Volunteer Faculty Research Articles

Using a cost-construction model to assess the cost of educating undergraduate medical students at the University of Texas--Houston Medical School.

To assess the cost of educating undergraduate medical students at the University of Texas-Houston Medical School (UT-Houston) in 1994-95 through the use of a cost-construction model developed elsewhere and adapted for UT-Houston. The cost-construction model identified the cost of the entire program as well as instructional costs (the cost of activities related to direct-contact teaching), educational costs (instructional costs plus the costs of general supervision), and milieu costs (educational costs plus the costs of research). The model predicted these costs based on student contact hours, student enrollment, full-time-equivalent (FTE) faculty and residents required, professional-activity profiles, faculty and resident salaries, and supporting resource costs. Sensitivity analysis was used to explore the effects of such factors as institutional overhead, joint products, volunteer faculty, residents, and varying assumptions about the percentage of time the faculty dedicated to direct-contact teaching. The four-year undergraduate medical program at UT-Houston had a total cost of $82,692,280. For an average class of 200 students, the annual per-student instructional, educational, and milieu component costs were $43,993, $57,370, and $90,660, respectively. The program required 201 FTE faculty members and 258 FTE residents. Sensitivity analysis revealed the financial effects of the various factors, some of which increased costs and some of which decreased costs. Although the cost-construction model is conceptually straightforward, there are several inherent complexities and aspects open to debate that must be understood in its application: for example, assumptions regarding faculty time; assumptions regarding the allocation of faculty time to various activities; the definition of those activities; the difficulty of separating costs; the difficulty of accurately defining total educational costs; and so on. However, this study provides a starting point for identifying the distinct costs associated with an undergraduate medical school program and should encourage further discussion and research.

Raising standards: A prototyping strategy for undergraduate education

Public concerns about the quality of undergraduate education merit the attention of research universities. This policy analysis documents standards of learning and teaching that fall far short of a liberal education in one department. It attributes the problem primarily to factors that obscure differences in standards, especially quantitative performance measures. And it recommends liberating small working groups of faculty volunteers to develop and distinguish courses that do raise standards. This prototyping strategy is an alternative tot the status quo, which is unsustainable, and a comprehensive, centrally-directed plan, which is impractical. It may be adapted to similar situations elsewhere.

Clinical revenues used to support the academic mission of medical schools, 1992-93

This is the report of a study undertaken by the Association of America n Medical Colleges to estimate the total amount of clinical revenues that are used to support the academic mission of U.S. medical schools. The study was prompted by an awareness that recent market-driven changes in health care organization and financing threaten the structure of medical school financing that has evolved over the last half-century. A total of 60 medical schools (48%) participated in the study. The results, projected for all 126 U.S. medical schools, indicate that faculty practice plans in 1992-93 provided an estimated $2.4 billion in support for medical school academic programs. (1992-93 was the latest year for which complete financial data were available.) This amount represents 28 cents of every faculty-practice-plan dollar collected that year. The primary way in which faculty practice plans support academic programs is by underwriting clinical faculty time spent in academic activities, but direct transfers of funds, from the practice plan to the school and departments, also play a major role. The major beneficiary of faculty-practice-plan support is research, defined broadly to include a range of scholarly activities, at an estimated level of $816 million for all U.S. schools. This is followed by undergraduate medical education, at $702 million, graduate medical education, at $594 million, and other, largely undifferentiated academic support at $244 million. In addition to faculty practice plan revenues, teaching by volunteer faculty contributed another $545 million in imputed-dollar support of academic programs, bringing the total level of support to nearly $3 billion. Volunteer faculty teaching was divided nearly evenly between undergraduate and graduate medical education. Hospitals may also provide clinical revenues in support of the academic mission by applying hospital funds to academic programs and by absorbing academic-program expenses that are not otherwise reimbursed. However, unravelling the complex web of subsidies and cross-subsidies that characterizes medical school-hospital relationships proved to be beyond the capability of the present investigation. There is considerable evidence that changes in health care organization and financing will make it unlikely that the current level of support from practice plans and volunteer faculty can be sustained and that in some cases it is already diminishing. The restructuring of medical school financing to absorb the impact of this decline of support, which comes on top of reductions in indirect cost recoveries and pressures to lower state appropriations, constitutes one of the major challenges medical schools will face in the years ahead.

Educational Programs in US Medical Schools, 1994-1995

This is a time of considerable uncertainty about the future of medical education. There are threats to medical school finances from state and federal levels. While medical schools derive only an average of about 11% of total revenues from state and local sources, these funds potentially give states the basis for imposing specific mandates on medical schools, in areas such as enrollment levels, curriculum content, and a desired specialty mix of graduates. Medical schools appear to be changing at varying rates in response to the health care system, including the growth of managed care. While the total number of full-time faculty members continues to increase, there are regional differences. It is unclear how the faculty size and composition ultimately will be affected or what implications this will have for educational programs. A number of medical schools are expanding into the community to ensure a patient base, and educational opportunities for medical students appear to be increasing in the community, including some limited use of managed care organizations. as educational settings. Medical school practice sites in the community have the potential to exacerbate "town-gown" tensions in the increasingly competitive health care environment. This, in turn, could jeopardize community-based medical education by the large number of practicing physicians who serve as volunteer faculty members and who are a valuable resource. Care will need to be taken to minimize these tensions as much as possible. As the health care system becomes even more competitive, concerns are being raised about whether volunteer faculty will continue to serve without compensation. The ability to begin to compensate community physicians who serve as teachers could be affected by decreasing medical school revenues from patient care, which, in the past, have been used to support activities such as community-based education. This is a time for strong and visionary academic leadership: medical schools must not only adapt to a changing health care system, but also maintain excellence in education, research, and patient care. This annual article will continue to describe the efforts of educational programs to do so.

Providing Students with Tools to Increase Their Academic Success

In an elective course titled “Be A Master Student”, freshmen in The Pennsylvania State Univ.'s College of Agricultural Sciences were introduced to subjects ranging from university policies and procedures to skill enhancement in note-taking, test-taking, and time management techniques. A broad knowledge of agricultural sciences at local, state, national, and international levels was developed with the goal to relate agriculture to individual and societal needs. Mentoring relationships between students and faculty developed, not only with course instructors, but also with other faculty through required interviews and one-on-one discussions. Two volunteer faculty instructors taught 20 students per section. The number of sections has increased from four in 1990 to 13 in 1994. More than 70% of incoming freshmen opted to schedule the course in 1994. Student surveys indicated that >90% of those who enrolled would recommend the class to a close friend. Performance tracking shows that studentswho enrolled in the class maintained higher grade point averages than students who did not enroll. A higher rate of retention also has been documented for students who complete “Be A Master Student”!

Integration of Community Pediatricians into an Academic Department

A process of enhanced participation by community pediatricians in the programs and administration of an academic department is described. We realize that many departments incorporate volunteer faculty into their academic programs without creating a specific structure, such as our divisional classification. The customary paradigm of providing "ad hoc" opportunities and responsibilities for volunteer faculty is somewhat analogous to the traditional "quality assurance" model of management, which is responsive in nature and places the participants in a dependent relationship to the academic leadership. Creating academic division structure allows the volunteer faculty to initiate projects, create interdivisional work teams, and evaluate the results of their involvement and is more reflective of the new "continuous quality improvement" model. This system elevates the volunteer faculty into a partnership relationship with the academic faculty. The sense of ownership and opportunity for personal growth appear to be important drives for sustained community involvement. Although the benefits of our program appear promising, committed leadership within the academy and community will be required for long-term success. Re-analysis of the intramural dynamics and activities following systemic restructuring of the health care system will be of interest.

The Midlevel Practitioner Role: One Medical Center’s Experience

Numerous trends in the current health-care environment have converged to produce an increased emphasis on the role of the midlevel practitioner. Financial constraints head the list, including a mandate for the best care at the lowest rates and a resulting shift from costly specialists to primary care providers. The desire to conserve human and technologic resources requires a practitioner with advanced knowledge and skills to serve as gatekeeper in terms of facilitating access to health care, establishing efficient referral patterns, and developing a holistic care plan. The midlevel practitioner also is prepared to facilitate the transition from the intensive care unit to the less costly general care areas. In addition, the inevitable reduction in funds for graduate medical education and the dwindling number of first-year medical students choosing internal medicine as a specialty threaten the ability of academic medical centers in particular to provide adequate housestaff coverage to full-time and voluntary faculty members. Physicians eager to provide efficient, seamless care to patients in the acute care setting, while maintaining an office practice and caseloads at several hospitals, find the support provided by a midlevel practitioner an enhancement to their clinical practice and a solution to the continuous management of acute and chronically ill patients. In this article, the authors describe one medical center's experience in implementing the midlevel practitioner role.

Operation Desert Shield and Storm: Impact on Undergraduate and Graduate Internal Medicine Education

We evaluated the impact of mobilization during Operation Desert Shield and Storm on undergraduate and graduate internal medicine education. Surveys were sent to the 425 residency program directors and 128 chairs of departments of medicine of U.S. medical schools in February 1991. Among graduate programs (46% response), 1.6% of full-time faculty, 0.2% of voluntary faculty, and 0.1% of residents were mobilized. No full-time faculty, voluntary faculty, and residents were mobilized at 77%, 90%, and 93% of programs, respectively. Negative impact ranged from none (68%) to significant (2%). For undergraduate education (51% response), 1.2% of full-time faculty, 0.1% of voluntary faculty, and 0.3% of residents were activated. Sixty-three percent reported no full-time faculty, 97% no voluntary faculty, and 86% no residents activated. Negative impact ranged from none (53%) to significant (4%). The effect of mobilization was small, and program directors and chairs should feel comfortable supporting participation in reserve activities.

Impact of feedback on teaching by volunteer faculty in a third‐year family medicine clerkship: A pilot study

Using volunteer faculty in community private practices to teach medical students poses unique opportunities and potential problems. One problem is monitoring student experiences and ensuring that the experience of all students meets certain standards. This article describes how the clinical experiences of students working with community preceptors are monitored and the impact that feedback to these preceptors has had over a 1‐year study period. Community students and preceptors did well throughout the study period in several areas, including evaluating the targeted number of patients and the targeted percent of core problems. Feedback did not result in improvement in some deficiency areas, particularly in overall number of core problems seen and deficiencies in numbers of students evaluating specific core problems. These findings are discussed along with strategies to enhance the impact of feedback to preceptors.

Continuing Education in Psychotherapy as a Method to Attract and Involve Voluntary Faculty in an Academic Department of Psychiatry

This article describes the development and nature of an extensive program in continuing education in psychotherapy for voluntary faculty, which operates within a division of psychotherapy. A major goal of the program is to increase the number and quality of psychotherapy supervisors available to train residents.

Comparison of volunteer and full‐time faculty performance in a required third‐year family medicine clerkship

The increased number of required family medicine clerkships has created the need for more qualified faculty to serve as preceptors. One solution to the faculty shortage is to use volunteer faculty practicing in the private setting. This article describes how volunteer faculty at one institution were selected and trained and compares the performance of volunteer and full‐time faculty using several parameters. Student perception of their level of involvement in patient care activities was comparable between private practices and the university site. Students also rated general teaching skills of volunteer and full‐time faculty similarly. However, students placed at private practices felt less confident about their acquisition of fundamental clinical skills than did students placed at the university site, and volunteer faculty tended to grade more leniently than did full‐time faculty. In general, however, we conclude that volunteer faculty, properly selected and trained, can be a useful and valuable resource in undergraduate family medicine education.

Retraining faculty for the problem-based curriculum at the University of Hawaii, 1989-1991

The problem-based learning (PBL) curriculum, adopted by an increasing number of medical schools, requires retraining faculty for new roles as tutors with small groups of medical students. This study describes the procedures and results of four PBL training workshops (1989-1991) given at the University of Hawaii John A. Burns School of Medicine. Eighty-eight faculty volunteers each answered a 20-item multiple-choice questionnaire testing their knowledge of PBL both before and after they participated in a workshop. The posttest results were used to identify deficiencies in the tutors' knowledge and practice of both their role and their function. The authors conclude that these deficiencies, now identified, will be addressed in a systematic fashion in subsequent workshops.

An Evaluation of Surgery Departments in Community-Based Medical Schools

Since 1960, most newer medical schools have been community-based and have used existing community hospitals and a large number of volunteer faculty. As these schools have evolved, many have developed more traditional characteristics. To assess the positive and negative features of these new schools, chairs of departments of surgery from 21 community-based medical schools and 17 traditional schools were surveyed to acquire information on policies and practices related to faculty development, undergraduate and graduate education, hospital relationships, clinical activities, research, and relationships with community physicians. Responses were analyzed and compared. Most community-based schools have succeeded in their mission, partly at the expense of controls usually found in more traditional schools.

Integrating Production and Curriculum In The Liberal Arts Setting

COMMENTS ON PROCESS Integrating Production and Curriculum In The Liberal Arts Setting Patricia VandenBerg Blom We had problems. The faculty was overworked; the students were restless. More immediately, who was going to supervise the student-directed lab bills? For years this responsibility had been assumed on a non-credit (read "volunteer ") basis by the Director of Theatre. As the new hire in that position, I knew that I could not do a good job of supervising the lab bills in addition to all of my other responsibilities. I refused to do so and asserted that none of my colleagues should be expected to volunteer for the job either. Confronted with the likelihood of student outrage if their directing opportunities were eliminated, but having no faculty volunteers to allocate to the cause, my department was compelled to hunker down and get creative. One of the benefits of directing a theatre program under the auspices of a Department of Communication Arts and Sciences is that some of my non-theatre department colleagues came to the problem of theatre production/curriculum with few, if any, preconceived notions. Their innocence gave us fresh insights and more than the student-directed lab bill issue was resolved. Our departmental deliberations convinced us that in order to alleviate student and faculty burnout we had to more effectively integrate production and curriculum. We have now created a system by which all of our productions come out of classes. Students receive at least partial academic credit for work on any of the four productions we do annually. Faculty workloads are more reasonable. In addition to relieving the burnout problem, our solutions have resulted in some pedagogical benefits. While our plan is very specifically geared to our program and institution, I believe that variations on these solutions could be used in numerous contexts. Calvin College is a private, liberal arts college. The Theatre program employs three theatre faculty as well as a staff technical director, costume designer, and costumer. We produce four theatrical productions per year: three are faculty or guest-directed, and the fourth is the previously mentioned student-directed lab bill. We serve our own majors as well as many students from other fields. 149 150 Patricia VandenBerg Blom Fortunately, we did not have to start from scratch in integrating production and curriculum at Calvin. Our major fall and spring productions had long come out of a class called Theatre Production. It is a curious hybrid whose precursor was a drama club. During the 1960s the former Director of Theatre cleverly plotted a strategy whereby the students in the class receive 1/4 credit hour per term for participation. (This parallels the choirs and band at Calvin.) Students audition/interview for the class. If accepted, they can participate all four years and are able to accumulate up to two full course credits toward graduation. The group normally numbers around seventy and represents students from many majors. The class becomes a company of sorts which produces the major play each term. Only those in the class are allowed to audition for, or to crew the two mainstage plays. Competition to get into the class is stiff, drawing around 115 applicants for 20 positions each fall. (The other 50 places are already taken by students wishing to remain in the class.) In addition to producing the plays, the class meets once a week for one hour, and the instructor receives one course teaching credit per term for producing the plays and leading the class. There are some drawbacks to this plan, but we have found that the benefits outweigh the problems. One obvious drawback is that there are students on campus who would like to participate in mainstage productions but who either are not accepted into the class or do not audition because they don't have the time or the inclination to make the commitment to the course. (There are numerous other production outlets for these students, however, both within the department and sponsored by the student-run Drama Guild.) Another problem with the system is that directors are limited in casting to those who have been accepted into the class. The benefits, however, are many. The class sessions...

The threatened role of volunteer faculty members

The threatened role of volunteer faculty members

Clinical Pharmacology Education in a Division of Cardiology

A working model of how clinical pharmacology education can be interwoven into the matrix of an academic cardiology program that includes didactic teaching, clinical research, and patient care has been presented. Essential to the success of such a program is the commitment and dedication of both its full-time and voluntary faculty. Moreover, a comprehensive plan of organization and allocation of efforts is vital to the success of such a complex undertaking. As we look to the future, the discipline of clinical pharmacology will be increasingly relevant to the practicing cardiologist.

The Sayings of Chairman Joe or Some General Guidelines and Principles for Running Jewish Studies Programs or Activities

VoLume 9. No.4 Summer 1991 121 As part of the presentation at the MJSA Coriference, Joseph Haberer and Sam Shermis of Purdue University put together a workshop entitled "How to Start, Run, and Direct a Jewish Studies Program." Ifyou would like to order these materials, please write to Professor Haberer at the address in the front of the journal, and enclose a check for $4.00 made out to "Shofar." The following essay is part of the workshop packet. The Sayings of Chairman Joe or Some General Guidelines and Principles for Running Jewish Studies Programs or Activities Joseph Haberer Purdue University 1. Whatever advice or suggestions are offered, remember that there are no hard-and-fast rules. Advice mustbe geared to your situation, implemented on the basis of your experience, and dependent primarily on your good judgment. 2. Size is a critical factor. What you can or cannot do depends heavily on the type of institution in which you operate-small, medium-sized, or large; private or public-and on the existing infrastructure pertaining to Jewish Studies. Therefore, start by canvassing the existing situation. In a small institution, there may be even more support for Jewish Studies than you had imagined. 3. Start modestly, but don't be afraid to think big. It helps to have some kind of vision of what might be possible in the long run. Your vision, shared by colleagues, will enable you to keep going when there are obstacles and disappointments . It will also communicate itself to others, especially to potential patrons. Your imagination and enthusiasm are probably the key factors in generating support for a program or for other kinds of Jewish Studies activities . 4. Whether or not you start a program depends in part on your location. It is not necessary to create a program for there to be a Jewish Studies presence in your institution. Modest initial efforts may generate momentum to go on to bigger things. 122 SHOFAR 5. You and your colleagues need good ideas to render the program viable,' sufficient time and resources to make things work, and energy to accomplish the goals. All of these-ideas, time, resources, and energy-are relatively scarce commodities. Your scarcest items will probably be time and energy. The measure of commitment is likely to depend on how much of these are available. 6. The more these are harnessed, the more likely it is that you will be able to form a program with the requisite support structure-staff, budget, money-to make a program viable. Do not forget that your colleagues have plenty of other obligations, and while they may be supportive, they may not be inclined or able to give very much commitment. Do not overcommit your supporters. Delegate and share responsibilities. 7. Your program will be interdisciplinary, but the reward structure in the university and college typically is disciplinary. Therefore, do not expect to be rewarded for efforts or for your program. Your rewards will have to be intrinsic-you do it because it needs doing and because you want to do it. And you want to do it because you derive considerable intellectual stimuation and satisfaction from promoting Jewish Studies. 8. Keep in mind that colleagues working towards tenure and promotion, while often the most enthusiastic, are also the most vulnerable. Don't expect too much from them. Try to get the associate and full professors to work with you-no easy eask either-and be ready for disappointments. Sometimes you identify such faculty members who do research or teaching in the field and whom you would expect to be most involved in a Jewish Studies program. But they do the least and demonstrate almost total indifference. Be of stout heart. You will manage without them. 9. Initially you will depend completely on a volunteer faculty for the teaching of some courses, probably on an overload basis, and for running, i.e., administering, the program itself. Find kindred souls, with whom you can work. If the activities increase sufficiently to warrant the hiring of part-time or full-time staff-secretaries, clerks, program or research assistants, word processors-you will need to give attention to finding the necessary...

The Organization and Regulation of Voluntary Faculty

A large number of psychiatrists have been, or are currently, unpaid, voluntary, or "clinical" faculty. In 1987-1988, in 127 medical schools, there were approximately 122,000 clinical faculty members, outnumbering regular faculty by approximately two to one. Yet, in contrast to primary faculty, administrative policies (e.g., appointment, reappointment, promotion) regarding clinical faculty are often ill-defined or absent entirely. We discovered in a survey of 8 departments of psychiatry that most departments do not have separate administrative guidelines or policies for these faculty. This article addresses specific mechanisms for determining clinical faculty membership and duties and suggests policies for appointment, reappointment, and promotion. The authors focus on administrative management strategies, such as the creation of a departmental Clinical Faculty Committee and the consideration of quality assurance issues.

Preceptors for an introduction to clinical medicine course: needs of volunteer and full-time faculty

Recruiting clinicians to teach bedside skills is often a challenge for Introduction to Clinical Medicine (ICM) course co-ordinations. Little data is available concerning what motivates a faculty to participate in these programmes. Better understanding of these factors might allow enhanced faculty involvement. We surveyed full-time and volunteer faculty as to what forces promote and hinder participation as preceptors for an ICM course. Results documented that both faculty groups found student interactions and teacher fulfillment their major reward, with little perceived academic or patient recognition. Personal time limitations was the greatest deterrent to participation. Assessing faculty needs has allowed focused course changes and new activities to facilitate involvement.

Guidelines for Urgent Care in School

Minor injuries and illnesses can occur in children during the course of the school day. They are usually well-handled by the school nurse in consultation with a physician who serves as the school medical advisor. True medical emergencies are rare. Many school systems have part-time school medical advisors and nurses who are responsible for more than one school building and may not be readily available. Therefore, the burden of emergency recognition and management may fall on teachers, principals, or other personnel within a school. It is important for school administrators in consulation with the school medical advisoringand nursing service to formulate a guide for emergency care. The Committee on School Health of the American Academy of Pediatrics suggests the following: 1. Every school district should identify individuals als who are authorized and trained to make urgent medical care decisions. 2. An emergency care manual and standing orders for first aid should be written and made available to nurses, athletic staff, and faculty volunteers.1 3. Procedures should be in place to summon help in catastrophic and urgent care situations from emergency sources within the community including rescue squads and, where available, the 911 system. Transportation to a hospital or medical facility should be accessible. 4. The school nurse in each building should be the key person to carry out the program as she or he is most familiar with the students' health problems. All nurses should be trained in a program of emergency came developed by physicians, emergency medical technicians, and/or other nurses with special training in emergency care1