Clinical Faculty Members Research Articles

Transgender health education for medical students

Transgender individuals face numerous health disparities and report negative experiences with health care providers related to their gender identity. Significant gaps in medical education regarding transgender health persist despite calls for increased sexual and gender minority content. The purpose of this student-led study was to assess the effectiveness of a half-day educational intervention on first- and second-year medical students' attitudes and knowledge of transgender health. Students and faculty members collaborated to develop an educational session on transgender health. This content was presented to first- and second-year medical students at Integrated Grand Rounds, a pedagogical method in which basic science and clinical faculty members co-present didactic content interspersed between live patient interviews and student-led small group discussions. Student participants (n=138) completed voluntary 9-item pre- and post-session surveys assessing comfort with and knowledge of transgender medicine. Students' comfort with and perceived knowledge about transgender patients increased significantly between pre- and post-test. Students' knowledge of transgender medicine standards of care also improved, though not all items reached significance. A half-day educational intervention improved many facets of medical students' attitudes and knowledge about transgender patients. The significant disparities in physical health, mental health and access to care currently experienced by transgender persons in the United States warrants the continued testing and refinement of educational interventions for future and practising providers. Students' comfort with transgender patients increased significantly between pre- and post-test.

Effective and Ineffective Clinical Teaching in Dental Hygiene Education: A Qualitative Study.

Clinical instructors play a significant role in student learning in dental hygiene education, but more information is needed on which instructor characteristics best promote student development. The aim of this study was to identify clinical dental hygiene instructor traits that are effective and ineffective for student learning as defined by dental hygiene students and instructors. A qualitative study using grounded theory and critical incident technique was conducted to investigate junior students', senior students', and instructors' perceptions in one U.S. dental hygiene program in 2014. The methods used were an open-ended electronic survey, one-on-one interviews, and focus groups. Qualities identified were coded and organized into categories and themes, then tabulated by importance by cohort. A total of 24 junior students, 22 senior students, and nine clinical faculty members participated in all three parts of the study. The surveys revealed 322 qualities and characteristics, and the interviews revealed 162, which were then coded into 26 and 23 categories of effective and ineffective traits, respectively. Three major themes of instructor characteristics emerged: affective, pedagogical, and expertise-related. Variances in the frequency of these themes were found between junior and senior students. Differences were also noted between students and instructors in terms of the importance of several characteristics. Specific effective teaching methods were also discovered in the interviews. In this study, multiple effective and ineffective dental hygiene clinical instructor characteristics were identified. These findings have implications for curriculum, instructor training, and evaluation and create a foundation for future research.

Professional self-concept and burnout among medical school faculty in South Korea: a cross-sectional study

BackgroundMedical school faculty members have been reported to be highly likely to suffer burnout. Research is being conducted on professional self-concepts as a factor that relieves burnout in many professions. However, there is a paucity of data on the relationship between professional self-concept and burnout among medical school faculty. Professional self-concept means a perception of oneself as a member of the profession. It influences an individual’s thoughts, actions, and emotions. The more positive the professional self-concept, the higher is the self-esteem in the profession, which can contribute to reducing burnout. This study aimed to investigate the professional self-concept and incidence of burnout among medical school clinical faculty members, and to ascertain the factors that affect professional self-concept with respect to burnout.MethodsA total of 68 clinical faculty members at the Ajou University School of Medicine completed a modified form of the professional self-concept scale and the Maslach Burnout Inventory. We undertook the following statistical analyses: a descriptive analysis to understand the distribution of participants, correlation analysis to indicate associations between variables and a multiple regression analysis to examine the influence of gender, position, and specialty on professional self-concept and burnout, and the effect of each subscale of professional self-concept on burnout.ResultsAs professional self-concept increases, burnout decreases. There was no significant difference between professional self-concept and burnout with respect to gender or field of medical specialty, while a significant difference was observed across faculty position levels. Additionally, the professional self-concept subscale, which included satisfaction and communication skill, was found to significantly affect burnout.ConclusionsThis study shows that professional self-concept affects burnout. Through these results, we can infer that professional self-concept functioned to protect medical school faculty from burnout. This may be a strategy that fortifies the professional identity of medical school faculty, and it is suggested that educational programs that are directed toward this goal be established.

Factors predicting identity as educators and openness to improve: an exploratory study.

Researchers suggest that teachers' work environment affects their sense of connectedness and appreciation, which affects their educator identity. However, sessional (also known as adjunct, clinical, contingent and non-tenured) faculty members may struggle with their educator identity. The purpose of this exploratory study was to examine the extent to which perceived connectedness and received appreciation predicted identity as a medical (health care science) educator and openness to improve in tenure-track and sessional faculty members. We utilised an 'identification with teaching' scale to measure medical educator identity. We developed scales to measure perceived connectedness to university department, openness to improve teaching, and appreciation as a motivation to try a new teaching method. We then hypothesised a path model between these constructs. We surveyed faculty members at a health sciences school and performed confirmatory factor analyses and structural equationmodelling using data from a sample of 73 tenure-track and 146 sessional faculty members to explore support for the hypothesised model. Connectedness and appreciation predicted identity as a medical educator and openness to improve in different ways for sessional and tenure-track faculty members. For tenure-track faculty members, appreciation predicted medical educatoridentity and openness to improve, whereas a sense of connectedness trended towards predicting an openness to improve.For sessional faculty members, connectedness to their department predicted their identity as a medical educator, which acted as a mediator to predict an openness to improve. Our data supported the hypothesised model, but the sessional and tenure-track faculty models differed in strength and focus. We explore reasons for these differences based on the working environment of each teacher type. We suggest that the two models partially explain the transformation from 'a clinician who teaches' to a medical educator. Finally, we make suggestions for how identity as a medical educator and openness to improve may be encouraged in both types of teachers.

A pharmacist-run anabolic osteoporosis clinic: An abaloparatide descriptive report

ObjectivesTo review the first-year experience of abaloparatide use in a pharmacist-run anabolic osteoporosis clinic. SettingThis ambulatory-care health system endocrinology practice consists of 10 board-certified endocrinologists and 6 nurse practitioners and physician assistants. Approximately 1200 patients are seen weekly. The practice is affiliated with the Albany College of Pharmacy and Health Sciences and hosts 2 clinical pharmacy faculty members and a PGY-2 endocrinology pharmacy resident. A pharmacist-run teriparatide clinic was implemented in 2002. In 2017, the clinic was expanded to accept referrals for abaloparatide. No description of a pharmacist-run abaloparatide clinic has yet been reported. Practice descriptionPatients are referred to a clinical pharmacist for initiation and education of anabolic osteoporosis therapy. The pharmacist is responsible for assessing for contraindications to anabolic therapy, securing managed care coverage of an anabolic agent, and providing medication counseling. This pharmacist is available as a resource to patients throughout their course of anabolic osteoporosis therapy. Practice innovationThis is the first description of a pharmacist-run abaloparatide clinic. EvaluationNot applicable. ResultsDuring its first year of availability, 52 patients were referred for abaloparatide therapy. Of these, 31 patients (59.6%) initiated treatment. The population predominately consisted of postmenopausal white women. Approximately two-thirds of patients had a history of an osteoporosis-related fracture, and half of patients had previously received antiresorptive therapy for osteoporosis. Mean baseline T-scores for the lumbar spine and femoral neck were −2.41 and −2.57, respectively. Twenty-one patients did not initiate abaloparatide therapy owing to cost (9), concerns of therapy (8), or contraindication to therapy (4). An additional 5 patients discontinued abaloparatide therapy owing to adverse effects. ConclusionThis paper reviews the first-year experience of abaloparatide use in a pharmacist-run anabolic osteoporosis clinic. The fact that only 60% of referred patients initiated therapy indicates that significant barriers (e.g., high patient cost and safety concerns) remain.

In Memoriam: Herbert L. Fred, MD (1929–2018)

In Memoriam: Herbert L. Fred, MD (1929–2018)

Role Transition of Clinical Nurse Educators Employed in Both Clinical and Faculty Positions.

The aim of this study was to explore how nurses experienced the role transition from clinical expert to part-time clinical faculty member when they worked in both a clinical and academic setting. In response to the current nurse faculty shortage and the anticipated return of a nationwide shortage of registered nurses, the use of part-time clinical nurse educators has been increasing. Fourteen RNs were interviewed using online video conferencing for this qualitative phenomenological study. Study findings revealed seven key themes: different background-different experiences, guidance and support, challenges along the way, maintaining two work roles, influences of prior work experience, influence of personal attributes, and recommendations for successful transition. This work-role transition was found to be highly individualized and multifactorial. Results of the study may be beneficial in future administrative decision-making.

From clinical assistant to clinical associate professor: Examination of a sample of promotion guidelines

IntroductionAs accreditation standards for doctor of pharmacy programs have placed a greater emphasis on practice experiences, programs have a need for more clinical faculty. While clinical faculty are expected to achieve success in teaching, scholarly activity, and service, they tend to hold lower academic ranks and take more time to achieve promotion. This may be especially true when promotion guidelines lack clarity. MethodsGuidelines for promotion of clinical faculty from assistant to associate rank for 10, research-intensive pharmacy programs were reviewed for predetermined factors in the areas of teaching, scholarly activity, and service using the following scale: required, desired, considered, not considered, or not specified. Some factors reviewed included: classroom teaching hours, number of clerkship students, types of scholarly activity considered, grantsmanship, and patient care services. ResultsThere is significant variation in criteria utilized when considering promotion of clinical faculty from assistant to associate rank; few programs provide quantifiable requirements. All programs expect clinical faculty to participate in teaching. Only one program quantifies the amount of teaching expected. One program does not describe types of scholarly activity considered for promotion. No programs expect salary support from grants for clinical faculty. All programs consider direct patient care activities. ConclusionsA wide variety of criteria are considered when evaluating a clinical faculty member for promotion to the rank of associate professor. Clearly defined promotion criteria may help faculty direct their efforts toward activities that are recognized to ensure timely promotion.

Integration of an Academic Medical Center and a Large Health System: Implications for Pharmacy.

Objective: To provide lessons learned for colleges of pharmacy and large health systems that are contemplating or in the process of undergoing integration. Method: This report describes the merger of an academic medical center and large health system with a focus on the implications of the merger for pharmacy from the perspectives of both a college of pharmacy and a health system's pharmacy services. Results: Overarching pharmacy issues to consider include having an administrator from the college of pharmacy directly involved in the merger negotiation discussions, having at least one high-level administrator from the college of pharmacy and one high-level pharmacy administrator from the health system involved in ongoing discussions about implications of the merger and changes that are likely to affect teaching, research, and clinical service activities, having focused discussions between college and health system pharmacy administrators on the implications of the merger on experiential and research-related activities, and anticipating concerns by clinical faculty members affected by the merger. Conclusion: The integration of a college of pharmacy and a large health system during the acquisition of an academic medical center can be challenging for both organizations, but appropriate pre- and post-merger discussions between college and health system pharmacy administrators that include a strategic planning component can assuage concerns and problems that are likely to arise, increasing the likelihood of a mutually beneficial collaboration.

Onramp to Scholarship: Putting Clinical Faculty Members on the Path to Academic Productivity.

Many faculty members in the health professions who come from a clinical background lack the research experience to produce original scholarship. Most faculty development programs focus on supporting individual projects, which helps faculty members who are already pursuing an intellectual question to locate useful resources. Those programs provide limited benefit, however, to faculty members without an identified academic project. An independent, health sciences graduate school designed and implemented a solution to create scholarship groups in which early career faculty members joined ongoing projects led by an experienced investigator. Groups presented internally at a midyear check-in and an end of the academic year poster session. Of the four groups launched in September 2017, three pursued systematic reviews or analyses of existing data. At the end of 9 months, all 4 groups had drafted a manuscript for peer review. Collectively, members of the group had made five poster presentations at national or international conferences and hosted one continuing education workshop. The experience suggests that collaborative projects are a viable form of faculty development to enhance scholarly productivity. Borrowing from the postdoctoral model of scientific mentoring, early career faculty members sacrifice some autonomy of intellectual pursuits in exchange for expert guidance. Senior investigators invest time in coaching novice researchers in exchange for additional intellectual labor and perspectives.

Eliciting the Student Perspective on Point-of-Care Diagnostic Testing in Association with a Primary Care Rotation

The majority of North American veterinary students enter general practice upon graduation. Tertiary teaching hospitals provide extensive case exposure; however, primary case responsibility and decision making are often provided by clinical faculty members. Primary care services at veterinary teaching hospitals are a central component of student preparation for general practice. Primary care cases allow students to function as the primary clinician, making real-time clinical decisions. To better emulate a private practice veterinary hospital, point-of-care diagnostics (hematology, blood chemistry, and blood coagulation) were introduced into two primary care services in North American veterinary colleges. One objective of the study was to determine the influence of point-of-care testing on students' diagnostic selections and attitudes toward point-of-care diagnostics. An additional objective was to determine student perception of the impact of the primary care service on the development of clinical decision making and their technical skills. During the study period, 166 students voluntarily completed a pre-rotation survey, and 81 completed a post-rotation survey. Questions elicited student opinions regarding the value and application of point-of-care diagnostics in a general practice setting and whether a primary care service impacted the students' overall comfort level with case management. Point-of-care diagnostics were recognized as significant assets, with 98% of students agreeing that point-of-care diagnostics improved patient care and outcome. Results supported that primary care services provide valuable experiences for students as primary case clinicians, with 93% of respondents agreeing or strongly agreeing that the rotation improved their diagnostic ability and confidence.

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

Simulation to Prepare Graduate Nursing Students for Clinical Faculty Role

Limited clinical sites and faculty to teach graduate students to be undergraduate clinical faculty have led to the exploration of innovative teaching strategies. This article describes and evaluates a simulation experience to supplement didactic learning about best clinical teaching practices within a graduate nursing course. Scenarios were created to simulate complex teaching situations with a patient, an undergraduate nursing student, and a clinical faculty member. Evaluations were positive regarding knowledge, performance, self-confidence, critical thinking, and satisfaction. Results of this project support the use of simulation in the preparation of graduate nursing students to become clinical faculty.

The Methodology for the CLER National Report of Findings 2018.

The Methodology for the CLER National Report of Findings 2018.

Learner-centred teaching in a non-learner-centred world: An interpretive phenomenological study of the lived experience of clinical nursing faculty

BackgroundWith the growing complexities in the contemporary health care system, there is a challenge of preparing nurses for the practice demands. To this end, learner-centred teaching has emerged in many nursing curricula in Canada and evidence indicates its effectiveness in developing the essential practice skills in nursing students. It is important to examine the experience of the clinical faculty members who implement learner-centred teaching, as doing so would provide an insight to the factors that may hinder the implementation of learner-centred teaching in the practice settings. ObjectiveThis phenomenological study aimed to address two research questions: what does learner-centred teaching mean to clinical nurse faculty? What is the lived experience of clinical nursing faculty who incorporate learner-centred teaching? MethodsTen clinical nurse faculty members who had at least two years of clinical teaching experience volunteered to participate in the study. Data were collected using a semi-structured interview guide and audio recorder. Additional data sources included a demographic survey and a reflective journal. ResultsMultiple sub-themes emerged from this study from which three significant themes were consolidated: diversity of meanings, facilitators of LCT, and barriers to LCT. However, an overarching theme of “learner-centred teaching in a non-learner-centred world” was coined from participants' accounts of their experiences of barriers in incorporating LCT in the practice settings. ConclusionA collaborative effort between faculty and the stakeholders is paramount to a successful implementation of learner-centred teaching in practice settings.

Exploring the Association Between Electronic Health Record Use and Burnout Among Psychiatry Residents and Faculty: a Pilot Survey Study.

Burnout is a phenomenon with profound negative effects on the US healthcare system. Little is known about the relationship between time spent working on electronic health record (EHR) and burnout among psychiatry residents. The purpose of this study is to generate preliminary data on EHR use and burnout among psychiatry residents and faculty. In August 2017, psychiatry residents and faculty at an academic medical center were given the Maslach Burnout Inventory (MBI), a standardized measurement tool for burnout, and a survey of factors related to EHR use and potential risk factors for burnout. MBI data along with selected burnout risk and protective factors were analyzed with R Studio software. Responses were obtained from 40 psychiatry residents (73%) and 12 clinical faculty members (40%). Residents reported 22h per week using EHR on average. Mean score of residents surveyed in postgraduate year (PGY)-1-4 met criteria for high emotional exhaustion associated with burnout. The magnitude of correlation between EHR use and emotional exhaustion was stronger than for other burnout factors including sleep, exercise, and clinical service. Psychiatry residents show signs of high emotional exhaustion, which is associated with burnout. Results demonstrate a strong positive correlation between EHR use and resident burnout. Time spent on EHR use may be an area of importance for psychiatry program directors and other psychiatric educators to consider when seeking to minimize burnout and promote wellness.

Faculty Vitality in Osteopathic Medical Schools: A Pilot Study.

Faculty vitality is defined as the synergy between high levels of satisfaction, productivity, and engagement that enables faculty members to maximize their professional success and achieve goals in concert with institutional goals. Many studies have examined faculty development efforts with regard to satisfaction, retention, or vitality, but, to the authors' knowledge, they have all been conducted in allopathic medical schools and academic health centers. To examine faculty vitality in osteopathic medical schools and address contributors to productivity, engagement, and career satisfaction. This multi-institutional exploratory survey-based study included faculty members from 4 osteopathic medical schools. Surveys with items related to productivity, engagement, career satisfaction, primary department climate and leadership, professional development, and career and life management were sent to faculty members at the 4 participating schools. Most item responses were ranked on Likert-type scales, ranging from 1 (low) to 5 (high). Open-ended questions that explored the participants' experience at their college, factors outside the institution that may affect vitality, and perceived faculty development needs were included at the end of the survey. The overall vitality index was calculated by taking the average of the 3 vitality indicator scores (ie, productivity, engagement, and career satisfaction). Of 236 potential participants, 105 returned the survey for analysis. The mean overall faculty vitality index was 3.2 (range, 1-5). Regarding the 3 contributors to faculty vitality, the mean productivity score was 2.3; professional engagement, 3.5; and career satisfaction, 3.7. Primary department climate and leadership was a significant predictor of faculty vitality (P=.001). The influence of individual vitality factors did not differ between basic science and clinical faculty members. Open-ended questions generated the following themes related to faculty vitality: leadership support, organizational climate, collegiality and value, workload, research funding climate, and family/home life. Participants listed a variety of faculty development needs in the areas of teaching, research, leadership, and professional development. The results of this study suggest that career satisfaction is a significant contributor to vitality in osteopathic medical school faculty members. Additionally, primary department climate and leadership is a significant predictor of faculty vitality. Responses to the open-ended questions further elucidated extrinsic factors that positively and negatively affect vitality, including family and home life and dwindling funding from national medical research agencies. Faculty development efforts should be directed toward enhancing contributors to vitality.

Doctor becomes a patient: a qualitative study of health care work place violence related perception among junior doctors working in a teaching hospital in India

Background: Health care work place violence (HCWPV) is four times higher compared to violence against other professions. The problem remains under-reported and under-researched. Qualitative perception studies among junior doctors have not been paid due attention hitherto.Methods: Six individual face-to-face-indepth-interviews and six focus-group-discussions were conducted during December 2017 and January 2018 among 41 young doctors (interns, resident doctors i.e. post graduate students and young clinical faculty members). Thematic (content) analysis method was used for analysis of the data (texts).Results: Relevance, causes as well as consequences of HCWPV and measures for its prevention and control were brought up and discussed. Four themes emerged in thematic analysis. Almost all of the participants believed that it is an extremely important topic. Causation is multifactorial whereby all stakeholders are responsible. Consequences are affecting the whole society not merely the victims. Measures suggested were related to - in view of the causes - medical profession; patients and society; behavior and process; system and administration.Conclusions: Increasing materialism and eclipse of humanitarian values, media-created-violence, negative image of medical profession, patient-physician-distrust, zero-protection for doctors, apathetic governments and deficiencies in the process of justice are among the main causes of HCWPV. Junior doctors were not much optimistic of any improvement in near future in their safety and security as this would require more probity and unity among doctors and a clientele, a Health Care Delivery System, the Governments and a Judiciary much different from what it is today.

Medical students’ professional identity development from being actors in an objective structured teaching exercise

Introduction: Medical students develop professional identity through structured activities and impromptu interactions in various settings. We explored if contributing to an Objective Structured Teaching Exercise (OSTE) influenced students’ professional identity development.Methods: University clinical faculty members participated in a faculty development program on clinical supervision. Medical students who participated in OSTEs as simulated residents were interviewed in focus groups about what they learnt from the experience and how the experience influenced their vision of learning and teaching. Transcripts were analyzed using the Goldie’s personality and social structure perspective model.Results: Twenty-five medical students out of 32 students involved in OSTEs participated. On an institutional level, students developed a feeling of belonging to the institution. At an interactional level, students realized they could influence the teaching interaction by actively seeking or giving feedback. On the personal level, students realized that errors could become sources of learning and felt better prepared to receive faculty feedback.Conclusion: Taking part in OSTEs as a simulated resident has a positive impact on students’ vision regarding the institution as a learning environment and their own role by actively seeking or giving feedback. OSTEs support their professional identity development regarding learning and teaching while sustaining faculty development.

Considering the interdependence of clinical performance: implications for assessment and entrustment.

IntroductionOur ability to assess independent trainee performance is a key element of competency‐based medical education (CBME). In workplace‐based clinical settings, however, the performance of a trainee can be deeply entangled with others on the team. This presents a fundamental challenge, given the need to assess and entrust trainees based on the evolution of their independent clinical performance. The purpose of this study, therefore, was to understand what faculty members and senior postgraduate trainees believe constitutes independent performance in a variety of clinical specialty contexts.MethodsFollowing constructivist grounded theory, and using both purposive and theoretical sampling, we conducted individual interviews with 11 clinical teaching faculty members and 10 senior trainees (postgraduate year 4/5) across 12 postgraduate specialties. Constant comparative inductive analysis was conducted. Return of findings was also carried out using one‐to‐one sessions with key informants and public presentations.ResultsAlthough some independent performances were described, participants spoke mostly about the exceptions to and disclaimers about these, elaborating their sense of the interdependence of trainee performances. Our analysis of these interdependence patterns identified multiple configurations of coupling, with the dominant being coupling of trainee and supervisor performance. We consider how the concept of coupling could advance workplace‐based assessment efforts by supporting models that account for the collective dimensions of clinical performance.ConclusionThese findings call into question the assumption of independent performance, and offer an important step toward measuring coupled performance. An understanding of coupling can help both to better distinguish independent and interdependent performances, and to consider revising workplace‐based assessment approaches for CBME.