A randomised controlled study of role play in a faculty development programme.

BACKGROUND: The Stanford Faculty Development Center at Stanford University has developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model. AIMS: This study was designed to investigate the relative impact of role playing as an instructional technique within that course for facilitating change in teaching behaviours. METHOD: From January 2009 to April 2010, six faculty development courses were delivered at Uppsala University Hospital to 48 physicians from different departments. The standard course presentation includes a range of instructional methods including short lectures, small group discussion, review of video re-enactments, role-play exercises and personal goal setting. For this study, participants were randomised to participate in (1) a 'standard' course with role play or (2) an 'alternative' course with no role play. The effects of the course on teaching performance were assessed with retrospective pre- and post-course self-ratings of 29 specific teaching behaviours. RESULTS: Self-assessment ratings indicated significantly greater positive changes in teaching behaviour among faculty who attended the standard course (with role play) as compared to those in the alternative course (p = 0.015). CONCLUSIONS: This study validates the commonly held view that role play is a useful instructional method for improving teaching.

Physician confidence and interest in learning more about common geriatric topics: a needs assessment.

OBJECTIVE: To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics. DESIGN: Written survey. SETTING: Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP). PARTICIPANTS: Seven hundred and fifty-eight physicians (547 ACP members, 211 AAFP members). MEASUREMENTS: For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five-point Likert scale. RESULTS: Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee-for-service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r =.44, P <.0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified. CONCLUSIONS: These findings provide useful information on the physician-learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.

Regional teaching improvement programs for community-based teachers.

PURPOSE: Community-based clinical teachers provide an important cadre of faculty for medical education. This study was designed to examine the feasibility and value of an American College of Physicians-sponsored regional teaching improvement program for community-based teachers. SUBJECTS AND METHODS: We conducted five regional (Connecticut, New Hampshire/Vermont, New York, Ohio, and Virginia) 1- to 2-day teaching-improvement workshops for 282 faculty (49% community based, 51% university based). The workshops were conducted by regional facilitators trained by the Stanford Faculty Development Program using large group and small group instructional methods to teach participants a framework for analyzing teaching, to increase their repertoire of teaching behaviors, to define personal teaching goals, and to identify the educational needs of their teaching site. Participants used Likert ratings [1 (low) to 5 (high) scale] to assess workshop quality, facilitator effectiveness, and rewards for and barriers to teaching in their clinics. Using retrospective pre- and postintervention ratings, participants also assessed workshop impacts on teacher knowledge, attitudes, and skills. Finally, participants completed open-ended questions to identify recommended changes to improve their clinic as an educational site for students and residents. RESULTS: At all sites, participants evaluated the program as highly useful (4.6 +/- 0.6, mean +/- SD). Participants' ratings indicated that the program had a positive effect on their knowledge of teaching principles (4.0 +/- 0.9), an increase in their teaching ability (P <0.001), and an increase in their sense of integration with their affiliated institution (P <0.001). CONCLUSIONS: Regional training of university and community faculty can be an effective way of promoting the improvement of teaching and the collaboration between community-based teachers and academic centers. National physician organizations and regionally based facilitators can provide important resources for the delivery of such training.

Factorial validation of a widely disseminated educational framework for evaluating clinical teachers.

PURPOSE: To examine an instrument for evaluating clinical teaching using factor analysis and to refine the validated instrument to a practical length. METHOD: Factor analysis on a split sample of 1,581 student evaluations rating 178 teachers. The instrument was based on the seven-category Stanford Faculty Development Program's (SFDP's) clinical teaching framework and contained 58 Likert-scaled items, with at least seven items per category plus five items measuring "teacher's knowledge." Standard methodology for survey item reduction was used to remove items with low or complex factor loadings and iteratively remove items with low item-scale correlation. Results were replicated on the second sample. RESULTS: The seven original categories emerged and items originally categorized under "knowledge" statistically combined with "promoting self-directed learning." Over 73% of the variance was explained. Item reduction resulted in 25 items with overall internal consistency over .97 and internal consistency of constructs ranging from .82 to .95. CONCLUSIONS: Factor analysis of student ratings validated the seven-category SFDP framework. An abbreviated instrument to measure the seven categories is described. Results suggest that students may not systematically distinguish between their teachers' knowledge and their teachers' ability to promote self-directed learning, an important finding for both administrators and faculty development programs.

A pilot study of faculty development for basic science teachers.

PURPOSE: Relatively little research has focused on faculty development methods that assist basic science teachers to improve their instructional skills. This study was designed to assess the effectiveness for basic science faculty of a faculty development seminar series that had been previously shown useful for clinical teachers. METHOD: The Stanford Faculty Development Program's seminars on clinical teaching were adapted for basic science instruction. Eight pathology faculty participated in a series of nine small-group seminars designed to provide teachers with knowledge of a framework for analyzing teaching and identifying areas for improvement, and skill-based training in specific teaching behaviors. Each seminar included (1) brief lectures, (2) review of videotaped reenactments of teaching interactions, (3) role-play exercises with videotape review, and (4) formulation of personal and departmental teaching goals. RESULTS: Program evaluation included multiple measures: participant self-assessment, student ratings of the participants, and blinded ratings of pre- and post-seminar videotapes of participants' classroom teaching. All measures indicated a positive effect of the intervention. CONCLUSION: Faculty development programs have significant potential to enhance basic science instructors' teaching effectiveness.

Beneficial and harmful effects of augmented feedback on physicians' clinical-teaching performances.

PURPOSE: To evaluate whether clinical-teaching skills could be improved by providing teachers with augmented student feedback. METHOD: A randomized, controlled trial in 1994 included 42 attending physicians and 39 residents from the Department of Medicine at the Indiana University School of Medicine who taught 110 students on medicine ward rotations for one-month periods. Before teaching rotations, intervention group teachers received norm-referenced, graphic summaries of their teaching performances as rated by students. At mid-month, intervention group teachers received students' ratings augmented by individualized teaching-effectiveness guidelines based on the Stanford Faculty Development Program framework. Linear models were used to analyze the students' mean ratings of teaching behaviors at mid-month and end-of-month. Independent variables included performance ratings, intervention status, teacher status, teaching experience, and interactions with baseline ratings. RESULTS: Complex interactions with baseline performance were found for most teaching categories at mid-month and end-of-month. The intervention-group teachers who had high baseline performance scores had higher student ratings than did the control group teachers with similar baseline scores; the intervention group teachers who had low baseline performance scores were rated lower than were the control group teachers with comparable baseline scores. The residents who had medium or high baseline scores were rated higher than were the attending physicians with comparable baseline scores; the performance of the residents who had low baseline scores was similar to that of the attending physicians with comparable baseline scores. CONCLUSION: Baseline performance is important for targeting those teachers most likely to benefit from augmented student feedback. Potential deterioration in teaching performance warrants a reconsideration of distributing students' ratings to teachers with low baseline performance scores.

Clinical teaching improvement: past and future for faculty development.

Faculty development programs have focused on the improvement of clinical teaching for several decades, resulting in a wide variety of programs for clinical teachers. With the current constraints on medical education, faculty developers must reexamine prior work and decide on future directions. This article discusses 1) the rationale for providing faculty development for clinical teachers, 2) the competencies needed by clinical teachers, 3) the available programs to assist faculty to master those competencies, and 4) the evaluation methods that have been used to assess these programs. Given this background, we discuss possible future directions to advance the field.

Impact of a clinical preventive medicine curriculum for primary care faculty: results of a dissemination model.

BACKGROUND: This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States. METHODS: The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise. RESULTS: Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics. CONCLUSIONS: The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.

Improving clinical teaching. Evaluation of a national dissemination program.

This study assessed a dissemination approach to improve clinical teaching. We hypothesized that (1) physicians from a variety of institutions nationwide could be trained to conduct teaching improvement seminars for faculty colleagues; (2) such seminars would be perceived as highly useful; (3) pre/post self-evaluations by faculty participants and evaluations of faculty participants by house staff/students would indicate improved teaching performance. Selected medical faculty completed 1 month of facilitator training at the Stanford Faculty Development Program, Palo Alto, Calif. They then delivered teaching improvement seminars for other faculty. From 1986 to 1988, 12 facilitators from 12 institutions trained 107 faculty at their home institutions in their initial seminar series. Their seminars were rated as highly useful by participants. Both faculty self-assessments and house staff/student ratings indicated improved teaching performance. We concluded that this dissemination approach provides one possible mechanism for ongoing teaching improvement within institutions across the country.