Building and Developing Our Team

LuAnn Wilkerson, Ed.D.David Geffen School of Medicine at UCLA

Objectives

Consider the role that faculty development plays in revitalizing an organization

Identify the components of a comprehensive faculty development program and examples of “best practices” for each component Opportunities for networking Programs to meet a diversity of needs Institutional environment that values teaching

Loss of Faculty Vitality Changes in academic medicine are threatening the

environment for learning Individual faculty are under increased time

pressures Increasing clinical productivity demands Loss of time for academic collaboration

Academic Health Centers are focused on survival Increasing emphasis on the business of medicine Deterioration in the work environment Increasing regulation Lack of a vision by institutional leadership that encompasses

education

Ludmerer, Bland

Faculty Development is a Tool for Renewal

Commonwealth Fund Task Force of AHCs, 2002

IOM, Health Professions Education, 2003 Blue Ridge Academic Health Group, 2003 AAMC Institute for Improving Med Education,

2004

Envisioning the Future of Academic Health Centers

Commonwealth Fund Task Force on AHCs, 2003

Invest in training faculty as educators Develop systems of performance

measurement that promote continuous improvement in education

Reforming Medical Education: Urgent Priority for AHCs

Blue Ridge Academic Health Group, 2003

Make education an explicit, manifest priority Devote more and better resources to

teaching the clinical transaction Develop a budget for education Develop a core of faculty with education

expertise

Educating Doctors to Provide High Quality Medical Care

AAMC Institute for Improving Medical Education, 2004

Develop and support a cadre of teaching faculty Require participation in orientation programs on

curricular goals & competencies Ensure that all students are exposed to the

outstanding clinical faculty

What is faculty development?

Programs, leaders, and resources to:

Assist individual faculty in acquiring the knowledge, skills and values needed to succeed in their academic roles

Create a productive institutional environment for learning in which teaching is visible, valued and rewarded

Designing a Comprehensive Faculty Development Program

1. Networks and teams to support teachers

2. Faculty development programs targeted to identified teaching needs

3. An organizational climate that values excellence in education

- Faculty continue to report a lack of opportunity to learn how to teach.

- They feel unsupported in their work as teachers.

+ Satisfied faculty report having a network of productive colleagues who share a common vision

Networks and Teams that Support Teachers

Examples of Networks and Teams to Support Teachers A Learning Community for excellent teachers

Common goal is to foster a culture of learning. The work of all members is valued. Discussion is the medium for formulating a

shared understanding. Offices of educational development and

evaluation Clerkship site director teams

An Academy of Medical EducatorsUniversity of California, San Francisco

Creates a network of excellent teachers using a peer-reviewed process

Encourages interdisciplinary collaboration Provides small grants for innovation Sponsors an annual education day to

display best work Facilitates mentoring of new teachers

UCLA Center for Educational Development & Support

Provides professional consultation to faculty members

Faculty development Curriculum development Course and faculty evaluation Instructional design and technology Interdisciplinary course support

Conducts educational research in partnership with faculty

Collaborative Clerkship Team Meet regularly Develop and refine

objectives Share teaching ideas

and materials Design and review

assessment tools Review performance

results

A Range of Programs Targeted to Needs

• Educational leaders & innovators

•New teachers & residents

•Effective teachers

• Educational scholars

•Organizational leaders committed to education

Wilkerson & Irby, Acad Med, 1998

What do we know about improving teaching skills?

Multifaceted programs of 12 - 14 hours over 2+ days

Resources targeted to identified needs Individual consultation and feedback Reminder systems

Wilkerson & Irby, Acad Med, 1998.

Needs of New Faculty as Teachers

Understand the educational goals of the school Know values, norms, and expectations for

teaching Identify opportunities to teach Develop basic teaching skills Understand the promotion process Connect with senior mentors for teaching and

scholarship

Mentoring for New Faculty Mayo Medical School

Assignment of an experienced faculty member to a new faculty

An individualized plan to optimize academic success

Regular review

Needs of Effective Clinician Educators Teach during patient care

Outpatient clinics Hospital wards

Facilitate case-based discussions Give effective presentations Evaluate learning and give feedback Use information technology to support

teaching and patient care

Outpatient Teaching Workshops 4 evening CME workshops with dinner Topics:

Creating Shared Expectations The One-Minute Preceptor Arrows in the Quiver: Strategies for Teaching

with Patients Evaluation and Feedback

Educational Topics in Departmental Conferences In grand rounds

Highlight work of departmental educators Invite national figures in education

In resident conferences In faculty meetings Through awards for resident and student

education

Needs of Educational Leaders & Innovators

Understand how people learn Identify and respond to learning problems Analyze innovations in medical education

Plan a curriculum Set learning objectives Select appropriate teaching methods Evaluate learning

Manage the curricular change process

APGO / Solvay Scholars

Format: 8-day course over 3 sessions Purpose: develop faculty leaders for ob/gyn education Topics:

Teaching Skills Program administration Educational research

Needs of Clinician Educator Researchers

Review the educational literature Design educational research and

evaluation studies Collect and analyze data Write and present results Develop professional networks in

education

Fellowship in EvaluationMedical College of Wisconsin

Format: One-year, part time Purpose:

Build a network of colleagues Develop skills in educational research and

writing Participate in “works in progress” seminars

Participants: 6-8 faculty a year Outcomes: publications and presentations on

medical education

An institutional environment in which teaching is valued

Frequent communication and group cohesiveness

Adequate and fair salary structure Credit for inquiry, innovation, &

scholarship in teaching Quality improvement system Individual empowerment Open to learning and change

Bland et al, Acad Med, 2002

Is Education a Valued Contribution?

0123456789

1011

CEDept ChairCommittee

Ranking: 1 = most important

Beasley & Wright, JAMA, 1997.

Two Strategies for Increasing the Value of Education

Making education required and visible. Educator’s Portfolio

Working to revise the promotion system Creating new tracks or revising criteria

Making Education Visible: The Portfolio

A portfolio is a systematic collection of information documenting expertise in an

area, usually incorporating multiple sources of information collected over time to

demonstrate excellence

Educational Portfolios

64% of medical schools have a portfolio with at least 3 of the following: Teaching Advising Curriculum development Educational administration Honors/Awards Teaching evaluation: student, resident, peer Evidence of dissemination of innovations Personal statement, e.g., philosophy, goals, etc. Assessment of learning outcomes

Simpson, Hafler, Brown, & Wilkerson, Acad Med,2004.

UCLA Dossier Personal statement intended to make a case for one’s

accomplishments: why, what, impact, quality. Teaching Record, i.e., term, enrollment, role Other Teaching Activities, i.e., grand rounds Mentorship and Advising Honors and Special Recognition Professional Activities, i.e., societies, invited talks Summarized student/resident evaluations Peer evaluations Bibliography

Working to Revise the Promotion System

Creation of Clinical series Redefinition of scholarship Requirement for peer review of teaching Systematic collection of teaching evaluations

with comparative reports

Clinical Tracks 91 (73%) of medical

schools have 1 or more clinical tracks Teaching Clinical service

64 require scholarship defined broadly

Jones & Gold, Acad Med, 1998

Clinical Series University of California

Clinical X: A series for clinical educators and investigators added in early 1980’s

Broadly defined scholarship Classroom and clinical teaching Academic Senate membership 7-year limit

Salaried Clinical: a series for clinical service and teaching added in the early 1990’s

No research/creative requirement Clinical teaching No 7-year limit

Howell & Bertakis, Acad Med, 2004.

Scholarship in EducationScholarship in Education

Integration

Teaching

Discovery

Application

Boyer, Scholarship Reconsidered, 1990

Scholarship of Discovery What is yet to be found?What is yet to be found?

research in clinical teachingresearch in clinical teaching educational outcome studieseducational outcome studies

Morrison EH et al. Reliability and validity of an Morrison EH et al. Reliability and validity of an Objective Structured Teaching Exam for Objective Structured Teaching Exam for Generalist Resident Teachers. Generalist Resident Teachers. Acad MedAcad Med, , 77:S29-3277:S29-32

Scholarship of IntegrationScholarship of Integration

• What do these various findings mean when taken What do these various findings mean when taken together?together?

textbookstextbooks

review articlesreview articles

CME review coursesCME review courses

Scholarship of ApplicationScholarship of Application

• How can knowledge be applied to solve How can knowledge be applied to solve consequential problems?consequential problems?

Shrank, Reed & Jernstedt, Fostering Shrank, Reed & Jernstedt, Fostering Professionalism in Medical Education: A Call for Professionalism in Medical Education: A Call for Improved Assessment and Meaningful Incentives. Improved Assessment and Meaningful Incentives. JGIMJGIM, 2004., 2004.

Scholarship of TeachingScholarship of Teaching

• How can knowledge be transformed for the How can knowledge be transformed for the learners?learners?

New courses and rotationsNew courses and rotations

Cases for problem-based learningCases for problem-based learning

On-line learning modulesOn-line learning modules

Other Ideas for Clinical Tracks Levinson & Rubenstein, Acad Med, 2000

Eliminate national reputation requirement Establish & support Clinical Education Researchers

Beasley & Wright, JGIM, 2003 Increase protected time for creative work Increase senior mentorship for teaching & research “take charge of their own promotion”

Beckman et al, JGIM, 2004 Improve measures of clinical teaching

Designing a Comprehensive Faculty Development Program

1. Create networks and teams to support teachers

2. Provide faculty development resources targeted to identified teaching needs

3. Develop an organizational climate that values excellence in education