Faculty Development for Ambulatory Care Education

1. Faculty Development for Ambulatory Care Education LuAnn Wilkerson, Ed.D. UCLA

2. What is faculty development? • Assists faculty in acquiring the knowledge, skills and values needed to succeed in their academic roles • as educators • as scholars • as members of the academy • Strengthens organizations so they can fulfill their educational mission

3. The Dilemmas • Physicians skilled in ambulatory care but inexperienced as teachers • Physicians skilled in inpatient teaching but inexperienced as ambulatory teachers • Increasing productivity demands. • Residents unskilled as teachers • Office staff unclear about expectations for teaching

4. Does your school use community preceptors? N=100Fields et al, Acad. Med.,1998 • 96 schools use community preceptors • 73 used them in each year of the curriculum • 10 -27 hours a week • 12-18 weeks a year • Most frequently from primary care • Multiplicity of sites

5. Objectives • Consider the possible goals of faculty development and effective strategies • Discuss predominant models of ambulatory faculty development • Explore possible models for the future

6. Possible Goals of Instructional Development • Motivate and Stimulate New Ideas • Change Beliefs and Behaviors • Promote Educational Scholarship • Change Curriculum and Organizations

7. Types of Faculty Development • Professional Development • Instructional Development • Improving teaching skills • Connecting teaching and learning • Leadership Development • Organizational Development

8. Teaching Improvement -- 1950’s Teaching can be improved by increasing content knowledge and expertise.

9. Teaching Improvement -- 1960’s Teaching can be improved by providing feedback from student evaluations.

10. Teaching Improvement -- 1970’s Teaching can be improved by coupling teaching evaluations with consultation.

11. Teaching Improvement -- 1980’s Teaching can be improved by helping teachers connect knowledge, beliefs, and reasoning with teaching acts.

12. Teaching Improvement -- 1990’s Teaching can be improved by • using reflective practices • in collaboration with colleagues • with institutional support for education

13. The Proposed Solution Models that Work More faculty development! FFI PEP GIMGEL

14. What Works? • Workshops that are longer, involve more than one intervention, and are followed up with practice and feedback. • Feedback on teaching coupled with expert consultation

15. Current Models of Ambulatory Faculty Development • Round Them Up • Train the Trainers • Disseminate Tips • Catch Them Unaware • Stimulate Self-Improvement • Incentivize Participation

16. Round Them Up • Goals: • Motivate and stimulate new ideas • Change beliefs and behaviors • Formats: • Interactive workshops • Multiple modalities • Examples: • Arrows in the Quiver • One Minute Preceptor • Primary Care Futures

17. Train the Trainers • Goals: • Change curriculum & organizations • Promote scholarship • Formats: • “sabbaticals” • degrees or fellowships • Observed practicum • Examples: • Stanford Program • USC Masters • MSU Fellowship

18. Disseminate Tips • Goals: • Stimulate new ideas • Formats: • WWW • Videotape • Handbooks, newsletters Contracts • Examples: • EPIC at UNC • PEP from STFM

19. Catch Them Unaware • Goal: • Motivate and stimulate new ideas • Formats: • Presentations at regularly scheduled meetings • CME activities • Examples: • Using Grand Round at UTMB • Community teams at UCLA

20. Stimulate Self-Improvement • Goals: • Change beliefs and behaviors • Formats: • Student ratings linked to norms, guidelines • Site visits • Self-assessment Examples: Peer coaching at Case Reflective practice at MCOW

21. Incentivize Participation • Goals: • Motivate and stimulate new ideas • Change attitudes and behaviors • Change curriculum and organizations • Formats: • Faculty appointments • Financial support • Computer assistance Examples: Value added students Connectivity

22. Academic Educators • Organizational leaders committed to education • Educational scholars • Educational leaders • Skilled teachers with PCK • Skilled teachers

23. Conclusion • Faculty development is a key to academic vitality, organizational learning and change • Strategies should be matched to desired outcomes. • Evidence suggests some strategies may be more powerful in changing teaching behaviors than others.

24. References • Anderson WA, et al. Faculty development for ambulatory care education. Acad Med.1997;72:1072-5. • Anderson WA, et al. Outcomes of Three Part-time Faculty Development Fellowship Programs. Fam Med. 1997;29:204-8. • Bland, et al. Faculty Development Special Issue. J. Fam. Med. 29(4):230-293, 1997. • DeWitt TG, Goldberg RL, Roberts K. Developing community faculty: principles, practice, and evaluation. AJDC. 1993;147:49-53.

25. References • Dodson MC. Motivation and reward factors that affect private physician involvement in an obstetrics and gynecology clerkship. Ob Gyn,1998;92:628-33. • Fields SA, et al. The use and compensation of community preceptors. Acad Med. 1998;73:95-7. • Flynn SP, Bedinghaus J., Snyder, Hekelman F. Peer coaching in clincal teaching. Fam Med. 1994;26:569-70. • Hitchcock MA, Stritter FT, Bland CJ. Faculty development in the health professions. Med Teach. 1993;14:295-309.

26. References • Krippendorf MD, Simpson DE, Schiedermayer D. Promoting reflective teaching with PDAs. Acad Med. 1999;74:577. • Irby DM. Faculty Development and Academic Vitality. Academic Medicine. 68:760-763, 1993. • Lesky LG, Wilkerson L. Using ‘standardized students’ to teach a learner-centered approach to ambulatory precepting. Acad Med. 1994;69:955-7. • Quirk ME, et al. Evaluation of Primary Care Futures. Acad Med. 1998;73:705-7.

27. References • Rediske V, Simpson DE. Web-based instruction to enhance the clinical teaching of community preceptors. Acad Med. 1999;74;577-8. • Reid A, Stritter FT, Ardt JE. Assessment of faculty development program outcomes. Fam Med. 1997;29:242-247. • Skeff KM, et al. The Stanford Faculty Development Program. Teach Learn Med. 1992;4:180-7. • Szauter K, Boisaubin E, Levetown M. Teaching professionalism in medical grand rounds. Acad Med. 1999;74:581-2.

28. References • Tresoilini CP, Loonsk J. The Expert Preceptor Interactive Curriculum (EPIC). IME, 1998. • Wilkerson L, Irby DM. Strategies for Effective Change in Teaching Practices: A Comprehensive Approach to Faculty Development. Acad Med. 73:387-396, 1998. • Wilkerson L, Sarkin R. Arrows in the quiver: evaluation of a workshop on ambulatory teaching. Acad Med. 1998;73:67-9.

29. Reading the Future