- Email: [email protected]
A Model Clinical Faculty Workshop Program for a Multisite Clerkship
Graduate Education A model clinical faculty workshop program for a multisite clerkship Lynn P. Mandel, PhD, Morton A. Stenchever, MD, and Louis A. Vontver, MD, MEd Over the past 20 years, the University of Washington Department of Obstetrics and Gynecology has conducted twice-yearly faculty development workshops at the University for clinical faculty at community sites spread over three time zones in Washington, Alaska, Montana, and Idaho. These workshops consist of three separate parts: 1) a session to report on student clerkship performance and faculty ratings, 2) a session on curriculum and/or teaching, and 3) a session to update medical topics. Faculty found the workshops useful for improving their clinical teaching, keeping in touch with the full-time faculty, and developing a sense of cohesiveness. The department found the workshops useful in maintaining the teaching of consistent content and ensuring that all sites provide students with comparable experiences and evaluation. (Obstet Gynecol 1997;90:1011– 14. © 1997 by The American College of Obstetricians and Gynecologists.)
The major purpose of this paper is to describe a model of faculty development workshops designed to help community-based faculty participate fully in a university teaching program. It is a “how-to” description of one method to maintain consistency and continuity over time between the parent university and multiple 3rd-year basic obstetrics and gynecology clerkship sites located at the university and in the community. There are approximately 166 students in each year’s class, with approximately 120 being taught at sites away from the university. Each site trains from one to six students during the 6-week clerkship. The need for community sites arose for the following reasons: to provide primary
From the Division of Education, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington.
VOL. 90, NO. 6, DECEMBER 1997
and ambulatory care experiences away from tertiarycare facilities; to teach in the communities where many of the students will practice eventually; to increase student access to patients; and to involve community physicians in the educational process. Faculty development can help enhance the teaching skills of community faculty and increase their value as a resource for medical students and residents.1 A number of studies1– 4 have examined models and approaches to faculty development. Although most are descriptive rather than experimental and quantitative, evaluation data generally show that faculty are willing to use the teaching skills that are learned and that faculty development efforts result in an improvement of student and resident ratings of faculty teaching effectiveness. In addition to enhancing attendees’ skills, workshops have been used to train faculty, who can then conduct teaching improvement seminars for other faculty at their home institutions.5 Taking a broader view, Evans6 suggested that faculty development may be thought of as more than improving teaching skills but also as “nurturing the growth of trainees into accomplished faculty.”
Description of Workshops Twice-yearly University of Washington obstetrics and gynecology faculty development workshops were begun in May 1977 to improve consistency among multiple obstetric and gynecology clerkship sites, which eventually spread out over the four-state region of Washington, Alaska, Montana, and Idaho. As of spring 1997, 41 workshops had been conducted. During this time, the number of obstetrics and gynecology basic clerkship sites has increased from three to nine. The workshops were designed to do the following: 1) provide feedback to faculty about student ratings of clerkships, student performance, and how well the clerkship goals were met, 2) provide faculty development for all teachers, including provision for feedback, improvement of instruction, and participation in the development of the curriculum and the evaluation system for use at all sites, and 3) present general medical information to enhance the clinical faculty members’ medical knowledge. A review of the last 5 years’ experience indicated that an average of 25 faculty members attended each workshop, with at least half from the community sites outside the medical school. There was almost always at least one representative from each site outside the Seattle area. Attendees at the fall 1996 workshop included 11 faculty and two staff from distant community sites, ten faculty from nearby Seattle-Tacoma commu-
0029-7844/97/$17.00 PII S0029-7844(97)00475-4
1011
Table 1. Examples of Teaching and Curriculum Topics Presented in Faculty Workshops Characteristics of effective teachers The medical school grading system “What motivates me to be a better teacher?” How to write multiple-choice test items How to develop oral test items Problem-based learning Psychosocial resources Evaluation of student write-ups Recognizing and dealing with problem students Using standardized patients Internet resources Giving feedback
nity sites, 15 from the medical school site, and three department staff. The format of each workshop has remained consistent over the years. Three segments are presented at each half-day workshop. The first is the “clerkship report card”—feedback to the faculty in an effort to increase their motivation, improve performance, document consistency, and provide a mechanism for continuous quality improvement. The head of the education division of the department (a physician) and the departmental educator (a PhD) provide a summary of student performance, student ratings of faculty teaching effectiveness, ratings of the extent to which each clerkship site met its course goals and objectives, and the students’ reports of the number and types of experiences they have had at each site. The second segment is devoted to teaching and/or curriculum development methodologies, including how to improve teaching skills and how to develop and use assessment tools. A list of representative educational topics is shown in Table 1. This segment is intended to provide confidence to clinical faculty with little teaching experience as well as to maintain consistency and rapport among the faculty members. Going through the learning process together fosters group cohesiveness and gives the faculty a sense of ownership of the clerkship. The head of the education division, the departmental educator, and occasionally faculty from the Department of Medical Education or the Dean’s office present this segment. All attendees participate in the activities. The third part of the workshop is a continuing medical education presentation to increase the faculty members’ knowledge base and to provide information to use in patient care and to teach to the students. This presentation is usually given by full-time University of Washington faculty or visiting professors and showcases their current clinical interests or provides an update on contemporary clinical issues. Examples of these topics are presented in Table 2.
1012 Mandel et al
A Model Faculty Workshop
The “clerkship report card” provides faculty with direct, albeit belated, feedback about student performance and perception of their clerkship experience. The data presented during this segment of each of the 41 workshops consisted of student performance on a written pretest and posttest, an oral presentation and examination, preceptors’ evaluations of student interactions with patients, and the student write-ups; student ratings of faculty teaching effectiveness; and assessment of how well the student’s experience met the clerkship’s stated goals and objectives. The data also included the numbers, types, and degrees of participation in experiences and procedures the students had at each site. Comparison has shown consistency in the grades received as well as consistency in student ratings of the clerkship goals and objectives among the sites. There was some variability in the number and types of clinical experiences, as would be expected with student placements in both tertiary-care facilities and community practitioners’ offices. For example, students at most community sites performed more deliveries, whereas those at the University of Washington Medical Center had more encounters with oncology patients. However, careful monitoring ensured that all students received sufficient experience in each core area to meet the clerkship goals. Each faculty member received a notebook containing summaries of the results by clerkship site as well as their own individual student evaluations. These data were mailed to those faculty who did not attend. These clerkship “report cards” have been remarkably consistent over time and among the sites, with almost all faculty and clerkship ratings averaging at least 4 of a maximum of 6 on a Likert scale. The results are used by the department chair, the clerkship director, and attendees to guide clerkship changes as well as to develop future workshop topics. For example, when students indicated that the clerkship did not cover genetic counseling as well as it did other areas, we included a genetics presentation in a subsequent workshop. We Table 2. Examples of Medical Topics Presented in Faculty Workshops Geriatrics, care of the older female Ethics in obstetrics and gynecology Effects of managed care on obstetrics and gynecology AIDS Obtaining a sexual history (with role-playing) Cancer treatment Obstetric anesthesia for medical students Genetics update Aspects of pelvic pain New treatments for stress incontinence Update on assisted reproductive technologies Gestational diabetes
Obstetrics & Gynecology
addressed the issue of feedback in a recent workshop after noting that faculty have consistently received lower ratings in this area. As an example, the October 1996 workshop included the usual feedback to the faculty, an educational segment on how the faculty could provide feedback to the students, and a clinical update on gestational diabetes. For the educational segment, we illustrated positive and negative feedback using a brief presentation, a demonstration of types of feedback, and hands-on activities that involved the faculty in role-playing. After the demonstration, we invited faculty to share their own experiences with feedback from their medical school and residency years. It was quite easy for them to relate instances of negative feedback and the severe impact it had on them at the time, as well as how little such feedback contributed to learning. They did not relate many encounters with positive feedback. The faculty then worked in groups of three, with one member playing the role of the student receiving feedback. Another played the preceptor giving feedback, and the third faculty member observed and provided feedback to the other two participants. Both written and verbal comments indicated that they greatly valued the exercise. Future workshops are planned to cover areas such as gender issues, teaching students in a managed care environment, application of medical informatics to the clinical provider, techniques used to identify and correct student deficiencies, and a presentation by two to three students of their perceptions of what constitutes positive feedback and a “good” clerkship experience.
Discussion It is our impression that faculty consider the workshops to be useful in their clinical instruction and in developing cohesiveness among widely dispersed colleagues. This was confirmed by evaluations completed by participants in the 1996 workshops in which they rated selected aspects on a scale of 1 (not useful) to 5 (extremely useful). The average ratings are shown in Figure 1. Overall, these sessions appear to have been worthwhile for the clinical faculty as they continue to attend with enthusiasm. In addition, most have continued to teach, and most sites have remained in the program. From the department standpoint, the workshops have been extremely useful in keeping consistent content and ensuring that all sites provide students with comparable experiences and evaluation. Cost is always a consideration in the decision of the best way to provide opportunities for the faculty to interact. The workshops are held at a Seattle restaurant, with coffee and pastries provided in the morning and
VOL. 90, NO. 6, DECEMBER 1997
Figure 1. Participant ratings of how the obstetrics and gynecology clinical faculty workshops held in 1996 were useful (n 5 40). UW 5 University of Washington.
lunch provided after the program. The room rental and refreshments are provided by educational grants from various pharmaceutical firms interested in sponsoring educational activities. The guidelines of the ACOG Committee on Ethics7 are followed, and no conditions or obligations are attached to the use of the funds. Although representatives from the sponsoring firms are invited to attend the workshop, they put out no literature and do no marketing. There is a brief acknowledgment of the sponsorship in the written program. The School of Medicine pays the travel and lodging expenses for one or two participants from each of the sites outside the Seattle-Tacoma area. The workshops are supplemented by a visit to each distant site during each 6-week clerkship as part of a comprehensive program to maintain communication. In the future, E-mail and the World Wide Web may supplement some of these activities, but they will not replace the personal contact provided by a workshop. We acknowledge that bringing faculty from distant sites twice a year can be expensive, time-consuming, and sometimes cumbersome. However, as a regional school serving four states, we believe that personal contact is the best way to foster trust and commitment. The model described in this paper is an excellent way to foster camaraderie, continuity, and consistency among clinical faculty while increasing teaching skills.
References 1. DeWitt TG, Goldberg RL, Roberts KB. Developing community faculty. Principles, practice, and evaluation. Am J Dis Child 1993; 147:49 –53. 2. Anderson J, Hess G, Rody N, Smith W. Improving a community
Mandel et al
A Model Faculty Workshop
1013
3.
4. 5.
6. 7.
preceptorship through a clinical faculty development program. Fam Med 1991;23:387– 8. Keenan JM, Seim HC, Bland CJ, Altemeier TM. A workshop program to train volunteer community preceptors. Acad Med 1990;65:46 –7. Mahler S, Benor DE. Short and long-term effects of a teacher training workshop in medical education. Higher Educ 1984;13:265–73. Skeff KM, Stratos GA, Berman J, Bergen MR. Improving clinical teaching. Evaluation of a national dissemination program. Arch Intern Med 1992;152:1156 – 61. Evans CH. Faculty development in a changing academic environment. Acad Med 1995;70:14 –20. American College of Obstetricians and Gynecologists Committee on Ethics. Guidelines for relationships with industry. ACOG committee opinion no. 182. Washington, DC: American College of Obstetricians and Gynecologists, 1997.
1014 Mandel et al
A Model Faculty Workshop
Address reprint requests to:
Lynn Mandel, PhD Department of Obstetrics and Gynecology Box 356460 University of Washington Seattle, WA 98195-6460 E-mail: [email protected] Received April 14, 1997. Received in revised form July 14, 1997. Accepted August 1, 1997.
Copyright © 1997 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
Obstetrics & Gynecology
The major purpose of this paper is to describe a model of faculty development workshops designed to help community-based faculty participate fully in a university teaching program. It is a “how-to” description of one method to maintain consistency and continuity over time between the parent university and multiple 3rd-year basic obstetrics and gynecology clerkship sites located at the university and in the community. There are approximately 166 students in each year’s class, with approximately 120 being taught at sites away from the university. Each site trains from one to six students during the 6-week clerkship. The need for community sites arose for the following reasons: to provide primary
From the Division of Education, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington.
VOL. 90, NO. 6, DECEMBER 1997
and ambulatory care experiences away from tertiarycare facilities; to teach in the communities where many of the students will practice eventually; to increase student access to patients; and to involve community physicians in the educational process. Faculty development can help enhance the teaching skills of community faculty and increase their value as a resource for medical students and residents.1 A number of studies1– 4 have examined models and approaches to faculty development. Although most are descriptive rather than experimental and quantitative, evaluation data generally show that faculty are willing to use the teaching skills that are learned and that faculty development efforts result in an improvement of student and resident ratings of faculty teaching effectiveness. In addition to enhancing attendees’ skills, workshops have been used to train faculty, who can then conduct teaching improvement seminars for other faculty at their home institutions.5 Taking a broader view, Evans6 suggested that faculty development may be thought of as more than improving teaching skills but also as “nurturing the growth of trainees into accomplished faculty.”
Description of Workshops Twice-yearly University of Washington obstetrics and gynecology faculty development workshops were begun in May 1977 to improve consistency among multiple obstetric and gynecology clerkship sites, which eventually spread out over the four-state region of Washington, Alaska, Montana, and Idaho. As of spring 1997, 41 workshops had been conducted. During this time, the number of obstetrics and gynecology basic clerkship sites has increased from three to nine. The workshops were designed to do the following: 1) provide feedback to faculty about student ratings of clerkships, student performance, and how well the clerkship goals were met, 2) provide faculty development for all teachers, including provision for feedback, improvement of instruction, and participation in the development of the curriculum and the evaluation system for use at all sites, and 3) present general medical information to enhance the clinical faculty members’ medical knowledge. A review of the last 5 years’ experience indicated that an average of 25 faculty members attended each workshop, with at least half from the community sites outside the medical school. There was almost always at least one representative from each site outside the Seattle area. Attendees at the fall 1996 workshop included 11 faculty and two staff from distant community sites, ten faculty from nearby Seattle-Tacoma commu-
0029-7844/97/$17.00 PII S0029-7844(97)00475-4
1011
Table 1. Examples of Teaching and Curriculum Topics Presented in Faculty Workshops Characteristics of effective teachers The medical school grading system “What motivates me to be a better teacher?” How to write multiple-choice test items How to develop oral test items Problem-based learning Psychosocial resources Evaluation of student write-ups Recognizing and dealing with problem students Using standardized patients Internet resources Giving feedback
nity sites, 15 from the medical school site, and three department staff. The format of each workshop has remained consistent over the years. Three segments are presented at each half-day workshop. The first is the “clerkship report card”—feedback to the faculty in an effort to increase their motivation, improve performance, document consistency, and provide a mechanism for continuous quality improvement. The head of the education division of the department (a physician) and the departmental educator (a PhD) provide a summary of student performance, student ratings of faculty teaching effectiveness, ratings of the extent to which each clerkship site met its course goals and objectives, and the students’ reports of the number and types of experiences they have had at each site. The second segment is devoted to teaching and/or curriculum development methodologies, including how to improve teaching skills and how to develop and use assessment tools. A list of representative educational topics is shown in Table 1. This segment is intended to provide confidence to clinical faculty with little teaching experience as well as to maintain consistency and rapport among the faculty members. Going through the learning process together fosters group cohesiveness and gives the faculty a sense of ownership of the clerkship. The head of the education division, the departmental educator, and occasionally faculty from the Department of Medical Education or the Dean’s office present this segment. All attendees participate in the activities. The third part of the workshop is a continuing medical education presentation to increase the faculty members’ knowledge base and to provide information to use in patient care and to teach to the students. This presentation is usually given by full-time University of Washington faculty or visiting professors and showcases their current clinical interests or provides an update on contemporary clinical issues. Examples of these topics are presented in Table 2.
1012 Mandel et al
A Model Faculty Workshop
The “clerkship report card” provides faculty with direct, albeit belated, feedback about student performance and perception of their clerkship experience. The data presented during this segment of each of the 41 workshops consisted of student performance on a written pretest and posttest, an oral presentation and examination, preceptors’ evaluations of student interactions with patients, and the student write-ups; student ratings of faculty teaching effectiveness; and assessment of how well the student’s experience met the clerkship’s stated goals and objectives. The data also included the numbers, types, and degrees of participation in experiences and procedures the students had at each site. Comparison has shown consistency in the grades received as well as consistency in student ratings of the clerkship goals and objectives among the sites. There was some variability in the number and types of clinical experiences, as would be expected with student placements in both tertiary-care facilities and community practitioners’ offices. For example, students at most community sites performed more deliveries, whereas those at the University of Washington Medical Center had more encounters with oncology patients. However, careful monitoring ensured that all students received sufficient experience in each core area to meet the clerkship goals. Each faculty member received a notebook containing summaries of the results by clerkship site as well as their own individual student evaluations. These data were mailed to those faculty who did not attend. These clerkship “report cards” have been remarkably consistent over time and among the sites, with almost all faculty and clerkship ratings averaging at least 4 of a maximum of 6 on a Likert scale. The results are used by the department chair, the clerkship director, and attendees to guide clerkship changes as well as to develop future workshop topics. For example, when students indicated that the clerkship did not cover genetic counseling as well as it did other areas, we included a genetics presentation in a subsequent workshop. We Table 2. Examples of Medical Topics Presented in Faculty Workshops Geriatrics, care of the older female Ethics in obstetrics and gynecology Effects of managed care on obstetrics and gynecology AIDS Obtaining a sexual history (with role-playing) Cancer treatment Obstetric anesthesia for medical students Genetics update Aspects of pelvic pain New treatments for stress incontinence Update on assisted reproductive technologies Gestational diabetes
Obstetrics & Gynecology
addressed the issue of feedback in a recent workshop after noting that faculty have consistently received lower ratings in this area. As an example, the October 1996 workshop included the usual feedback to the faculty, an educational segment on how the faculty could provide feedback to the students, and a clinical update on gestational diabetes. For the educational segment, we illustrated positive and negative feedback using a brief presentation, a demonstration of types of feedback, and hands-on activities that involved the faculty in role-playing. After the demonstration, we invited faculty to share their own experiences with feedback from their medical school and residency years. It was quite easy for them to relate instances of negative feedback and the severe impact it had on them at the time, as well as how little such feedback contributed to learning. They did not relate many encounters with positive feedback. The faculty then worked in groups of three, with one member playing the role of the student receiving feedback. Another played the preceptor giving feedback, and the third faculty member observed and provided feedback to the other two participants. Both written and verbal comments indicated that they greatly valued the exercise. Future workshops are planned to cover areas such as gender issues, teaching students in a managed care environment, application of medical informatics to the clinical provider, techniques used to identify and correct student deficiencies, and a presentation by two to three students of their perceptions of what constitutes positive feedback and a “good” clerkship experience.
Discussion It is our impression that faculty consider the workshops to be useful in their clinical instruction and in developing cohesiveness among widely dispersed colleagues. This was confirmed by evaluations completed by participants in the 1996 workshops in which they rated selected aspects on a scale of 1 (not useful) to 5 (extremely useful). The average ratings are shown in Figure 1. Overall, these sessions appear to have been worthwhile for the clinical faculty as they continue to attend with enthusiasm. In addition, most have continued to teach, and most sites have remained in the program. From the department standpoint, the workshops have been extremely useful in keeping consistent content and ensuring that all sites provide students with comparable experiences and evaluation. Cost is always a consideration in the decision of the best way to provide opportunities for the faculty to interact. The workshops are held at a Seattle restaurant, with coffee and pastries provided in the morning and
VOL. 90, NO. 6, DECEMBER 1997
Figure 1. Participant ratings of how the obstetrics and gynecology clinical faculty workshops held in 1996 were useful (n 5 40). UW 5 University of Washington.
lunch provided after the program. The room rental and refreshments are provided by educational grants from various pharmaceutical firms interested in sponsoring educational activities. The guidelines of the ACOG Committee on Ethics7 are followed, and no conditions or obligations are attached to the use of the funds. Although representatives from the sponsoring firms are invited to attend the workshop, they put out no literature and do no marketing. There is a brief acknowledgment of the sponsorship in the written program. The School of Medicine pays the travel and lodging expenses for one or two participants from each of the sites outside the Seattle-Tacoma area. The workshops are supplemented by a visit to each distant site during each 6-week clerkship as part of a comprehensive program to maintain communication. In the future, E-mail and the World Wide Web may supplement some of these activities, but they will not replace the personal contact provided by a workshop. We acknowledge that bringing faculty from distant sites twice a year can be expensive, time-consuming, and sometimes cumbersome. However, as a regional school serving four states, we believe that personal contact is the best way to foster trust and commitment. The model described in this paper is an excellent way to foster camaraderie, continuity, and consistency among clinical faculty while increasing teaching skills.
References 1. DeWitt TG, Goldberg RL, Roberts KB. Developing community faculty. Principles, practice, and evaluation. Am J Dis Child 1993; 147:49 –53. 2. Anderson J, Hess G, Rody N, Smith W. Improving a community
Mandel et al
A Model Faculty Workshop
1013
3.
4. 5.
6. 7.
preceptorship through a clinical faculty development program. Fam Med 1991;23:387– 8. Keenan JM, Seim HC, Bland CJ, Altemeier TM. A workshop program to train volunteer community preceptors. Acad Med 1990;65:46 –7. Mahler S, Benor DE. Short and long-term effects of a teacher training workshop in medical education. Higher Educ 1984;13:265–73. Skeff KM, Stratos GA, Berman J, Bergen MR. Improving clinical teaching. Evaluation of a national dissemination program. Arch Intern Med 1992;152:1156 – 61. Evans CH. Faculty development in a changing academic environment. Acad Med 1995;70:14 –20. American College of Obstetricians and Gynecologists Committee on Ethics. Guidelines for relationships with industry. ACOG committee opinion no. 182. Washington, DC: American College of Obstetricians and Gynecologists, 1997.
1014 Mandel et al
A Model Faculty Workshop
Address reprint requests to:
Lynn Mandel, PhD Department of Obstetrics and Gynecology Box 356460 University of Washington Seattle, WA 98195-6460 E-mail: [email protected] Received April 14, 1997. Received in revised form July 14, 1997. Accepted August 1, 1997.
Copyright © 1997 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
Obstetrics & Gynecology