Microteaching and standardized students support faculty development for clinical teaching.

Abstract

If faculty development programs are to have impact, we believe they should be made up of several self-reinforcing workshops that provide opportunities for behavior review, practice, reflection, and reinforcement within a context of interdisciplinary perspectives. A program was developed that supports these four activities and includes clinical faculty from medicine, dentistry, nursing, and pharmacy. At the University of Illinois at Chicago we have focused our efforts to improve clinical teaching through a program of two parallel courses. One course focuses on the "one-minute teacher" approach to clinical teaching. We call this course "Teaching-on-the-Fly," reflecting what many of our faculty attendees have suggested they do. The second course is "Feedback Strategies." The two courses are identical in format, which is a series of three three-to-four-hour small-group workshops of not more than eight participants. The first two workshops in each series are titled "Teaching-on-the-Fly I and II" and "Feedback Strategies I and II," respectively. Workshop I is separated from Workshop II by two weeks. During this hiatus faculty are urged to practice the skills learned and to reflect on what worked and what did not work in Workshop I. Six months following both series' Workshop II, "Advanced Teaching-on-the-Fly" and "Advanced Feedback Strategies" workshops are held. Each workshop begins with videotaping of two separate teaching encounters in which each participant interacts with standardized students. Standardized student and clinical faculty interactions are meant to mimic typical teaching and feedback situations. Teaching encounters are limited to five minutes, maximizing the similarity to the stress and frenetic quality of many of today's clinical settings. In Workshop II and in the advanced workshops the standardized students offer one positive comment to the faculty immediately following their encounter. Students are taught how to give this feedback. Immediately after videotaping, faculty adjourn to a small-group discussion. Workshops consist of reflective discussions during the review of each participant's videotape, brief lectures, and responsive comments and instruction by the workshop leaders. Participants are asked to reflect on each workshop and to bring examples of problems and opportunities gained to succeeding workshops in the series. Several theories support these clinical teaching workshops. (1) Outcomes research in continuing medical education suggests the need for ongoing reinforcement, which we do structurally through the three-session model. (2) We use a classical microteaching approach to develop insight and self-awareness. Each videotaped encounter is reviewed, stopped at key points, and discussed by the entire group. These discussions commonly open up after the workshop leaders ask questions such as, "What were you thinking there?" or "What were you trying to do?" or "What would you ask next?" (3) We emphasize the importance of knowing-in-action and the related reflection that guides action in practice. (4) The quality of the workshops is enhanced using standardized students, whom we carefully train and use repeatedly. At least two students have worked with us from their first years through their final clinical years. We are currently examining the program's impact through videotape review.