few methods of content analysis have been applied to problem-based programs. In 1989-90 and 1990-91, the authors analyzed the distribution of basic science content in the 53 cases in the problem-based curriculum of Rush Medical College of Rush University. They developed a content vocabulary and created a database using a widely available computer software program. The content areas specific to each case were identified by faculty using the content vocabulary. To determine whether these content areas were actually identified by the students participating in the problem-solving sessions, the authors surveyed the 36 student participants in the classes of 1993 and 1994 and also interviewed the 15 faculty facilitators of the sessions. The surveys and interviews demonstrated that over 90% of the content areas identified by the faculty were actually covered by the students. The authors conclude that the database assists in their review of the curriculum for omission and redundancy. Other uses and limitations of this method are also discussed.     

A new way to integrate clinically relevant technology into small-group teaching.

Medical educators need to teach learners to efficiently access the best available evidence at the point of care and apply it in a patient-centered manner. As information becomes more readily available via the Internet and handheld computers, strategies to use these tools as part of the educational process become more important. New teaching skills are needed when attempting to seamlessly introduce technology into small-group settings in the midst of blending old and new teaching methods. The authors' development of a conceptual model known as "e-microskills" at the University of Connecticut School of Medicine in 2002 has facilitated the smooth integration of technology into teaching. This model's cornerstone is direct empowerment of learners during small-group sessions to perform observed searches for the best medical evidence on the Internet and with handheld computer resources. This is done in the context of a mnemonic, PEARL: (1) Choose a "Preplanned search intervention"; (2) allow learners to "Execute the search," thus committing themselves; (3) "Allow learners to teach other learners" about their search process; (4) "Review the quality of evidence" for the information found; and (5) discuss "Lessons of the search." Additional features of this teaching model include ground rules for teaching with technology that optimizes teaching time by reducing anticipated obstacles. The rules add structure in an otherwise impromptu setting thus maximizing the teachable moment. While "e-microskills" are described here within the context of a third-year family medicine clerkship, they can easily be adapted to other small-group teaching settings.     

"Advising Oliver Mann"--a case-based, small-group orientation to medical school.

In 1998, the authors implemented a new academic orientation built around a problem-based clinical exercise for entering medical students, to prepare them for a curriculum emphasizing active learning in small groups. The exercise enables students to begin their professional studies with a "hands on" understanding of two major emphases of the curriculum: (1) the process of small-group learning that will guide their medical education and (2) the principles of patient care that will guide their future practice of medicine. Called "Advising Oliver Mann," this orientation presents students with a clinical problem that they must work in small groups to solve. By collaborating in teams of ten, they become acquainted with the small-group learning methods at the heart of the school's curriculum. Through solving a clinical problem, they discover vital principles of patient care, such as the need in clinical decision making to integrate the scientific perspective with the perspective of patient and family. In developing "Oliver Mann," the authors came to realize that orientations can be much more than introductions. They can be reflective moments in a busy curriculum, a time for students and faculty to step back and take stock of important issues in education and doctoring. The authors are currently experimenting with exercises linking their freshman orientation with orientations in the second and third years so participants can reflect on the challenges of each new year and carry forward the small-group methods and practice of medicine themes of the new curriculum.