The Role of Faculty Development in Advancing Change at the Organizational Level.

ABSTRACT: Although the traditional goal of faculty development (FD) has been to enhance individual growth and development, this goal may no longer suffice to address the compelling challenges faculty members are facing, such as increasing workloads, emotional well-being, and institutional support for education. Addressing these challenges will require change at the organizational level. The purpose of this perspective is to articulate a vision for FD programming that describes ways in which FD leaders, together with other educational leaders, can bring about change at the organizational level to support excellence and innovation in health professions education. To impact the organization at large, the authors propose a model that includes 4 major goals: (1) promoting individual and group development, through educational and leadership development programs, coaching and mentoring, and advanced degrees; (2) advocating for infrastructure and resources, including academies of medical educators, educational scholarship units, educational awards, and intramural funding for educational innovation and scholarship; (3) influencing policies and procedures, by engaging educators on key committees, reviewing appointment and promotion criteria, defining educator roles and portfolios, and valuing diversity, equity, and inclusion; and (4) contributing to organization-wide initiatives, such as addressing "hot button" issues, identifying value factors that support investments in FD and medical education, and enhancing the visibility of educators. In this model, the 4 goals are dynamically interconnected and can impact the culture of the organization. For each goal, the authors offer evidence-informed actions that FD leaders, along with other educational leaders, can adopt to improve the organizational culture and inspire institutionally relevant actions. Because each institution is unique, the options are illustrative and not prescriptive. The intent is to provide examples of how FD leaders and programs can enhance the educational mission through broader engagement with their institutions.

Medical Residents' Informal Learning from Pharmacists in the Clinical Workplace.

Workplace-based interactions between residents and pharmacists, though relatively underexplored, might contribute substantially to learning. This international study sought to investigate the affordances residents use for informal learning about medications, their interactions with pharmacists and patterns of resident-pharmacist engagement, as well as residents' perceived impact of these interactions on their learning. Contextual differences between US and Dutch residency training and electronic health record (EHR) may impact informal learning about medications. We conducted a cross-sectional, online, 25-item survey study, including closed-format and open-response questions among current resident physicians (post-graduate years 1-6, from a variety of residency programs n = 803) from the University of California San Francisco, the University of Minnesota, and the University Medical Center Utrecht. Responses from 173 residents in both countries revealed that these physician trainees were afforded opportunities to engage in a wide variety of pharmacotherapy-related activities but engaged differently with social and environmental resources for support. Residents from the United States (US) utilized pharmacists and Up-To-Date, whereas Dutch residents preferentially utilized the online Dutch medication information site and EHR-embedded medication resources. US residents interacted with pharmacists significantly more frequently than Dutch residents. Pharmacists provided residents with a wide range of useful information, much of which is integrated into the medication resources in the Dutch EHR-based decision-support system. While US residents reported overwhelmingly that informal interactions with pharmacists contribute to their learning about medications, Dutch residents' responses did not confirm this. Intentionally designing residents' training to include opportunities for interactions with pharmacists could potentially positively impact residents' informal workplace learning. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01784-1.

Preliminary evidence for a Tool to Observe the Construction of Knowledge in Interprofessional teams (TOCK-IP).

Collaborative knowledge construction (KC) is an important process in interprofessional learning and a logical assessment target. A tool supporting the formative evaluation of KC behaviors ideally would be: 1) applicable to interprofessional teams of learners in clinical contexts; 2) informed by contemporary learning frameworks; 3) feasible and useful. No existing assessment tool meets these criteria. This paper describes the development and preliminary validity evidence for a Tool for Observing Construction of Knowledge in Interprofessional teams (TOCK-IP). Following literature review and needs assessment, the TOCK-IP was drafted based upon Gunawardena's five-phase KC model. Educational expert review established content validity. Response process and internal structure validity, feasibility, and utility were assessed through step-wise evaluation. Faculty raters applied the tool to four videos of simulated interactions between health professions learners. Faculty ratings were compared to expert consensus ratings. Thematic analysis of post-rating survey and debrief allowed assessment of feasibility and utility. Across videos, faculty raters' agreement was fair (n = 25; Fleiss' kappa = 0.40, <0.001). Excellent agreement (95%) was found for raters' scores compared to consensus rating. Faculty supported tool feasibility and utility. The TOCK-IP meets the three criteria for evaluating team-level KC and offers a progression roadmap to help learners move toward collaborative learning.

Preliminary Evidence Supporting a Novel 10-Item Clinical Learning Environment Quick Survey (CLEQS).

BACKGROUND: The clinical learning environment (CLE) is a priority focus in medical education. The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review's (CLER) recent addition of teaming and health care systems obligates educators to monitor these areas. Tools to evaluate the CLE would ideally be: (1) appropriate for all health care team members on a specific unit/project; (2) informed by contemporary learning environment frameworks; and (3) feasible/quick to complete. No existing CLE evaluation tool meets these criteria. OBJECTIVE: This report describes the creation and preliminary validity evidence for a Clinical Learning Environment Quick Survey (CLEQS). METHODS: Survey items were identified from the literature and other data sources, sorted into 1 of 4 learning environment domains (personal, social, organizational, material) and reviewed by multiple stakeholders and experts. Leaders from 6 interprofessional graduate medical education quality improvement/patient safety teams distributed this voluntary survey to their clinical team members (November 2019-mid-January 2021) using electronic or paper formats. Validity evidence for this instrument was based on the content, response process, internal structure, reliability, relations to other variables, and consequences. RESULTS: Two hundred one CLEQS responses were obtained, taking 1.5 minutes on average to complete with good reliability (Cronbach's α ≥ 0.83). The Cronbach alpha for each CE domain with the overall item ranged from 0.50 for personal to 0.79 for social. There were strong associations with other measures and clarity about improvement targets. CONCLUSIONS: CLEQS meets the 3 criteria for evaluating CLEs. Reliability data supports its internal consistency, and initial validity evidence is promising.

Pediatric Workplace Learning Opportunities for Medical Students: Is Scribing a Win-Win?

This study examined if preclerkship medical students would find it educational to scribe in a pediatric setting. Scribing promoted students' learning about pediatric clinical encounters enhanced their competency with electronic health record use, and moderately reduced attending physician documentation burden.

Educator Identity Formation: A Faculty Development Workshop.

Introduction: Health professions faculty members often struggle deciding on career paths balancing their identities as clinicians, educators, and scholars. Identity formation research has identified three major influences: context, roles, and agency. Identity influences career decisions and, in turn, affects engagement in medical education and faculty development. We designed a single-session workshop to foster educator identity formation. Methods: The workshop varied from 1 to 3 hours. It explored how identity develops and considered how self, role, and context could be shaped to grow and sustain identity. Participants used a handout called Identity Quakes to indicate satisfaction with their support, engagement, and empowerment. The workshop employed direct instruction to provide language and tools to scaffold conversation and self-reflection leading to future plans aligning participants' professional identities and roles with resources to support further development. Results: From 2016 to 2020, we offered the workshop to faculty members from diverse professions, including medicine, nursing, dentistry, physical therapy, and others, on 11 occasions (locally, nationally, and internationally) with audiences of 15-200 participants. At offerings that collected evaluations, the workshop received high ratings of 4.61-4.90 (very good-excellent) on a 5-point scale. Discussion: This single-session workshop is a valuable opportunity to reflect on identity, which faculty members rarely get to do formally. The Identity Quakes handout prompts participants to challenge their assumptions about their professional identities and roles, employ their agency/choice, and consider future career choices.

Selecting Instruments for Measuring the Clinical Learning Environment of Medical Education: A 4-Domain Framework.

Learning environments shape the experiences of learners and practitioners, making them an important component of program evaluation. However, educators find it challenging to decide whether to measure clinical learning environments with existing instruments or to design their own new instrument and, if using an existing instrument, which to choose. To assist educators with these decisions, the authors compared clinical learning environment instruments based on their characteristics, underlying constructs, and degree to which items reflect 4 domains (personal, social, organizational, material) from a recently developed model for conceptualizing learning environments in the health professions. Building on 3 prior literature reviews as well as a literature search, the authors identified 6 clinically oriented learning environment instruments designed for medical education. They collected key information about each instrument (e.g., number of items and subscales, conceptual frameworks, operational definitions of the learning environment) and coded items from each instrument according to the 4 domains. The 6 instruments varied in number of items, underlying constructs, subscales, definitions of clinical learning environment, and domain coverage. Most instruments focused heavily on the organizational and social domains and less on the personal and material domains (half omitted the material domain entirely). The variations in these instruments suggest that educators might consider several guiding questions. How will they define the learning environment and which theoretical lens is most applicable (e.g., personal vitality, sociocultural learning theory)? What aspects or domains of the learning environment do they most wish to capture (e.g., personal support, social interactions, organizational culture, access to resources)? How comprehensive do they want the instrument to be (and correspondingly how much time do they expect people to devote to completing the instrument and how frequently)? Whose perspective do they wish to evaluate (e.g., student, resident, fellow, attending, team, patient)? Each of these considerations is addressed.

An interaction analysis model to study knowledge construction in interprofessional education: proof of concept.

A goal of interprofessional clinical learning experiences is to facilitate learning through co-construction of knowledge in support of patient care. Yet, little is known about knowledge construction processes among health professions students working together to care for patients. Understanding knowledge construction processes can guide health professions educators in the design of interventions to support knowledge construction and high-quality learning in clinical placements. In this article, we describe findings from a proof of concept study that explores the feasibility and utility of using Gunawardena's Interaction Analysis Model (IAM) to evaluate health professions students' knowledge construction processes in clinical placements. The IAM has been used to study knowledge construction processes in computer-supported collaborative learning environments, but not in interprofessional education. The IAM describes five phases of knowledge construction - sharing/comparing; exploring dissonance; co-constructing meaning; testing; coming to agreement/applying co-constructed knowledge - each representing a progressively higher-level learning process. Application of the IAM to learner dialogue proved labor-intensive but feasible and useful as a research tool to characterize learners' knowledge construction behaviors. Our findings suggest that the IAM warrants further study and may offer a framework to guide the design of clinical placements and analysis of interprofessional learning behaviors.

Exploring current physicians' failure to communicate clinical feedback back to transferring physicians after transitions of patient care responsibility: A mixed methods study.

INTRODUCTION: After patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes. Factors associated with this communication are not well understood. This study clarifies how often, and for what reasons, current physicians do or do not communicate back to transferring physicians about transitioned patients. METHODS: In 2018, 38 physicians at two academic teaching hospitals were interviewed about communication decisions regarding 618 transitioned patients. Researchers recorded quantitative and qualitative data in field notes, then coded communication rationales using directed content analysis. Descriptive statistics and mixed effects logistic regression analyses identified communication patterns and examined associations with communication for three conditions: When current physicians 1) changed transferring physicians' clinical decisions, 2) perceived transferring physicians' clinical uncertainty, and 3) perceived transferring physicians' request for communication. RESULTS: Communication occurred regarding 17% of transitioned patients. Transferring physicians initiated communication in 55% of these cases. Communication did not occur when current physicians 1) changed transferring physicians' clinical decisions (119 patients), 2) perceived transferring physicians' uncertainty (97 patients), and 3) perceived transferring physicians' request for communication (12 patients). Rationales for no communication included case contextual, structural, interpersonal, and cultural factors. Perceived uncertainty and request for communication were positively associated with communication (p < 0.001) while a changed clinical decision was not. DISCUSSION: Current physicians communicate infrequently with transferring physicians after assuming patient care responsibilities. Structural and interpersonal barriers to communication may be amenable to change. Clarity about transferring physicians' uncertainty and desire for communication back may improve clinical feedback communication.

A Mobile Learning Module to Support Interprofessional Knowledge Construction in the Health Professions.

Objective. To develop and evaluate a mobile learning module to support knowledge construction between medical and pharmacy students through structured dialogue prompts. Methods. Rheumatologists and pharmacists collaboratively developed a two-week, case-based, asynchronous interprofessional learning module that was delivered via a mobile app and focused on collaborative medication management of a complex case involving a patient with systemic lupus erythematosus. The clinical case evolved over three phases: diagnosis, initial treatment, and medication-related complications. Dialogue prompts were incorporated in each phase as a mechanism to support knowledge construction among learners. Pharmacy and medical student pairs were randomized to receive either high guidance or low guidance prompts for collaborative learning. The student pairs worked together, asynchronously, online, to develop three collaborative care plans. The evaluation of the learning module to support knowledge construction included: analysis of text-based dialogue coded for knowledge construction phases; the accuracy and completeness of the three collaborative care plans; and quantitative and qualitative participant feedback. Results. Sixteen pairs of medical and pharmacy students (n=32) participated. Pairs who received high guidance engaged in all phases of knowledge construction more often than pairs who received low guidance. Guidance phase did not differentially impact collaborative care plan scores. Ninety-eight percent of students agreed or strongly agreed that the module improved their clinical reasoning, interprofessional communication, and knowledge of systemic lupus erythematosus. Conclusion. The knowledge construction framework can guide the design and evaluation of educational interventions such as a mobile learning module to support knowledge construction among health professionals.

A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61.

Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.

A view from the sender side of feedback: anticipated receptivity to clinical feedback when changing prior physicians' clinical decisions-a mixed methods study.

When physicians transition patients, the physician taking over may change the diagnosis. Such a change could serve as an important source of clinical feedback to the prior physician. However, this feedback may not transpire if the current physician doubts the prior physician's receptivity to the information. This study explored facilitators of and barriers to feedback communication in the context of patient care transitions using an exploratory sequential, qualitative to quantitative, mixed methods design. Twenty-two internal medicine residents and hospitalist physicians from two teaching hospitals were interviewed and data were analyzed thematically. A prominent theme was participants' reluctance to communicate diagnostic changes. Participants perceived case complexity and physical proximity to facilitate, and hierarchy, unfamiliarity with the prior physician, and lack of relationship to inhibit communication. In the subsequent quantitative portion of the study, forty-one hospitalists completed surveys resulting in 923 total survey responses. Multivariable analyses and a mixed-effects model were applied to survey data with anticipated receptivity as the outcome variable. In the mixed-effects model, four factors had significant positive associations with receivers' perceived receptivity: (1) feedback senders' time spent on teaching services (ß = 0.52, p = 0.02), (2) receivers' trustworthiness and clinical credibility (ß = 0.49, p < 0.001), (3) preference of both for shared work rooms (ß = 0.15, p = 0.006), and (4) receivers being peers (ß = 0.24, p < 0.001) or junior colleagues (ß = 0.39, p < 0.001). This study suggests that anticipated receptivity to feedback about changed clinical decisions affects clinical communication loops. Without trusting relationships and opportunities for low risk, casual conversations, hospitalists may avoid such conversations.

14 Years Later: A Follow-Up Case-Study Analysis of 8 Health Professions Education Scholarship Units.

PURPOSE: Internationally, health professions education scholarship units (HPESUs) are often developed to promote engagement in educational scholarship, yet little is known about how HPESUs change over time or what factors support their longevity. In hopes of helping HPESUs thrive, this study explored factors that shaped the evolution of 8 HPESUs over the past 14 years. METHOD: This study involved retrospective case-study analysis of the 8 American, Canadian, and Dutch HPESUs profiled in a 2004 publication. First, the research team summarized key elements of HPESUs from the 2004 articles, then conducted semistructured interviews with the current unit directors. In the first set of questions, directors were asked to reflect on how the unit had changed over time, what successes the unit enjoyed, what enabled these successes, what challenges the unit encountered, and how these challenges were managed. In the second set of questions, questions were tailored to each unit, following up on unique elements from the original article. The team used Braun and Clarke's 6-phase approach to thematic analysis to identify, analyze, and report themes. RESULTS: The histories of the units varied widely-some had grown by following their original mandates, some had significant mission shifts, and others had nearly disappeared. Current HPESU directors identified 3 key factors that shaped their HPESU's longitudinal development: the people working within and overseeing the HPESU (the need for a critical mass of scholars, a pipeline for developing scholars, and effective leadership), institutional structures (issues of centralization, unit priorities, and clear messaging), and funding (the need for multiple funding sources). CONCLUSIONS: Study findings offer insights that may help current HPESU directors to strategically plan for their unit's continued development. Tactically harnessing the factors identified could help directors ensure their HPESU's growth and contend with the challenges that threaten the unit's success.

Reflections From the Rearview Mirror: Internal Medicine Physicians' Reactions to Clinical Feedback After Transitions of Responsibility.

PURPOSE: Learning from practice is important for continuous improvement of practice. Yet little is known about how physicians assimilate clinical feedback and use it to refine their diagnostic approaches. This study described physicians' reactions to learning that their provisional diagnosis was either consistent or inconsistent with the subsequent diagnosis, identified emotional responses to those findings, and explored potential consequences for future practices. METHOD: In 2016-2017, 22 internal medicine hospitalist and resident physicians at Oregon Health & Science University completed semistructured interviews. Critical incident prompts elicited cases of patient care transitions before the diagnosis was known. Interview questions explored participants' subsequent follow-up. Matrix analysis of case elements, emotional reactions, and perceived practice changes was used to compare patterns of responses between cases of confirming versus disconfirming clinical feedback. RESULTS: Participants described 51 cases. When clinical feedback confirmed provisional diagnoses (17 cases), participants recalled positive emotions, judged their performance as sufficient, and generally reinforced current approaches. When clinical feedback was disconfirming (34 cases), participants' emotional reactions were mostly negative, frequently tempered with rationalizations, and often associated with perceptions of having made a mistake. Perceived changes in practice mostly involved nonspecific strategies such as "trusting my intuition" and "broadening the differential," although some described case-specific strategies that could be applied in similar contexts in the future. CONCLUSIONS: Internists' experiences with posttransition clinical feedback are emotionally charged. Internists' reflections on clinical feedback experiences suggest they are primed to adapt practices for the future, although the usefulness of those adaptations for improving practice is less clear.

Bioavailability testing of a newly developed clindamycin oral suspension in a pediatric porcine model.

Background: Clindamycin's bitter taste and odor is known to affect treatment adherence in children. Recently, a formulation of clindamycin HCl complexed with ion exchange resin IRP 69 was shown to mask the bitter taste. Because of the potential benefit of this formulation for children, a pilot study using a porcine model was conducted to evaluate its relative bioavailability. Methods: A randomized two-way crossover study design using six (n = 6) healthy male piglets 10-12 kg was used to evaluate the absorption profiles and pharmacokinetic parameters of clindamycin from the resinate complex formulation (Test) compared to a commercialized reference suspension. A dose of 15 mg/kg was administered orally by gastric gavage to each piglet followed by repeated blood sampling over 12 h. A wash-out period of 48 h occurred between treatments. Plasma concentration vs. time data was analyzed by non-compartmental analysis. Results: The mean relative bioavailability of clindamycin from the resinate formulation was 78.8%. A two-tailed, paired Student t test yielded a p < 0.05 for AUC∞ and Tmax parameters. A two one-sided test (TOST) suggested a difference in AUC∞ and Cmax for the Test formulation compared to the reference formulation according to the FDA's criteria for bioequivalence. Conclusion: The bioavailability of clindamycin from this novel oral formulation supports continued evaluation of the drug in humans for potential pediatric applications.

Conceptualizing Learning Environments in the Health Professions.

The learning environment (LE) is an important and frequently discussed topic in the health professions education literature. However, there is considerable inconsistency in how the LE is defined and described. The authors propose a definition of the LE and a conceptual framework to facilitate health professions educators in understanding, studying, and designing interventions to improve the LE. To arrive at this conceptual framework, the authors employed a living systems perspective that draws on various frameworks and theories, including ecological psychology, workplace learning, situated cognition, and sociomateriality theory. The conceptual framework identifies five overlapping and interactive core components that form two dimensions: the psychosocial dimension and material dimension. The psychosocial dimension comprises three components: the personal, social, and organizational. Intertwined with the psychosocial dimension at each level is the material dimension, which encompasses physical and virtual spaces. This theoretical lens can facilitate identifying and analyzing problems in the LE and guide development of interventions to mitigate them. The authors conclude with several practical suggestions for health professions educators, investigators, and editors.