- Email: [email protected]
HRSA Faculty Development Scholars Program: Introduction to the Supplement
The APA/HRSA Faculty Development Scholars Program: Introduction to the Supplement Lucy M. Osborn, MD, MSPH; Kenneth B. Roberts, MD; Larrie Greenberg, MD; Tom DeWitt, MD; Jeffrey M. Devries, MD; Modena Wilson, MD; Deborah E. Simpson, PhD Background.—The purpose of this project was to improve pediatric primary care medical education by providing faculty development for full-time and community-based faculty who teach general pediatrics to medical students and/ or residents in ambulatory pediatric community-based settings. Funding for the program came through an interagency agreement with the Health Resources and Services Administration (HRSA) and the Agency for Healthcare Research and Quality (AHRQ). Methods.—A train-the-trainer model was used to train 112 scholars who could teach skills to general pediatric faculty across the nation. The three scholar groups focused on community-based ambulatory teaching; educational scholarship; and executive leadership. Results.—Scholars felt well prepared to deliver faculty development programs in their home institutions and regions. They presented 599 workshops to 7989 participants during the course of the contract. More than 50% of scholars assumed positions of leadership, and most reported increased support for medical education in their local and regional environments. Conclusions.—This national pediatric faculty development program pioneered in the development of a new training model and should guide training of new scholars and advanced and continuing training for those who complete a basic program. KEY WORDS: teaching
ambulatory care; community-based teaching; faculty development; medical education; primary care
Ambulatory Pediatrics 2004;4:83 87
F
aculty development for the primary care disciplines has been characterized as a crisis in medical education.1 Studies of requirements for primary care health providers indicate a continuing and worsening imbalance between generalist and specialist physicians. The shortage of faculty trained to teach students and residents primary care has been even more crucial. To provide adequate training in primary care, practical and relevant teaching sites are needed, with community clinician teachers trained to teach their practice skills to medical students and residents. In the mid-1990s, leaders from the Health Resources and Services Administration (HRSA) expressed concern to representatives of the primary care academic organizations regarding efficacy of faculty development programs funded by the Bureau of Health Professions. It was
felt that funding of faculty development programs within medical school departments had significant impact within the local setting but that a larger impact was needed nationally. Each of the primary care academic organizations was invited to submit proposals to HRSA for funding of programs that were national in scope. In October 1997 HRSA contracted with the Ambulatory Pediatric Association (APA) to create and implement a faculty development program that could address the shortage of full-time faculty and community-based physicians with expertise in teaching pediatric primary care. The APA, through the directors of the contract, developed the Faculty Development Scholars Program. This program was national in scope with participants from all regions in the United States. The project was designed to create a critical mass of faculty trainers who could help primary care faculty and community-based pediatricians develop teaching skills, develop and evaluate programs and provide the leadership to sustain these efforts. Major goals of the program included increasing teaching skills of community-based preceptors; creating leadership that could focus on changing the culture within the medical community to support primary care education in pediatrics; and developing an infrastructure that could support sustained faculty development efforts at the local, regional, and national levels.2 The program was developed using proven models for the program structure and experts in the field for program implementation and evaluation.3–5 Program content was determined through literature review and needs assessments.
From the University of Utah Health Sciences Center (Dr Osborn), Teasdale, Utah; Moses Cone Health System (Dr Roberts), Greensboro, NC; Director of Creative Medical Education (Dr Greenberg), School of Medicine and Health Sciences, George Washington University, Washington, DC; Cincinnati Children’s Hospital Medical Center (Dr DeWitt), Cincinnati, Ohio; Oakwood Healthcare System (Dr Devries), Dearborn, Mich; American Academy of Pediatrics (Dr Wilson), Elk Grove Village, Ill; and the Office of Educational Services (Dr Simpson), Medical College of Wisconsin, Milwaukee, Wisc. Address correspondence to Lucy M. Osborn, MD, MSPH, Professor Emeritus, University of Utah Health Sciences Center, PO Box 87, Teasdale, UT 84773 (e-mail: [email protected]). Received for publication May 23, 2003; accepted September 18, 2003. AMBULATORY PEDIATRICS Copyright q 2004 by Ambulatory Pediatric Association
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Volume 4, Number 1 Supplement January–February 2004
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Osborn et al
AMBULATORY PEDIATRICS
Table 1. Advisory Groups to the APA/HRSA Faculty Development Scholars Program* Advisory group
General Pediatrics Generalist Education Leadership Group
Ambulatory Pediatric Association American Academy of Pediatrics American Board of Pediatrics American Medical Student Association American Pediatric Society Association of Medical School Pediatric Department Chairs Association of Pediatric Program Directors Council on Medical Student Education in Pediatrics Resident Representative from American Academy of Pediatrics Society for Adolescent Medicine Society for Developmental and Behavioral Pediatrics Society for General Internal Medicine Society for Pediatric Research Society of Teachers of Family Medicine Ambulatory Pediatric Association American Academy of Pediatrics American Board of Pediatrics Association of Medical School Pediatric Department Chairs Association of Pediatric Program Directors Council on Medical Student Education in Pediatrics
*APA indicates Ambulatory Pediatric Association; HRSA, Health Resources Services Administration.
Program design was particularly critical to this contract. One of the key factors was consideration of the effectiveness and impact of a faculty development program in which a national organization, the APA, provided the leadership and the administrative support. Formative evaluation was used to strengthen the program on an ongoing basis. Outcome evaluation assessed changes in participants associated with program participation.6 This article describes the program design, implementation, and general outcomes and discusses the potential long-term effectiveness of this and other similar programs. It also introduces the additional articles in this supplement on faculty development in general pediatrics. PROGRAM DEVELOPMENT General Considerations The program was structured and designed to include features known to be essential elements of outstanding faculty development: senior leadership, buy-in, explicit objectives, networking, and formative and outcomes evaluation.5 Leadership The project director, the track codirectors, the project consultants, and the project evaluators were all nationally recognized leaders in the field of faculty development. Workshop and plenary session presenters were experts in their field as well as talented teachers and educators. The program was structured to provide close, consistent, and continuous contact with senior leaders. The project director and track codirectors were active participants in each session, conducting workshops, conducting debriefing and problem-solving sessions, and being readily available to participants during formal sessions and social activities. Leaders were expected both to be role models and to provide mentoring to scholars. One particularly important aspect of the leadership group was inclusion of a nationally recognized evaluation consultant who was intimately in-
volved with development of the project from its inception. This both provided invaluable assistance with program design and ongoing program improvement and modeled the importance and value of effective evaluation to program participants. Administrative Structure The HSRA contracted with the APA to develop faculty to teach in community-based settings. Because the contract terms fit well with the portion of the association’s mission to improve teaching in ambulatory settings, the APA was felt to provide an attractive administrative and organizational structure for ensuring long-term viability and continuation of the program. The executive director of the APA managed and monitored all phases of the contract. Implementation of the program was the APA Presidential Project of the project director. Core faculty for the program also included five track coordinators, a program evaluation team, and program consultants. Background and Advice During a planning year, a master plan was developed. The project director and track coordinators reviewed literature on faculty development to evaluate models and content of faculty development. Several needs assessments were conducted to determine the needs for teaching, program development and evaluation, and leadership in pediatric primary care education. Two advisory groups, consisting of representatives from pediatric and primary care organizations, were assembled and met to inform the program directors regarding the needs of their constituents and to critique the proposed program. Table 1 lists the organizations that participated in these two groups. The General Pediatrics Generalist Education Leadership Group (GPGEL) reviewed and approved the master plan. The program was developed with explicit objectives that were based on the results of the needs assessments.
AMBULATORY PEDIATRICS
The program evaluation plan was developed based on the program objectives. The proposal for the program evaluation was also submitted to GPGEL for review and approval. Program Structure A train-the-trainer model was selected as the basic structure for the program. Program participants were designated as Pediatric Faculty Development Scholars and trained to give faculty development workshops in their home institutions and their regions. Scholars were divided into three tracks: community-based teaching, educational scholarship, and executive leadership. The purpose of the community-based teaching track was to prepare scholars to impart teaching skills to community preceptors such as use of feedback, adult education theory, and teaching in community settings. The educational scholarship track prepared scholars to teach faculty teaching skills and scholarly activities such as qualitative and quantitative educational research, curriculum development, and program evaluation. The purpose of the executive leadership group was to prepare scholars and their workshop participants to assume positions of leadership and change the culture of pediatric departments and medical schools to support medical education. Two cohorts of scholars received a series of 2-day basic workshops over a 12-month period, with a follow-up workshop 12 months after completing the program. Participants were expected to provide 3–5 local, regional, and/or national faculty development workshops over a 5-year period to train 1500 primary care faculty. Each 2-day session had a specific theme for the general plenary portion of the program. National experts in faculty development were recruited both for plenary presentations and as after dinner speakers. Social events were scheduled with the intent of making the sessions more enjoyable, creating a collegial environment, providing opportunities for informal content with project leaders and workshop and plenary presenters, and promoting personal contacts that could lead to effective networking. Scholar Recruitment A letter soliciting application to the program was sent to all members of key pediatric organizations, the department chairs of all pediatric residency programs, and the deans of all osteopathic and allopathic medical schools. Scholar Selection The project director, the track coordinators, and consultants developed selection criteria for scholars. These included previous teaching experience with and evidence of commitment to faculty development, documentation of teaching community-based primary care pediatrics, and evidence of commitment from their local institution to support the time and effort of the scholar. Regional representation and commitment to care delivery to underserved populations were also important considerations in selection. The program was designed to train 2 cohorts of 20 for the community-based teaching track, 2 cohorts of
APA/HRSA Faculty Development
85
Table 2. Health Resources Services Administration Required Content Areas Ambulatory care Continuity of care Evidence-based medicine Prevention Psychosocial aspects of health Health care delivery systems Population-based medicine Cost-of-care analyses Utilization of interdisciplinary health care teams Utilization of innovative technology
20 for the educational scholarship track, and 2 cohorts of 10 for the executive leadership track. A committee of key program faculty selected scholars from the applicant pool using the developed criteria for participation. Program Content Content for the general program was determined by the terms of the contract. Table 2 lists content areas that that were required by HRSA. Content at all levels also focused on methods of creating institutional changes that support medical education and sustained faculty development. Content for each of the tracks was determined through needs assessments conducted at the beginning of the project and after each 2-day workshop, expert opinion, and process evaluation; the tracks are described individually elsewhere in this supplement. The program evaluation team provided data after each 2-day session, and the content was revised accordingly. RESULTS The master plan was written and developed by the project director and track codirectors. The plan was submitted to GPGEL, revised according to this group’s recommendations, and then approved. The evaluation plan was likewise developed, reviewed by the project director and codirectors, submitted to GPGEL, and approved. Because the number of qualified applicants exceeded the capacity of the program and because efficient use of the funding allowed additional participants, 112 scholars were enrolled: 42 in the community-based teaching track, 38 in the educational scholarship track, and 32 in the executive leadership group. Eighteen percent were community preceptors and 7% were from underrepresented minority groups, with all APA regions represented in each track. Six 2-day workshops were held between February 1999 and December 2001. Overall results indicated increased knowledge and skills in all targeted competency areas. After completing the program, 95% of scholars felt that they were prepared to meet the purpose of the contract, ‘‘to provide faculty development to general pediatrics to medical students and/or residents in ambulatory community settings.’’ Over half of the scholars reported outcomes related to professional growth and growth in their personal careers, including being recognized as having expertise in faculty
86
Osborn et al
development, stronger senses of identity as pediatric educators, and increased national recognition. Scholars also reported significant changes in their local environment, including positive organizational changes, development of a cohort of educators and educational initiatives, and increased supervision and expectations regarding educational scholarship. Scholars also reported developing a strong network of colleagues. All required HRSA content areas were addressed. Scholars felt prepared to teach and assume expanded educational roles specific to the HRSAidentified priority topics in all but 2 areas: cost-of-care analysis and population-based medicine. At the conclusion of the program, scholars reported having formed effective networks.6 Scholars recorded the total number of faculty development workshops that they had presented and the number of attendees since becoming an APA/HRSA Faculty Development Scholarship. The contract goal was to have scholars train 1500 faculty. As of October 1, 2001, scholars had presented 438 local workshops and 161 regional/ national workshops to a total of 7989 participants, far exceeding the goals of the contract. THE SUPPLEMENT This supplement provides a thorough description of this pioneering program in pediatric faculty development. The articles here include more in-depth description of each of the three scholar tracks. Lucy Osborn and Tom DeWitt describe the executive leadership program; Modena Wilson and Larrie Greenberg, the educational scholarship track; and Ken Roberts and Jeff Devries, the community based teaching track. In addition, Deb Simpson and her colleagues describe the formative and summative evaluation activities and results, providing helpful indications of some of the ways the program may have changed the training and status of pediatric educators as well as their potential impact on educators in their home communities. One aspect of the program for participants was the opportunity to carry out their own program evaluations or educational research programs in conjunction with their participation in the faculty scholars program. Four articles in this supplement represent the successful completion of these projects. Fred McCurdy (now at Texas Tech, formerly at the University of Nebraska) and colleagues describe the development of an imaginative administrative colloquium to enhance faculty leadership skills, with changes in faculty knowledge associated with participation in the colloquium. Michelle Barratt and Virginia Moyer (University of Texas Houston Medical Center) carried out a faculty development program to enhance confidence and teaching skills and measured faculty perceptions of changes with a fairly long followup period. Constance Baldwin and Virginia Niebuhr (University of Texas at Galveston) repeatedly assessed community faculty’s knowledge of computer technology for teaching and their interest in enhancing their knowledge, using their findings to develop programs to enhance the use of computer technology in pediatric edu-
AMBULATORY PEDIATRICS
cation. Jennifer Christner and colleagues (Medical College of Ohio and University of South Florida) carried out an imaginative assessment of the views of community program administrators of their experience of having house officers participate in their community programs. These four articles represent particularly promising results of the faculty development effort. SUSTAINING THE EFFORT Although the program successfully trained a cadre of faculty development trainers representing diverse institutions and regions, the major issue is that of long-term sustainability. Effective faculty development requires continuous opportunities for new learning, developing new skills, and advanced training. The annual meeting of the Faculty Development Special Interest Group meets only the needs for continued networking, but it does not train new scholars or provide continuing and advanced training for program participants. The major obstacle for maintaining faculty development programs is financing. National and regional programs are difficult to organize and fund. Although the APA provided an effective organizational structure, faculty development is only a part of the organization’s mission. It cannot fund such programs or provide program directors, faculty, and staff without jeopardizing other parts of its mission. Some local institutions may be willing to pay for faculty to attend a faculty development program, but all too often the institutions most in need of such a program are either unwilling or unable to support faculty to attend and meet the obligations required by participation. Funding from governmental agencies, private foundations, or gifts is needed. RECOMMENDATIONS 1) A national pediatric faculty development program using the train-the-trainer model should be continued. 2) The structure and implementation of a continuing faculty development program should be based on the principles of successful faculty development. 3) Faculty development for community-based education should continue to provide 3 types of training: community-based ambulatory teaching, educational scholarship, and executive leadership. 4) Faculty development should provide opportunities for advanced and continuing training for those who complete a basic program. 5) Governmental agencies with missions to improve the quality of primary care for children should fund such faculty development programs. 6) The APA should continue to support the Faculty Development Special Interest Group and facilitate continuation of the program. AKNOWLEDGMENTS This project was supported by the US Division of Medicine and Dentistry, Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services (HRSA Contract 240-97-0043) Faculty Development for General Pediatrics Generalist Faculty in Community Based Ambulatory Set-
AMBULATORY PEDIATRICS tings (Project Director: Lucy Osborn, MD, MSPH). The authors thank HRSA for financial support and Ruth Kahn of HRSA and Marge Degnon and her APA staff for gracious administrative support.
REFERENCES 1. Council on Graduate Medical Education. Thirteenth Report: Physician Education for a Changing Health Care Environment. Bethesda, Md: U.S. Department of Health and Human Services, Bureau of Health Professions, Health Care Resources and Services Administration; 1999. 2. Roberts KB. Educational principles of community-based education. Pediatrics. 1996;98:1259–1263. 3. Roberts KB, DeWitt TG. Faculty Development of Pediatric
APA/HRSA Faculty Development
4.
5.
6.
7. 8.
87
Practitioners: Complexities in Teaching Clinical Precepting. Pediatrics. 1995;97:389–393. Skeff KM, Stratos G, Mygdal WK, et al. Faculty development: a resource for clinical teachers. J Gen Intern Med. 1997;12: S56–S63. Bland CJ, Schmitz CC, Stritter FT, Henry FC, Aluise J. Successful Faculty in Academic Medicine: Essential Skills and How to Acquire Them. New York, NY: Springer Publishing; 1990. Simpson DE, Bragg D, Biernat K, Treat R. Outcomes Results From the Evaluation of the APA/HRSA Faculty Scholars Program. Ambul Pediatr. 2004;4(suppl 1):103–112. Bland CJ, Ruffing M. Characteristics of a productive research environment: literature review. Acad Med. 1992;67:385–397. Hitchcock M, Bland C, Hekelman F, Blumenthal M. Professional networks: the influence of colleagues on academic success of faculty. Acad Med. 1995;70:1108–1116.
ambulatory care; community-based teaching; faculty development; medical education; primary care
Ambulatory Pediatrics 2004;4:83 87
F
aculty development for the primary care disciplines has been characterized as a crisis in medical education.1 Studies of requirements for primary care health providers indicate a continuing and worsening imbalance between generalist and specialist physicians. The shortage of faculty trained to teach students and residents primary care has been even more crucial. To provide adequate training in primary care, practical and relevant teaching sites are needed, with community clinician teachers trained to teach their practice skills to medical students and residents. In the mid-1990s, leaders from the Health Resources and Services Administration (HRSA) expressed concern to representatives of the primary care academic organizations regarding efficacy of faculty development programs funded by the Bureau of Health Professions. It was
felt that funding of faculty development programs within medical school departments had significant impact within the local setting but that a larger impact was needed nationally. Each of the primary care academic organizations was invited to submit proposals to HRSA for funding of programs that were national in scope. In October 1997 HRSA contracted with the Ambulatory Pediatric Association (APA) to create and implement a faculty development program that could address the shortage of full-time faculty and community-based physicians with expertise in teaching pediatric primary care. The APA, through the directors of the contract, developed the Faculty Development Scholars Program. This program was national in scope with participants from all regions in the United States. The project was designed to create a critical mass of faculty trainers who could help primary care faculty and community-based pediatricians develop teaching skills, develop and evaluate programs and provide the leadership to sustain these efforts. Major goals of the program included increasing teaching skills of community-based preceptors; creating leadership that could focus on changing the culture within the medical community to support primary care education in pediatrics; and developing an infrastructure that could support sustained faculty development efforts at the local, regional, and national levels.2 The program was developed using proven models for the program structure and experts in the field for program implementation and evaluation.3–5 Program content was determined through literature review and needs assessments.
From the University of Utah Health Sciences Center (Dr Osborn), Teasdale, Utah; Moses Cone Health System (Dr Roberts), Greensboro, NC; Director of Creative Medical Education (Dr Greenberg), School of Medicine and Health Sciences, George Washington University, Washington, DC; Cincinnati Children’s Hospital Medical Center (Dr DeWitt), Cincinnati, Ohio; Oakwood Healthcare System (Dr Devries), Dearborn, Mich; American Academy of Pediatrics (Dr Wilson), Elk Grove Village, Ill; and the Office of Educational Services (Dr Simpson), Medical College of Wisconsin, Milwaukee, Wisc. Address correspondence to Lucy M. Osborn, MD, MSPH, Professor Emeritus, University of Utah Health Sciences Center, PO Box 87, Teasdale, UT 84773 (e-mail: [email protected]). Received for publication May 23, 2003; accepted September 18, 2003. AMBULATORY PEDIATRICS Copyright q 2004 by Ambulatory Pediatric Association
83
Volume 4, Number 1 Supplement January–February 2004
84
Osborn et al
AMBULATORY PEDIATRICS
Table 1. Advisory Groups to the APA/HRSA Faculty Development Scholars Program* Advisory group
General Pediatrics Generalist Education Leadership Group
Ambulatory Pediatric Association American Academy of Pediatrics American Board of Pediatrics American Medical Student Association American Pediatric Society Association of Medical School Pediatric Department Chairs Association of Pediatric Program Directors Council on Medical Student Education in Pediatrics Resident Representative from American Academy of Pediatrics Society for Adolescent Medicine Society for Developmental and Behavioral Pediatrics Society for General Internal Medicine Society for Pediatric Research Society of Teachers of Family Medicine Ambulatory Pediatric Association American Academy of Pediatrics American Board of Pediatrics Association of Medical School Pediatric Department Chairs Association of Pediatric Program Directors Council on Medical Student Education in Pediatrics
*APA indicates Ambulatory Pediatric Association; HRSA, Health Resources Services Administration.
Program design was particularly critical to this contract. One of the key factors was consideration of the effectiveness and impact of a faculty development program in which a national organization, the APA, provided the leadership and the administrative support. Formative evaluation was used to strengthen the program on an ongoing basis. Outcome evaluation assessed changes in participants associated with program participation.6 This article describes the program design, implementation, and general outcomes and discusses the potential long-term effectiveness of this and other similar programs. It also introduces the additional articles in this supplement on faculty development in general pediatrics. PROGRAM DEVELOPMENT General Considerations The program was structured and designed to include features known to be essential elements of outstanding faculty development: senior leadership, buy-in, explicit objectives, networking, and formative and outcomes evaluation.5 Leadership The project director, the track codirectors, the project consultants, and the project evaluators were all nationally recognized leaders in the field of faculty development. Workshop and plenary session presenters were experts in their field as well as talented teachers and educators. The program was structured to provide close, consistent, and continuous contact with senior leaders. The project director and track codirectors were active participants in each session, conducting workshops, conducting debriefing and problem-solving sessions, and being readily available to participants during formal sessions and social activities. Leaders were expected both to be role models and to provide mentoring to scholars. One particularly important aspect of the leadership group was inclusion of a nationally recognized evaluation consultant who was intimately in-
volved with development of the project from its inception. This both provided invaluable assistance with program design and ongoing program improvement and modeled the importance and value of effective evaluation to program participants. Administrative Structure The HSRA contracted with the APA to develop faculty to teach in community-based settings. Because the contract terms fit well with the portion of the association’s mission to improve teaching in ambulatory settings, the APA was felt to provide an attractive administrative and organizational structure for ensuring long-term viability and continuation of the program. The executive director of the APA managed and monitored all phases of the contract. Implementation of the program was the APA Presidential Project of the project director. Core faculty for the program also included five track coordinators, a program evaluation team, and program consultants. Background and Advice During a planning year, a master plan was developed. The project director and track coordinators reviewed literature on faculty development to evaluate models and content of faculty development. Several needs assessments were conducted to determine the needs for teaching, program development and evaluation, and leadership in pediatric primary care education. Two advisory groups, consisting of representatives from pediatric and primary care organizations, were assembled and met to inform the program directors regarding the needs of their constituents and to critique the proposed program. Table 1 lists the organizations that participated in these two groups. The General Pediatrics Generalist Education Leadership Group (GPGEL) reviewed and approved the master plan. The program was developed with explicit objectives that were based on the results of the needs assessments.
AMBULATORY PEDIATRICS
The program evaluation plan was developed based on the program objectives. The proposal for the program evaluation was also submitted to GPGEL for review and approval. Program Structure A train-the-trainer model was selected as the basic structure for the program. Program participants were designated as Pediatric Faculty Development Scholars and trained to give faculty development workshops in their home institutions and their regions. Scholars were divided into three tracks: community-based teaching, educational scholarship, and executive leadership. The purpose of the community-based teaching track was to prepare scholars to impart teaching skills to community preceptors such as use of feedback, adult education theory, and teaching in community settings. The educational scholarship track prepared scholars to teach faculty teaching skills and scholarly activities such as qualitative and quantitative educational research, curriculum development, and program evaluation. The purpose of the executive leadership group was to prepare scholars and their workshop participants to assume positions of leadership and change the culture of pediatric departments and medical schools to support medical education. Two cohorts of scholars received a series of 2-day basic workshops over a 12-month period, with a follow-up workshop 12 months after completing the program. Participants were expected to provide 3–5 local, regional, and/or national faculty development workshops over a 5-year period to train 1500 primary care faculty. Each 2-day session had a specific theme for the general plenary portion of the program. National experts in faculty development were recruited both for plenary presentations and as after dinner speakers. Social events were scheduled with the intent of making the sessions more enjoyable, creating a collegial environment, providing opportunities for informal content with project leaders and workshop and plenary presenters, and promoting personal contacts that could lead to effective networking. Scholar Recruitment A letter soliciting application to the program was sent to all members of key pediatric organizations, the department chairs of all pediatric residency programs, and the deans of all osteopathic and allopathic medical schools. Scholar Selection The project director, the track coordinators, and consultants developed selection criteria for scholars. These included previous teaching experience with and evidence of commitment to faculty development, documentation of teaching community-based primary care pediatrics, and evidence of commitment from their local institution to support the time and effort of the scholar. Regional representation and commitment to care delivery to underserved populations were also important considerations in selection. The program was designed to train 2 cohorts of 20 for the community-based teaching track, 2 cohorts of
APA/HRSA Faculty Development
85
Table 2. Health Resources Services Administration Required Content Areas Ambulatory care Continuity of care Evidence-based medicine Prevention Psychosocial aspects of health Health care delivery systems Population-based medicine Cost-of-care analyses Utilization of interdisciplinary health care teams Utilization of innovative technology
20 for the educational scholarship track, and 2 cohorts of 10 for the executive leadership track. A committee of key program faculty selected scholars from the applicant pool using the developed criteria for participation. Program Content Content for the general program was determined by the terms of the contract. Table 2 lists content areas that that were required by HRSA. Content at all levels also focused on methods of creating institutional changes that support medical education and sustained faculty development. Content for each of the tracks was determined through needs assessments conducted at the beginning of the project and after each 2-day workshop, expert opinion, and process evaluation; the tracks are described individually elsewhere in this supplement. The program evaluation team provided data after each 2-day session, and the content was revised accordingly. RESULTS The master plan was written and developed by the project director and track codirectors. The plan was submitted to GPGEL, revised according to this group’s recommendations, and then approved. The evaluation plan was likewise developed, reviewed by the project director and codirectors, submitted to GPGEL, and approved. Because the number of qualified applicants exceeded the capacity of the program and because efficient use of the funding allowed additional participants, 112 scholars were enrolled: 42 in the community-based teaching track, 38 in the educational scholarship track, and 32 in the executive leadership group. Eighteen percent were community preceptors and 7% were from underrepresented minority groups, with all APA regions represented in each track. Six 2-day workshops were held between February 1999 and December 2001. Overall results indicated increased knowledge and skills in all targeted competency areas. After completing the program, 95% of scholars felt that they were prepared to meet the purpose of the contract, ‘‘to provide faculty development to general pediatrics to medical students and/or residents in ambulatory community settings.’’ Over half of the scholars reported outcomes related to professional growth and growth in their personal careers, including being recognized as having expertise in faculty
86
Osborn et al
development, stronger senses of identity as pediatric educators, and increased national recognition. Scholars also reported significant changes in their local environment, including positive organizational changes, development of a cohort of educators and educational initiatives, and increased supervision and expectations regarding educational scholarship. Scholars also reported developing a strong network of colleagues. All required HRSA content areas were addressed. Scholars felt prepared to teach and assume expanded educational roles specific to the HRSAidentified priority topics in all but 2 areas: cost-of-care analysis and population-based medicine. At the conclusion of the program, scholars reported having formed effective networks.6 Scholars recorded the total number of faculty development workshops that they had presented and the number of attendees since becoming an APA/HRSA Faculty Development Scholarship. The contract goal was to have scholars train 1500 faculty. As of October 1, 2001, scholars had presented 438 local workshops and 161 regional/ national workshops to a total of 7989 participants, far exceeding the goals of the contract. THE SUPPLEMENT This supplement provides a thorough description of this pioneering program in pediatric faculty development. The articles here include more in-depth description of each of the three scholar tracks. Lucy Osborn and Tom DeWitt describe the executive leadership program; Modena Wilson and Larrie Greenberg, the educational scholarship track; and Ken Roberts and Jeff Devries, the community based teaching track. In addition, Deb Simpson and her colleagues describe the formative and summative evaluation activities and results, providing helpful indications of some of the ways the program may have changed the training and status of pediatric educators as well as their potential impact on educators in their home communities. One aspect of the program for participants was the opportunity to carry out their own program evaluations or educational research programs in conjunction with their participation in the faculty scholars program. Four articles in this supplement represent the successful completion of these projects. Fred McCurdy (now at Texas Tech, formerly at the University of Nebraska) and colleagues describe the development of an imaginative administrative colloquium to enhance faculty leadership skills, with changes in faculty knowledge associated with participation in the colloquium. Michelle Barratt and Virginia Moyer (University of Texas Houston Medical Center) carried out a faculty development program to enhance confidence and teaching skills and measured faculty perceptions of changes with a fairly long followup period. Constance Baldwin and Virginia Niebuhr (University of Texas at Galveston) repeatedly assessed community faculty’s knowledge of computer technology for teaching and their interest in enhancing their knowledge, using their findings to develop programs to enhance the use of computer technology in pediatric edu-
AMBULATORY PEDIATRICS
cation. Jennifer Christner and colleagues (Medical College of Ohio and University of South Florida) carried out an imaginative assessment of the views of community program administrators of their experience of having house officers participate in their community programs. These four articles represent particularly promising results of the faculty development effort. SUSTAINING THE EFFORT Although the program successfully trained a cadre of faculty development trainers representing diverse institutions and regions, the major issue is that of long-term sustainability. Effective faculty development requires continuous opportunities for new learning, developing new skills, and advanced training. The annual meeting of the Faculty Development Special Interest Group meets only the needs for continued networking, but it does not train new scholars or provide continuing and advanced training for program participants. The major obstacle for maintaining faculty development programs is financing. National and regional programs are difficult to organize and fund. Although the APA provided an effective organizational structure, faculty development is only a part of the organization’s mission. It cannot fund such programs or provide program directors, faculty, and staff without jeopardizing other parts of its mission. Some local institutions may be willing to pay for faculty to attend a faculty development program, but all too often the institutions most in need of such a program are either unwilling or unable to support faculty to attend and meet the obligations required by participation. Funding from governmental agencies, private foundations, or gifts is needed. RECOMMENDATIONS 1) A national pediatric faculty development program using the train-the-trainer model should be continued. 2) The structure and implementation of a continuing faculty development program should be based on the principles of successful faculty development. 3) Faculty development for community-based education should continue to provide 3 types of training: community-based ambulatory teaching, educational scholarship, and executive leadership. 4) Faculty development should provide opportunities for advanced and continuing training for those who complete a basic program. 5) Governmental agencies with missions to improve the quality of primary care for children should fund such faculty development programs. 6) The APA should continue to support the Faculty Development Special Interest Group and facilitate continuation of the program. AKNOWLEDGMENTS This project was supported by the US Division of Medicine and Dentistry, Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services (HRSA Contract 240-97-0043) Faculty Development for General Pediatrics Generalist Faculty in Community Based Ambulatory Set-
AMBULATORY PEDIATRICS tings (Project Director: Lucy Osborn, MD, MSPH). The authors thank HRSA for financial support and Ruth Kahn of HRSA and Marge Degnon and her APA staff for gracious administrative support.
REFERENCES 1. Council on Graduate Medical Education. Thirteenth Report: Physician Education for a Changing Health Care Environment. Bethesda, Md: U.S. Department of Health and Human Services, Bureau of Health Professions, Health Care Resources and Services Administration; 1999. 2. Roberts KB. Educational principles of community-based education. Pediatrics. 1996;98:1259–1263. 3. Roberts KB, DeWitt TG. Faculty Development of Pediatric
APA/HRSA Faculty Development
4.
5.
6.
7. 8.
87
Practitioners: Complexities in Teaching Clinical Precepting. Pediatrics. 1995;97:389–393. Skeff KM, Stratos G, Mygdal WK, et al. Faculty development: a resource for clinical teachers. J Gen Intern Med. 1997;12: S56–S63. Bland CJ, Schmitz CC, Stritter FT, Henry FC, Aluise J. Successful Faculty in Academic Medicine: Essential Skills and How to Acquire Them. New York, NY: Springer Publishing; 1990. Simpson DE, Bragg D, Biernat K, Treat R. Outcomes Results From the Evaluation of the APA/HRSA Faculty Scholars Program. Ambul Pediatr. 2004;4(suppl 1):103–112. Bland CJ, Ruffing M. Characteristics of a productive research environment: literature review. Acad Med. 1992;67:385–397. Hitchcock M, Bland C, Hekelman F, Blumenthal M. Professional networks: the influence of colleagues on academic success of faculty. Acad Med. 1995;70:1108–1116.