Faculty Time Research Articles

Chair Agency, Chair Preparation, and Academic Supports in Educational Leadership Doctoral Programs in the United States

Aim/Purpose: The purpose of this exploratory qualitative case study was to understand dissertation chair agency, chair preparation, and academic supports provided by experienced Educational Leadership Ed.D. dissertation chairs in the United States. Background: Previous research has identified attrition rates of 50-60 percent in education doctoral programs. This research helps identify the faculty profiles and academic supports provided by Educational Leadership faculty who have served on successful dissertation committees. Understanding these findings may help to improve retention and completion in other doctoral programs. Methodology: This was an exploratory qualitative case study. Ten doctoral faculty who have successfully chaired 419 Ed.D. Educational Leadership dissertations at accredited U.S. colleges and universities were interviewed. Data were analyzed using the constant comparative method. Contribution: The findings from this study contribute to the body of knowledge on doctoral retention and dissertation completion by providing information on promising practices from the perspective of dissertation chairs. Findings: While successful dissertation chairs exhibited expertise as researchers, seven of the ten participants reported that they had limited training for chairing dissertations. Academic supports included coursework that was organized coherently with a focus on opportunities for substantive feedback, writing support and research methodology. Recommendations for Practitioners: Dissertation chairs should utilize their agency to ensure that the program has the proper resources to support doctoral education. This includes adequate writing support for graduate students, courses taught by faculty who are engaged in research and understand the requirements for completing a dissertation, and protecting faculty time so that they are able to provide students substantive feedback within coursework and at the dissertation phase. Recommendation for Researchers: Researchers should continue to explore the causes of attrition in doctoral programs and identify specific actions that can be taken to improve program completion rates. Impact on Society: Increasingly U.S. institutions of higher learning are being called to validate their success and improve retention rates. Understanding the faculty profiles and academic supports utilized by successful doctoral faculty has the potential to improve retention and thereby increase completion rates and consequentially alleviate the stressors that ABD students experience. Future Research: Future research could focus on expanding the findings of this study by exploring the perspectives of faculty based on institution type and examining how socio-emotional factors such as student-student and faculty-student relationships are intentionally established in programs with high graduation rates.

Instructional Designers and Open Education Practices: Negotiating the Gap Between Intentional and Operational Agency

In their role as support to faculty in the course development process, Instructional Designers (IDs) can play an important part in alleviating some of the well-known barriers of open education practices (OEP): faculty time, institutional or faculty resistance to change, and institutional support for faculty (Annand & Jensen, 2017; Barker et al., 2018; Jhangiani et al., 2016). This study examines how IDs negotiate OEP in the course development process or in the process of working with faculty. The findings suggest that IDs are negotiating institutional constraints while attempting to be OEP advocates in their work. To use Campbell, Schwier and Kenny’s (2009) framing of intentional and operational agency, the IDs in this study described a high level of intentional agency, but their operational agency could be enhanced with greater clarity of expectations with respect to their role, resources and capacity to engage with OEP, clarity of directives and support from senior leadership, as well as a broader awareness of the moral and practical affordances of OEP within their institutions.

Patient Safety Escape Room: A Graduate Medical Education Simulation for Event Reporting.

Although residents are on the front lines of patient care, they enter few formal patient safety reports on the adverse events and near misses they witness. Demonstrating the rationale and mechanics of reporting may improve this. We designed and implemented an escape room patient safety simulation to incorporate active learning, gamification, and adult learning theory into intern patient safety onboarding. Interns from all sponsoring institution programs participated, identifying, mitigating, and reporting a range of patient safety hazards. Props and faculty time were the major resources required. One hundred twenty interns participated in this simulation in June 2018. Forty-one percent reported previous training on reporting errors, and only 5% had previously entered an event report. Average confidence in ability to identify patient safety hazards improved after the simulation from 6.35 to 8.00 on a 10-point rating scale. The simulation was rated as relevant or highly relevant to practice by 96% of interns. Several factors contribute to a low error-reporting rate among house staff. We developed a simulation modeled on popular escape room activities to increase awareness of safety hazards and ensure familiarity with the actual online reporting system our interns will use in the clinical environment.

Mini-Clinical Evaluation Exercise in the Era of Milestones and Entrustable Professional Activities in Obstetrics and Gynaecology: Resume or Reform?

The Accreditation Council for Graduate Medical Education (ACGME) milestones and the core Entrustable Professional Activities (EPAs) provide guiding frameworks and requirements for assessing residents' progress. The Mini-Clinical Evaluation Exercise (Mini-CEX) is a formative assessment tool used to provide direct observation after an ambulatory or clinical encounter. This study aimed to investigate the feasibility and reliability of the Mini-CEX in the authors' obstetrics and gynaecology (OB/GYN) residency program and its ability to measure residents' progress and competencies in the frameworks of ACGME milestones and EPAs. OB/GYN residents' 5-academic-year Mini-CEX performance was analyzed retrospectively to measure reliability and feasibility. Additionally, realistic evaluation was conducted to assess the usefulness of Mini-CEX in the frameworks of ACGME milestones and EPAs. A total of 395 Mini-CEX evaluations for 49 OB/GYN residents were analyzed. Mini-CEX evaluation data significantly discriminated among residents' training levels (P < 0.003). Residents had an average of 8.1 evaluations per resident completed; 10% of second-year residents and 28% of third-year residents were evaluated 10 or more times per year, whereas no postgraduate year 1 or postgraduate year 4 residents achieved this number. Mini-CEX data could contribute to all 6 primary measurement domains of OB/GYN milestones and 8 of 10 EPAs required for first-year residents. The Mini-CEX demonstrated potential for measuring residents' clinical competencies in their ACGME milestones. Faculty time commitment was the main challenge. Reform is necessary for the current feedback structure in Mini-CEX, faculty development, and operational guidelines that help residency programs match residents' clinical competency ratings with ACGME milestones and EPAs.

Perceived impact of faculty practice on nurse practitioner education

Faculty practice is believed to positively affect health education, however limited research exists on the impact of faculty practice on nurse practitioner education. The purpose was to explore the perceived impact of faculty practice on nurse practitioner education. A preliminary mixed methods approach was used to evaluate nurse practitioner student and faculty perspectives on the impact of faculty practice on nurse practitioner education. Student group interviews were conducted and practicing faculty were surveyed. Study findings included student and faculty-perceived benefits and challenges of faculty practice on nurse practitioner education. Specific benefits were increased access to faculty preceptors and clinical sites for nurse practitioner students, influencing faculty-developed education materials, increased number of real-world examples, faculty credibility, applying evidence-based practice, and overall improvement in the quality of teaching. Specific challenges were time, faculty availability to students, managing multiple roles, and clinical sites not conducive to precepting. This study provided preliminary information on the perceived impact of faculty practice on nurse practitioner education including the benefits and challenges. Findings support faculty practice as having a positive perceived impact on nurse practitioner education.

Teacher training for rheumatology fellows: a national needs assessment of fellows and program directors.

Teaching is an integral part of what we do as physicians, and exposure to training on how to effectively teach is not consistently implemented in the curricula within medical training. We administered anonymous, in-person surveys to fellows and program directors (PDs) at the 2017 American College of Rheumatology national conference to evaluate fellow and PD attitudes regarding development of programs dedicated to teaching fellows on how to teach. One hundred seven of 150 fellows returned surveys (response rate 71%). About 60% demonstrated interest in pursuing a teaching-focused career. About 97% felt their teaching skills can be improved; 88% felt improved teaching skills will be valuable for their career. With 61% response rate (57/94 PD surveys), most PDs agreed their fellows could use additional instruction in teaching. About 90% noted this would be an asset for fellows' careers. When compared, 56% of fellows reported no structured training in education during fellowship, while 64% of PDs said this type of training was available. All agreed fellow teaching skills can be improved but significantly more fellows than faculty felt confident in the fellows' ability to give feedback (p = 0.03). Both groups identified time constraints and other faculty interest as barriers. There is significant need to develop effective fellow-as-teacher programs aimed at enhancing fellows' teaching skills, with focus on giving feedback and working within fellow and faculty time constraints. The program can help address a curriculum gap identified by fellows as well as PDs before fellowship-to-faculty transition.Key Points• There is a notable gap between faculty physicians' expectations to teach as clinician-educators and the lack of training dedicated to learning how to teach during medical training. Despite the fact that past clinical educators have identified instructional design and assessment as low-confidence areas, there is a paucity of structured program dedicated to developing these teaching skills during fellowship training.• With 97% fellows and 84% program directors, both groups agreed fellows could use additional instruction in teaching skills, but there was a significant discrepancy between fellow and program director perspectives regarding fellows' ability to give feedback.• Consistent with past needs assessments in other medical specialties, lack of time and potential faculty interest were recognized as potential barriers, calling for a structured training program dedicated to education on didactics that takes into account trainee and faculty time constraints.• Our needs assessment can direct future research on analyzing effectiveness of fellow-as-teacher program implementation by focusing on improvement of fellow teaching and feedback skills.

Establishing Trust When Assessing Learners: Barriers and Opportunities

Trust plays a critical role in the assessment of learners in the clinical setting. In an ideal system, learners can be vulnerable and share their limitations and areas for improvement, while faculty possess the time and skill to provide specific feedback that enables learners to achieve competency in clinical skills. For medical students, a number of threats to the establishment of trust in the learning environment exist, including the interplay between feedback and grades, the existence of bias, and competing demands for faculty time. However, several strategies can help institutions to overcome these threats and foster a culture of trust related to assessment and assessment systems: Provide ungraded environments where learners are able to be vulnerable, cocreate assessments and assessment systems with faculty and learners, acknowledge and address bias, and provide faculty with adequate time and resources to employ best practices in assessment. By intentionally employing these strategies, our institutions can support trust in assessment systems and further learner growth and achievement.

Improving Residency Education on Chronic Pain and Opioid Use Disorder: Evaluation of CDC Guideline-Based Education

Background: National surveys show that primary care physicians feel responsible for addressing the opioid epidemic. They feel their training in managing chronic pain and addiction was insufficient, and commonly endorse the need for more residency training in these areas. However, residency training in these areas remains low, with a lack of faculty expertise and time as the most commonly cited barriers for improvement. Objective: To evaluate the feasibility of an educational program for chronic pain management and addiction that does not rely on faculty expertise or additional time, and assess resident opioid-prescribing practices and confidence in managing chronic pain after its implementation. Methods: A 16-week educational curriculum was incorporated into existing residency didactics. Internal medicine residents attended six educational sessions in 2016 over a 16-week period and implemented a protocol based on CDC Guidelines for Prescribing Opioids for Chronic Pain. Surveys were completed pre- and post-intervention. Results: Implementation of this educational intervention was feasible. Surveys showed improvement in resident confidence in detecting and managing addiction and improved prescribing practices and adherence to CDC recommendations. Conclusion: This pilot study demonstrates that increasing residency education in managing chronic pain and opioid use disorder is feasible, and no longer needs to be postponed due to lack of time or faculty expertise.

Stakeholder perspectives and status of surgical simulation and skills training in Canadian urology residency program.

With the shift to competency-based training, surgical skills lab training (SSLT) may become a mandatory part of Canadian urology residency programs (CURPs). This study aims to identify: 1) the status of SSLT in CURP; 2) stakeholder perspectives on the utility of SSLT; 3) barriers to developing and implementing SSLT; and 4) how to address these barriers. Surveys were developed and issued to three groups of stakeholders: 1) SSLT directors at all 13 CURPs (response rate 100%); 2) teaching faculty (response rate 33%); and 3) urology residents (response rate 24%). Surveys 2 and 3 were sent to 10 English CURPs. Results were collected through email and SurveyMonkey®. Nine of 13 CURPs have a dedicated SSLT; 46% of CURP have 1-3 sessions per year, 8% have 5-7, and 30% >7. Most residents have independent lab access, but 80% do so less than once monthly. Over 90% of stakeholders find SSLT useful, of which high-fidelity models are most preferred (faculty rated 3.66/4, residents 3.18/4). Program directors (PDs) identified lack of protected faculty time, funding, and infrastructure as the top three barriers to SSLT implementation. Residents found lack of faculty time, protected academic time, and infrastructure as barriers. PDs viewed protecting faculty time and more funding as potential solutions, while residents suggested protected faculty and academic time, and after-hours lab access. Residents, faculty, and PDs in CURPs view SSLT as useful. Most CURPs have defined SSLT; programs without this have labs for resident use but are underused. To continue to develop and progress SSLT, more time, participation, and funding must be made available.

Peer assisted feedback: a successful approach for providing feedback on United States Medical Licensing Exam-style clinical skills exam notes in the United States.

PurposePeer-assisted learning (PAL) promotes the development of communication, facilitates improvements in clinical skills, and is a way to provide feedback to learners. We utilized PAL as a conceptual framework to explore the feasibility of peer-assisted feedback (PAF) to improve note-writing skills without requiring faculty time. The aim was to assess whether PAL was a successful method to provide feedback on the United States Medical Licensing Exams (USMLE)-style clinical skills exam notes by using student feedback on a survey in the United States.MethodsThe University of Florida College of Medicine administers clinical skills examination (CSEs) that include USMLE-like note-writing. PAL, in which students support the learning of their peers, was utilized as an alternative to faculty feedback. Second-year (MS2) and third-year (MS3) medical students taking CSEs participated in faculty-run note-grading sessions immediately after testing, which included explanations of grading rubrics and the feedback process. Students graded an anonymized peer’s notes. The graded material was then forwarded anonymously to its student author to review. Students were surveyed on their perceived ability to provide feedback and the benefits derived from PAF using a Likert scale (1–6) and open-ended comments during the 2017–2018 academic year.ResultsStudents felt generally positively about the activity, with mean scores for items related to educational value of 4.49 for MS2s and 5.11 for MS3s (out of 6). MS3s perceived peer feedback as constructive, felt that evaluating each other’s notes was beneficial, and felt that the exercise would improve their future notes. While still positive, MS2 students gave lower scores than the MS3 students.ConclusionPAF was a successful method of providing feedback on student CSE notes, especially for MS3s. MS2s commented that although they learned during the process, they might be more invested in improving their note-writing as they approach their own USMLE exam.

Experience With a Research and Innovation Office to Support Laboratory Medicine and Pathology Research

Abstract Objectives Translational research in laboratory medicine and pathology is transforming health care based on recent quantum advances in omics technologies, computational science, and precision medicine. However, high-volume clinical settings where this research may be most effective often have significant constraints on faculty time that challenge productivity. The objective of this study was to assess our experience with a new resource designed to address this challenge. Methods In September 2016, we established the Research and Innovation Office (RIO) in the Department of Laboratory Medicine and Pathology, Mayo Clinic–Rochester. The goal was to provide infrastructure to unburden faculty from performing administrative, organizational, and operational tasks related to research. Over 30 months, we solicited faculty input into desired services, conducted surveys on utility and ease of use, and tracked metrics, including faculty participation, numbers of projects, and publications. Results Faculty members were highly satisfied with the range of services, ease of use, and service-oriented approach of RIO. Initial services included project organization, institutional process support (eg, IRB protocol management), biospecimen requests and handling, and data management. Based on early feedback, patient consenting, budget support, and manuscript assistance were added as additional services. Total RIO staff increased from 6 to 10 during in the first 30 months. Over this time, 97 of 160 faculty members (60%) utilized RIO services in over 1,000 discrete project requests. Annual departmental publications increased by 50% during this time. Conclusion Faculty time is a critical element for translational research productivity in laboratory medicine and pathology departments. Numerous tasks previously performed by faculty could be managed effectively by a team of research facilitators that unburdened constraints on research time and led to high levels of faculty engagement, satisfaction, and productivity. This model may promote advances in transformative laboratory medicine and pathology research in high-volume clinical settings.

Mentorship of US Medical Students: a Systematic Review.

Mentoring of medical students remains a core pillar of medical education, yet the changing landscape of medicine has called for new and innovative mentoring models to guide students in professional development, career placement, and overall student well-being. The objective of this review is to identify and describe models of mentorship for US medical students. We searched PubMed, PsycINFO, Education Resources Information Center, and Cochrane Databases of Systematic Reviews following PRISMA guidelines. We included original, English-language studies of any research design including descriptive studies that described a mentorship program at a US medical school designed for medical students. Our search yielded 3743 unique citations. Thirty articles met our inclusion criteria. There was significant diversity of the identified programs with regard to program objectives and size. The traditional dyad model of mentorship was the most frequently cited model, with a combination of models (dyad and group mentorship) cited as the second most common. Outcome measures of the programs were largely survey based, with satisfaction being the most measured outcome. Overall, satisfaction was highly rated throughout all the measured mentoring programs. Seven programs provided objective outcomes measures, including improved residency match data and increased scholarly productivity. The programs with objective outcomes measures were smaller, and 6/7 of them focused on a specific clinical area. Five of these programs relied on the traditional dyad model of mentorship. Cost and faculty time were the most frequently cited barriers to these programs. Our review demonstrates that mentoring programs for medical students can positively improve medical school satisfaction and career development. These results underscore the need for continued innovative mentoring programs to foster optimal student development in the setting of the increasingly competitive residency match process, growing expectations about student research productivity, and the national focus for overall student wellness.

Simulation in Neonatal-Perinatal Medicine Fellowship Programs.

This study aimed to investigate the use of simulation in neonatal-perinatal medicine (NPM) fellowship programs. This was a cross-sectional survey of program directors (PDs) and simulation educators in Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowship programs. Responses were received from 59 PDs and 52 simulation educators, representing 60% of accredited programs. Of responding programs, 97% used simulation, which most commonly included neonatal resuscitation (94%) and procedural skills (94%) training. The time and scope of simulation use varied significantly. The majority of fellows (51%) received ≤20 hours of simulation during training. The majority of PDs (63%) wanted fellows to receive >20 hours of simulation. Barriers to simulation included lack of faculty time, experience, funding, and curriculum. While the majority of fellowship programs use simulation, the time and scope of fellow exposure to simulation experiences are limited. The creation of a standardized simulation curriculum may address identified barriers to simulation.

A Review of Forensic Fellowship Training: Similar Challenges, Diverse Approaches.

As the specialty of forensic psychiatry and the numbers of justice involved individuals with mental illness continue to grow, forensic education is receiving more attention. To add to this discussion, the authors reviewed current training practices in forensic psychiatry fellowship programs. As part of a project funded by the state legislature looking at psychiatry and psychology training, with special focus on state hospital partnerships, the authors interviewed and surveyed forensic psychiatry fellowship program directors and conducted site visits to select programs. Given the mandate, special attention was given to programs with state hospital and psychology training affiliations. The literature and fellowship directors identified several key features and challenges for forensic training programs. Forensic fellowships focused primarily on evaluations and consultations but differed in their offerings related to training in treatment, scholarship, and particular types of evaluations. Common concerns included maintaining adequate funding, variety of training experiences, adequate faculty time, and adequate institutional support. Directors described cultivating institutional support by demonstrating mutual benefit as particularly important for securing resources. Forensic fellowships operational during the 2016-2017 academic year offered a range of forensic training activities, but experienced common challenges such as inadequate funding and faculty supervision. Empirical studies are needed to evaluate the relationship between programmatic offerings, the noted challenges, and acquired competencies.

Education Research: Flipped classroom in neurology

How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.

LO44: Simulation in the continuing professional development of Canadian academic emergency physicians: a national survey

Introduction: Capitalizing on the success of Simulation-Based Education (SBE) in residency-training programs, simulation has been gradually integrated into Continued Professional Development (CPD) programs for Emergency Physicians (EPs) in Canada. This study sought to characterize how Canadian academic emergency medicine (EM) departments have implemented SBE for CPD. Methods: We conducted two national surveys: 1) the National Faculty Simulation Status Assessment Survey, administered by telephone to the simulation directors (or equivalent) at 20 Canadian academic EM sites and 2) the Faculty Simulation Needs Assessment Survey administered online to all full-time EPs across 9 Canadian academic EM sites. Results: The response rates for the National Status and Needs Assessment Surveys were 100% (20/20), and 40% (252/635), respectively. The majority (60%) of Canadian academic EM sites reported utilizing SBE for CPD, though only 30% reported dedicated funding support. EPs reported participating in a median of 3 hours per year of SBE (IQR 1-6 hours). Reported incentivization offered in the form of continued medical education credits varied between simulation directors (67%) and EPs (44%). Simulation directors identified several significant barriers to SBE including a lack of faculty time, fear of peer judgment, and faculty inexperience. In contrast, EP-identified barriers included time commitments outside of shift, lack of opportunities, and lack of departmental. The three most common topics of interest for SBE by EPs were performance of rare procedures, pediatric resuscitation, and neonatal resuscitation. Interprofessional involvement in SBE CPD was valued by both simulation directors and EPs, with most EPs (79%) indicating it is useful. Conclusion: Most Canadian EPs and simulation directors recognize the value of SBE for CPD, yet it is only utilized, infrequently, by 67% of Canadian academic EM departments for this purpose. This may be explained, in part, by poor incentivization for participation. Simulation directors and EPs noted different barriers to SBE implementation for CPD suggesting the need for dialogue to improve utilization. As SBE for CPD is incorporated more frequently, and at more sites, content should be guided by local needs assessments with an emphasis on interprofessional participation.

Publish With Undergraduates or Perish?: Strategies for Preserving Faculty Time in Undergraduate Research Supervision at Large Universities and Liberal Arts Colleges

Publish With Undergraduates or Perish?: Strategies for Preserving Faculty Time in Undergraduate Research Supervision at Large Universities and Liberal Arts Colleges

MON-003 Enhancing Formative Feedback of Pediatric Endocrinology Fellows through Structured Oral Exams

INTRODUCTION: The inadequacy of formative feedback (FF) in graduate medical education (GME) has been a concern of physician-educators and trainees for more than three decades. FF in GME is most often obtained through two assessments, the global ratings scale and In-Training Exam (ITE), both with well documented limitations. The global ratings scale (i.e. “milestones”) is subject to numerous threats to validity including limited direct observations of trainees, rater bias, inaccurate recall, and lack of specific clinical skills to rate. The ITE suffers from construct underrepresentation as atypical clinical scenarios and basic science knowledge is frequently assessed. The multiple-choice format can result in cueing, seem artificial, and removed from real situations. The structured oral exam (SOE), used for FF, does not have limitations of the assessments noted above. To the best of the authors’ knowledge, there have been no published reports of the use of a SOE to provide FF in GME. OBJECTIVE: To determine the educational impact, as well as the feasibility, cost, and acceptability of a SOE for FF of Pediatric Endocrinology (PE) fellows. METHODS: Four cases (precocious and delayed puberty, PCOS, congenital hypothyroidism) were developed for this pilot SOE. Each question and scoring rubric was evidence-based and peer-reviewed by four PE attending physicians. A 5-point Likert scale survey with short answers was developed utilizing best practice guidelines to address our research question. Three faculty/fellow dyads completed the pilot. RESULTS: With regards to educational impact, all fellows and faculty reported that the exam was helpful for both identifying previously unrecognized knowledge deficits, and for providing guidance for the fellow’s future learning, with the majority stating it was quite helpful or extremely helpful. There were no significant concerns regarding need for specialized training to administer the exam, clarity of questions, subjectivity in scoring, or stress on the fellow. Several participants proposed shorter, more frequent sessions to enable longitudinal assessment. An estimated 4 hours of faculty time would be required per fellow per year to administer our comprehensive SOE, consisting of 35 cases, over the course of a 3 year fellowship. Administration by senior fellows was suggested if faculty time is limited. CONCLUSIONS: To the authors’ knowledge, this is the first description of a SOE as a FF tool in GME. Fellows and faculty found this SOE to be educationally impactful, however, modifications could further improve it’s feasibility, cost, and acceptability. The full-scale, multi-center study will provide further investigation of this SOE as a FF tool for PE fellows.

Using Digital Tools to Assess and Improve College Student Writing

Employers have continually indicated that writing instruction is much needed in higher education across all majors. It has become more imperative now than before to better prepare our graduates for professional success in an age of increasing writing necessity, data analytics and reporting, and technical sophistication. Writing assessment in a class setting has learning goals and needs to be differentiated from a mass testing evaluation context. When learning to write well, especially relating to subject-specific content, feedback is necessary. Performing analysis and evaluation, then providing explanation and recommendations takes time. Newer digital tools can provide formative feedback; and therefore transparency about grading as well. Among teaching tasks, grading assignments consumes the majority of online faculty time. This study identifies what type of online grading could take up the majority of faculty time and specifies estimates of time needed for such grading. Faculty workload is high in adopting an optimal combined formative and summative assessment model. Results of the study might help develop more sound policies of academic support. Faculty might use the study&amp;rsquo;s information for better curricula planning and improved utilization of student assistants.

Applying the Hedgehog Concept to Transform Undergraduate Medical Education.

As the U.S. health care system changes and physician responsibilities shift, medical educators must reconsider how best to prepare medical school graduates for the future practice of medicine. Thoughtful reexamination of the goals of undergraduate medical education (UME) and the roles of educators, medical students, and physicians is warranted to ensure that they align with evolving health care environments and delivery systems. In this Invited Commentary, the authors apply Jim Collins's "hedgehog concept" from Good to Great-a business-world framework designed to transform companies-to UME. The hedgehog concept is defined by the intersection of an organization's passion, area of expertise, and economic and resource engines. Focusing on this single concept can guide key decisions, reject what does not align conceptually, and drive overall organizational success. The authors use the hedgehog concept to frame the programmatic development of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (Zucker SOM), a millennial medical school, as an organization with the passion to develop innovative UME curricula by challenging the status quo; the drive to be the best at leveraging health system resources to train graduates to excel in systems-based care; and the economic and resource engine of faculty time, financial and infrastructure support, and reputation building. The success of this approach is assessed at Zucker SOM through student and graduate outcomes data. The authors suggest that this hedgehog concept is generalizable to other UME programs whose leaders seek to transform medical education to meet 21st-century workforce and health care delivery needs.