Building and Developing Our Team

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Building and Developing Our Team

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

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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

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Loss of Faculty Vitality
Ludmerer, Bland

• 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

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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

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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

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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

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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

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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

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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

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Networks and Teams that Support Teachers

• - 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

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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

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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

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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

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Collaborative Clerkship Team

• Meet regularly
• Develop and refine objectives
• Share teaching ideas and materials
• Design and review assessment tools
• Review performance results

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A Range of Programs Targeted to Needs

• Organizational leaders committed to education

• Educational scholars

• Educational leaders
• innovators

• Effective teachers

• New teachers residents

Wilkerson Irby, Acad Med, 1998
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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.
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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
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Is Education a Valued Contribution?
Beasley Wright, JAMA, 1997.
Ranking 1 most important
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Two Strategies for Increasing the Value of
Education

• Making education required and visible.
• Educators Portfolio
• Working to revise the promotion system
• Creating new tracks or revising criteria

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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

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Educational Portfolios
Simpson, Hafler, Brown, Wilkerson, Acad
Med,2004.

• 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

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UCLA Dossier

• Personal statement intended to make a case for
  ones 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

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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

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Clinical Tracks
Jones Gold, Acad Med, 1998

• 91 (73) of medical schools have 1 or more
  clinical tracks
• Teaching
• Clinical service
• 64 require scholarship defined broadly

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Clinical Series University of California
Howell Bertakis, Acad Med, 2004.

• Clinical X A series for clinical educators and
  investigators added in early 1980s
• 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 1990s
• No research/creative requirement
• Clinical teaching
• No 7-year limit

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Scholarship in Education
Integration
Discovery
Teaching
Application
Boyer, Scholarship Reconsidered, 1990
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Scholarship of Discovery

• What is yet to be found?
• research in clinical teaching
• educational outcome studies
• Morrison EH et al. Reliability and validity
  of an Objective Structured Teaching Exam for
  Generalist Resident Teachers. Acad Med, 77S29-32

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Scholarship of Integration

• What do these various findings mean when taken
  together?
• textbooks
• review articles
• CME review courses

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Scholarship of Application

• How can knowledge be applied to solve
  consequential problems?
• Shrank, Reed Jernstedt, Fostering
  Professionalism in Medical Education A Call for
  Improved Assessment and Meaningful Incentives.
  JGIM, 2004.

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Scholarship of Teaching

• How can knowledge be transformed for the
  learners?
• New courses and rotations
• Cases for problem-based learning
• On-line learning modules

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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

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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