Faculty development of medical educators: Training evaluation and key challenges

Howard University College of Medicine.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

East Tennessee State University James H. Quillen College of Medicine.

University of New Mexico School of Medicine

Keck School of Medicine of the University of Southern California

As one of the first generation medical education pioneers, Charles W. Dohner, PhD established the ninth office of medical education at the University of Washington (UW) where he served as chairman from 1967-1996. With a background in education and measurement, he focused his work on evaluation of educational programs and faculty development. The Department of Medical Education went through three distinct stages of development: pathfinding 1967-1972 focused on developing working relationships with the faculty and clarifying identity, integration into academic affairs 1972-1980, and direct leadership by department faculty 1980-1996. Dohner helped to create and evaluate the WAMI program, a regional medical education program for the states of Washington, Alaska, Montana, and Idaho. He served as a consultant to a specialty board, the founding president of the Society of Directors of Research in Medical Education, and a frequent consultant in international medical education. Dohner identified three important innovations in medical education: educators in academic medicine, simulations and performance assessment, and community-based medical education. Success factors for professional education include technical competence in education, interpersonal communication and collaboration skills, a plan for personal growth, and use of mentors. Future trends in medical education will involve information technology, professionalism, wellness and complementary medicine, and performance assessment. He has been a passionate spokesman for excellence in medical education and most noted for his roles as an evaluator, program developer, and mentor of academic leaders.

University of Miami Leonard M. Miller School of Medicine

Louisiana State University Health Sciences Center School of Medicine at New Orleans

University of Missouri School of Medicine in Columbia

The University of Kansas School of Medicine.

Medical Education Program Highlights The University of Nevada, Reno School of Medicine (UNR Med) combines research-intensive, cutting-edge biomedical sciences with community-based clinical education to create a unique medical school experience for students and faculty. Our mission is to improve the health and well-being of all Nevadans and their communities. Highlights of our program include: The required immersive experience in rural health care provides students with an opportunity to engage in the full range of clinical and community health issues experienced by physicians in communities with limited resources and access to specialty care. This provides an opportunity to increase students’ clinical skills, knowledge, problem-solving, and decision-making skills while learning firsthand the unique aspects of life and health care in our state’s rural and frontier areas. UNR Med has a major emphasis on encouraging our future physicians to embrace their role as teachers. Our yearlong Teaching in Medicine elective is taken by nearly the entire class of graduating students, giving them an opportunity to provide education, guidance, and mentorship to their junior colleagues, while developing the skills needed to step into their new teaching role as resident physicians. The Student Outreach Clinic is a student-run, voluntary experience founded by students at UNR Med more than 30 years ago. It continues to thrive as a place for students to provide a valuable service to the community, learn from early hands-on experience, and develop the administrative and leadership skills that are increasingly required of physicians. With general medicine, pediatric, women’s health, geriatric, and dermatologic clinics, the Student Outreach Clinic has expanded its impact in the underserved Reno health care community. Curriculum Curriculum description UNR Med has a traditional 4-year curriculum with 2 years of biomedical sciences education, enhanced by clinical experiences, followed by 2 years of fully immersive clinical education. Year 1 includes 40 weeks of instruction across 5 organ systems–based blocks. The Practice of Medicine (POM) course serves as the introduction to clinical skills course and runs concurrently with the blocks in the fall and spring. POM includes weekly community-based ambulatory care experiences for every student. Year 2 includes 31 weeks of instruction across 5 additional blocks in which students revisit the organ systems introduced in Year 1, but with an emphasis on pathophysiology. The Advanced Clinical Skills course runs concurrently with the blocks for both fall and spring and includes a second longitudinal community-based ambulatory care experience. The Context of Patient Care course serves as a transition between Years 2 and 3 where students receive exposure to the full spectrum of patient care including health policy, patient safety, public health, and preventative medicine. This course also prepares students for their clerkship experiences with further emphasis on clinical skills and understanding their role as third-year clerks. Year 3 marks the transition to the clinical phase of the medical education program. Students rotate through 7 required clerkships over 48 weeks. Additionally, students are provided an opportunity for a 4-week selective experience that is designed for career exploration. Ongoing clinical skills development is done in the longitudinal Clinical Reasoning in Medicine course. The third year also offers an opportunity for select students to have an early experience in rural health by completing their internal medicine and pediatrics clerkships in Elko, Nevada. Year 4 includes 32 weeks of electives, in addition to the required 4-week Advanced Clinical Experience in Rural Health course. All graduates of UNR Med are required to have an immersive clinical rural health experience in either the third or fourth year. See Supplemental Digital Appendix 1—Curriculum Overview—at https://links.lww.com/ACADMED/A964. Curriculum changes since 2010 Our preclerkship curriculum underwent a substantial reform in academic year 2012–2013. After an extensive evaluation of the prior curricular structure, the Medical Education Steering Committee adopted a plan to transition from a discipline, course-based structure to an integrated organ systems–based approach. This included transition to a centralized management system through the Office of Medical Education. This structure continues presently, however, following a recent whole curricular review, discussions have begun regarding the next phase of reform. The clerkship curriculum underwent a significant change in academic year 2017–2018 with the introduction of 2 new required 4-week experiences each, in neurology and selectives (career exploration). To accommodate these new experiences, 2 existing clerkships (internal medicine and surgery) were shortened from 12 to 8 weeks each. For much of our 50-year history, UNR Med was the sole MD-granting institution in the state of Nevada. As public medical education has expanded in our state, it has afforded us an opportunity to focus our resources in Northern Nevada, where the school is based. In academic year 2018–2019, UNR Med ceased the operation of clerkships at the Las Vegas campus and transitioned all student clerkship rotations to the Reno campus. Since 2010, our class size has increased from 62 to 70 students. This increase in class size did not substantially change our structure but rather was an expansion to fill preexisting available teaching capacity. Assessment Our medical education program objectives were last revised in 2017. With this revision, we transitioned from objectives based on the ACGME domains of competence to objectives based on the Physician Competency Reference Set. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A964. With the transition to a systems-based curriculum for the preclinical phase of the MD program, several new assessment methodologies were introduced. Integration of assessments associated with new pedagogical approaches including team-based learning as well as small-group and case-based activities Weekly formative self-assessments of foundational biomedical science content Assessment strategies to leverage the available technology of a newly constructed high-fidelity simulation center Expansion of clinical assessments using standardized patients in Years 1–3 using technology in the newly constructed standardized patient center Pedagogy We use multiple pedagogical approaches to achieve our medical education program objectives, which we have expanded and diversified since 2010. Changes include the expansion of peer teaching in Years 1 and 2 clinical courses, simulations integrated into preclinical courses and clerkships, addition of case-based learning and team-based learning, expansion of the use of standardized patients in Years 1–3, and an emphasis on self-directed learning. Other ongoing pedagogical approaches include: Hands-on clinical experiences in ambulatory and inpatient settings Small- and large-group discussions Laboratory-based experiences for pathology and microbiology as well as traditional cadaver and digital dissection in anatomy Lecture, with an increasing emphasis on enhanced, interactive sessions Early clinical preceptorship experiences Self-directed learning/tutorial Simulations Clinical experiences As a community-based medical school, we work closely with our local and regional affiliates to provide a comprehensive clinical education. Students rotate through each of the local hospitals, including the VA hospital. Our UNR Med clinical practices as well as private physician offices and outpatient practices affiliated with the major local health systems serve as clinical training sites for our required and elective experiences. Students have their first formal clinical experience within weeks of matriculation, when they perform interviews with volunteers who share their personal stories as patients. They work weekly with standardized patients and, beginning in the spring semester of the first year, students participate in weekly community-based ambulatory preceptorships. While we do have major health system partners, including the local VA medical center, we do not own a hospital or major health system. As a community-based medical school, we rely on our community partners to provide clinical experiences. Nearly all of our required clinical experiences as well as our electives are based in part or entirely at our inpatient and outpatient community sites. The most significant challenge in designing and implementing clinical experiences for our medical students is the availability of clinical training sites. The community-based nature of our program also brings challenges in ensuring consistent experiences for our students, who learn at a variety of locations with a variety of clinical faculty members. Curricular Governance Our bylaws designate the Medical Education Steering Committee (MESC) as the main curriculum committee with authority for overall design, management, and evaluation of the undergraduate medical education program. Two committees serve under the MESC: the Years 1–2 Curriculum Committee and Years 3–4 Curriculum Committee are responsible for the creation, implementation, coordination, and evaluation of the preclerkship and clerkship/elective phases, respectively. There is close collaboration with the departments for the management of the curricular content and assessments. Budget management for teaching is divided between the Office of Medical Education, which provides salary support for defined administrative and leadership roles in the curriculum (e.g., clerkship director), and the academic departments, which provide the academic time for faculty to engage in teaching. Education Staff Reporting to the dean, the senior associate dean for academic affairs leads the academic programs of the School of Medicine, including GME, UME, and admissions and student affairs. The UME program is led by the associate dean for medical education, who has broad oversight and responsibility for the curriculum of the MD program. The associate dean does not have direct oversight or responsibility for students before matriculation, nor those in GME programs. The associate dean for admissions and student affairs, in collaboration with the associate dean for medical education, is responsible for learner support through the Learning and Wellness Resource Center (LWRC), which includes the learning specialists. The LWRC, in collaboration with the teaching faculty and the staff of the Office of Medical Education, tracks the academic progress of all students from matriculation to graduation and ensures provision of comprehensive support services, as needed. Reporting to the dean, the senior associate dean for faculty oversees faculty development activities. Ongoing faculty development needs are determined collaboratively with the Office of Medical Education to ensure alignment with best practices in medical education. The Office for Faculty and the Office of Medical Education partner to deliver effective faculty development across a broad range of topics. The Office of Medical Education provides administrative support for the implementation and delivery of the curriculum at all levels. The director of curriculum development and assessment manages the systems-based blocks that make up the preclinical phase of the curriculum. Foundational science content is taught by a combination of basic science and clinical science educators. Faculty Development and Support in Education Our school offers a range of faculty development opportunities to enhance teaching effectiveness, research, and scholarship as well as leadership development. This is accomplished through orientations, workshops, longitudinal faculty development courses, and individual consultations. UNR Med supports programs and departments by facilitating retreats and offering targeted training activities: The Association of College and University Educators program provides training in educational best practices. The Academy for Development in Academic Medicine program provides education and mentoring for graduate students and residents interested in careers in academic medicine. Faculty interest groups such as Women in Medicine are supported. The Faculty Development Funding program provides research and professional development funding opportunities to all academic and administrative faculty members. Teaching and educational activities are included in the evaluation criteria for promotion and tenure decision at UNR Med in all tracks; however, they are particularly emphasized as a metric in the clinical educator track.

University of North Dakota School of Medicine and Health Sciences.

The authors present an overview of the educational programs, infrastructure to support them, and the assessment strategies of 128 medical schools in the United States and Canada, based on reports submitted by those schools and published in this supplement to Academic Medicine. The authors explore many important changes that have occurred since the publication of the Flexner Report in 1910 as well as the progress that is evident since a similar collection of medical school reports was published in September 2000, also as a supplement to Academic Medicine. Drawing on the reports, the authors summarize, among other topics, the advances that have taken place in the support for faculty, the funding of medical student education, changes in pedagogy and assessment, and the expansion of medical education to distributed models and regional campuses.The authors observe that the reports from the 128 schools illustrate that medical student education has undergone and continues to undergo substantive change, has advanced markedly since the reforms stimulated by the Flexner Report, and has continued to evolve during the past decade. The reports illustrate the strength of support for the educational programs, even in a time of financial constraints, and the increasing recognition of the scholarly contributions of faculty through teaching. The authors provide examples of the changes in pedagogy and new topics in the required curriculum in the past decade and describe selected highlights of the 128 educational programs.

Value-added medical education: engaging future doctors to transform health care delivery today.

Beginning in March 2020, the COVID-19 pandemic disrupted1 in-person medical education programming and required a rapid change in program delivery formats to ensure resident and faculty access to education programs.2 In this article we describe the experience and lessons learned by one institution, the Michigan State University College of Osteopathic Medicine (COM) Statewide Campus System (SCS) or MSUCOM SCS, as it transitioned from traditional in-person educational course offerings to a virtual format.Since 1989, MSUCOM SCS has delivered educational lectures, skills labs, and simulation training for community-based hospital graduate medical education (GME) residency programs.3–5 Within 72 hours of the pandemic shutdown of university, hospitality, and simulation facilities, like many other teaching institutions across the nation, MSUCOM SCS was able to transition resident and faculty education programs to the virtual learning environment, with little disruption to the content delivered. This article will review specific case examples that provide guidance for the transition to a virtual platform.With the onset of the pandemic, educational programming has been largely either postponed or converted to online formats to ensure compliance with COVID-19 safety requirements. Our experience with this transition has suggested that the pandemic is driving a paradigm shift in GME for both future education programming and required staffing needs, and that these changes will likely persist, even when restrictions to in-person learning are lifted. Although challenges remain, it is important to evaluate the efficacy of newly transitioned programming and the impact of these changes on learner engagement and perceptions of outcomes.This article aims to: (1) identify strategies to mitigate the loss of face-to-face instruction and to create the robust learning communities generated through such interactions, and (2) outline lessons learned in successful conversion of programming to online formats. In this article, the term “virtual learner environment” refers to the environment in which the learner is connected to the instructor virtually. The learner could be alone at a computer station or in a COVID-19-safe, appropriately distanced, classroom environment. “Virtual” will refer to synchronous learning and online will refer to asynchronous accessibility to learning tools, videos, or snippets.The rapid global spread of COVID-19 in late 2019 and early 2020 within the United States resulted in a profound disruption of MSUCOM SCS's traditional in-person GME programming to our community-based hospital partners. These educational programs are integral parts of many residency programs and, without the lab and didactic components of these offerings, many risk not meeting Accreditation Council for Graduate Medical Education (ACGME) residency, faculty development, and assessment requirements. Further, many MSUCOM SCS programs help meet licensing, maintenance of certification, and continuing medical education requirements. Special dispensations6–9 offered through accrediting bodies mitigated risks to accreditation through the close of the 2019–2020 academic year. However, the 2020–2021 academic year comes with expectations of continued programming and enhanced faculty development to ensure that graduating residents and fellows are validly and reliably assessed in all general competencies. Therefore, it was crucial that the Statewide Campus System, as the GME arm of the College of Osteopathic Medicine, adapt to this “new normal” by developing robust, engaging, virtual educational programming.In mid-academic year 2020, the MSUCOM SCS was required to rethink the delivery of at least 2 GME-based educational offerings: ACGME Regional Hub Faculty Development Course, “Developing Faculty Competency in Assessment,” and Chief Resident Leadership Skills Conference. The process of transitioning these offerings to a virtual format is discussed below.MSU is currently one of 17 international ACGME regional faculty development sites. The ACGME Regional Hub Faculty Development Initiative, launched in 2014,10 was designed to increase access for the GME community to faculty development in the basics of assessment. By Winter 2020, 17 international regional hubs had delivered live, highly interactive, faculty development courses to approximately 600 GME program directors, administrators, and faculty. The standard Regional Hub program consisted of an in-person 3-day workshop that included hands-on simulation experiences and frequent large and small group discussions designed to engage participants in the application of course content. When the live programs were halted due to the pandemic, the MSUCOM SCS Director of Faculty Development initiated a transition of the in-person regional hub format to a fully virtual environment.In late July 2020, course faculty who had agreed to deliver live regional hub course content scheduled for August participated in a 2-hour session to prepare for the transition to a virtual course format. This session involved reviewing technology requirements and a simulated walk-through of all components of the virtual course. Topics of discussion included instruction in balancing workshop content with small group breakout activities, virtual facilitation of both large and small groups of learners, and the use of the virtual platform for content delivery (Zoom). Individual faculty were encouraged to participate in one-on-one training sessions. Approximately half of the teaching faculty participated in these sessions, based on their comfort and familiarity with presenting virtually. The Zoom audio and web conferencing platform supported large group discussions using both chat and verbal communication, created multiple virtual breakout rooms populated with preidentified individuals, and allowed the faculty learner to participate in real-time scripted role-playing of clinical encounters. The participants provided feedback immediately following the encounters.This training was critical to the success of the course as all questions, technology issues, and troubleshooting of logistical concerns of the course faculty were addressed prior to going live. In early August 2020, the first virtual regional hub course was delivered by MSUCOM SCS. The course enrolled 30 GME educators and provided essential training in assessment that included the interactive small group and simulation activities essential to the success of the previously offered live regional hub programs.Course attendees reported that the virtual format for delivery (Zoom) was highly effective. Of participants completing the post-course survey (18 of 30, 60%), all reported the course completely or mostly met all course learning objectives. Relevant open-ended course evaluation comments are provided in Box 1. This commentary verifies that transitioning to the virtual learning platform continued to meet the intended outcome of the course.Another program that was immediately transitioned to synchronous online delivery was the Chief Resident Training program. Different from the ACGME Regional Hub Faculty Development program, this session was a single day program designed to outline the expectations and responsibilities of a chief resident. This program included, reviewed, and allowed methods for giving effective feedback, the 5 dysfunctions of a team,11 and discussion of leadership styles appropriate to the role.Transitioning this program to a virtual delivery platform required the same preparation described for the ACGME Regional Hub Program. As with the ACGME course, program attendees reported that the virtual environment and Zoom delivery platform was highly effective. The course evaluation form was completed by 60% (69 of 116) of participants. All 69 reported the course was both evidence-based and balanced. Although instructors from the 2019 program differed from the 2020 program, the reported “per-topic” scores were comparable from one year to the next and did not indicate a deficit in learning as a result of the transition to the virtual environment.Initial concerns discussed in the referenced planning meetings for both the ACGME course and the Chief Resident Training program highlighted the fear that transitioning to virtual education would be less effective than face-to-face programming because learners would not be as engaged and that negotiating the virtual platform would be technically challenging. Prior to the COVID-19 pandemic and the need for social distancing, the percentage of live vs virtual educational programs reflected a general hesitancy to adopt virtual course delivery. A major reason for this hesitancy appears to be the challenges associated with the implementation of virtually delivered course content and the perception that the robust learning communities created through in-person interaction would be diminished in the virtual environment. To address these concerns, we established required orientation sessions for all course faculty that identified specific roles and responsibilities for key stakeholders (Table 1) associated with the virtual course format designed to enhance engagement of course participants.Based on participant and faculty feedback and our lessons learned in transitioning to a virtual environment, developing an interactive, single, or multi-day educational program can be successful. However, such transitions require focused attention on several essential activities, including:It was also apparent that the virtual platform can be designed to bridge the gap between just viewing a program on a screen to actively interacting with other participants and instructors. Forming engaged learning communities in the virtual environment was a critical component of the success of these programs.Throughout this journey, transitioning from live to virtual learning, numerous pros and cons for each presentation format were identified (Table 2). Careful planning with attention to program design and delivery mitigated many of the cons to delivering a virtual course. The experience was reported to be relevant, well-received, engaging, and interactive.Educators involved in the transition to virtual learning, in turn, learned lessons through the process (Box 2). Programs that were once local, or at most, regional, provided the means to reach out-of-state participants who were less encumbered by the expense and time traditionally associated with travel. Additionally, invited speakers, course directors, and administrative support personnel also benefited from the elimination of travel. Finally, the adoption of the virtual format allowed the local development team to meet and plan course content and delivery safely.While virtual learning may not have been a preferred delivery platform for GME educational programing prior to the COVID-19 pandemic, necessity mandated the transition. Our experience has demonstrated that the transition to virtual faculty and resident development is an excellent option for future educational programming, regardless of the status of the pandemic.