GEORGE WASHINGTON UNIVERSITY
School of Medicine
Department of General Pediatrics
Washington, D.C.
Team Contact/Coordinator: Mary C. Ottolini, M.D., M.P.H.
E-Mail: ottolini40@aol.com
Phone: 301-754-7242
Fax: 301-754-7228
Faculty Development Needs Assessment
Located in our nation's capitol, the George Washington University School of Medicine and Health Sciences is experiencing the same pressures to increase clinical productivity while striving to improve undergraduate and postgraduate training programs that are felt nationally by U.S. medical schools. The philosophy for both our undergraduate and graduate education is to involve trainees as active participants in the learning process and to equip them with the skills necessary to become self-directed, life-long learners. We want faculty to model clinical problem solving skills based on the proper framing of clinical questions and the acquisition of literature-based knowledge known as "evidence-based medicine". In order for this apprentice model of education to work, trainees must interact with faculty members both one to one, and in small groups as they deliver clinical care or participate in case-based discussions. Because of the required intensity of faculty contact, it has become neither possible nor desirable to rely solely upon full-time academic faculty to accomplish this task. Over the past five years we have increasingly turned to volunteer community physicians to assist us in training our students and residents.
A major setting for community faculty involvement in GW undergraduate education is a longitudinal course entitled the "Practice of Medicine" (POM) which extends throughout the four year medical school curriculum. This course integrates the building blocks of a traditional medical education, a strong foundation of basic and clinical sciences, with progressive exposure to and responsibility for clinical work throughout the four-year curriculum. The students are introduced to the clinical setting from the beginning and throughout the first two years while learning the basic sciences. In the final two years they "revisit" the basic sciences through interactive case-based problem solving sessions as they progress through their clinical rotations. The POM course enables and encourages the students to integrate basic science and clinical knowledge into their developing skills in scientific and clinical reasoning.
Volunteer community physicians have several roles in the POM course. Over 250 physicians participate as preceptors in the Primary Care Apprenticeship program in which students become involved with clinical practice first hand by spending an afternoon bi-weekly with the same preceptor for the first two years of medical school. Community physicians also serve as mentors for small groups to teach clinical assessment skills and discuss important topics for the developing physician such as ethics and psycho social issues An individual mentor maintains his or her relationship with the same small group over three years. The third volunteer faculty component of pom involves serving as tutors for problem-based learning sessions; a relationship that usually occurs over an academic year.
In addition to their unique role in the POM course, community physicians serve as educators during the clinical years with students assigned to their offices for the six-week primary care rotation and the ambulatory portion of the pediatrics clerkship. On other rotations community based clinicians come in to serve as small group discussion leaders. In total over 600 full-time and volunteer faculty members play significant roles in undergraduate medical education.
Community faculty members are also essential to postgraduate training. Twenty percent of the 72 pediatric residents from our Pediatric Department at Children's National Medical Center have their weekly continuity patient experience for their entire residency with a volunteer, community pediatrician. In most other residencies volunteer clinical faculty frequently lead ward teaching rounds and morning report.
Community practice settings provide trainees the opportunity to interact closely with skilled physicians in "real life" situations. Ideally they should learn not only clinical skills and information, but also how to work as a member of a practice and to contribute to the communities in which they work. Through a cooperative effort with the new School of Public Health and Health Services we are striving to equip students and residents with skills that they can share with their preceptors to add value to the practice and to the community. We are currently beginning a pilot project between the internal medicine and primary care clerkships to improve the health of adult diabetic patients by utilizing students to help facilitate behavior change and health promotion with individual patients. Preceptors are also gaining the ability to implement evidence-based medicine in their practices with the help of students and residents who are being trained to search and analyze the literature to answer patient care problems.
Although inclusion of the many volunteer community faculty members in the educational process can have the advantages described, there is a great need to ensure that the quality of teaching and the content conform to a consistent, high standard. Ongoing faculty development is crucial to the future existence and success of the undergraduate and postgraduate primary care training programs at our university. We wish to draw upon the expertise of the panel of nationally renowned educators to help us develop, implement and evaluate a faculty development plan to achieve the following goals:
1. Maximize teaching effectiveness in the ambulatory setting. This should include training faculty to give appropriate feedback to trainees.
2. Train faculty to facilitate small group case discussions;
3. Assist faculty in efforts to model life-long learning skills, in part by efficient use of evidence-based medicine to answer clinical questions which arise in daily practice.
4. Guide faculty in teaching communication skills and behavioral modification strategies necessary to promote health and manage patients with chronic illness.
5. Develop an evaluation strategy to ensure that trainees are achieving the established learning goals and objectives in an environment which fosters self-directed learning.
6. Develop the ability to detect, properly assess, and re-mediate educational deficits in marginal trainees.
Instructional Environment
The George Washington Medical Center faculty are poised to maximally benefit from this faculty development workshop and will be able to accomplish the goals outlined above. This year the George Washington University School of Medicine and Health Sciences has created and implemented a "clinician-educator" track in their promotion and tenure process. This is evidence of a renewed commitment to foster and reward excellence in clinical teaching and research in medical education. Similarly, the recently appointed Vice President for Health Affairs for the Medical Center has confirmed his commitment to faculty development by establishing the office of Faculty Affairs, with faculty development as one of its priorities. The Office of Faculty Affairs staff, led by the Dean for Faculty Affairs, recently completed a survey of department chairs who rated assisting faculty in improving their teaching skills as a top priority. Last year the School of Public health and Health services was established within the medical center and its faculty are able to provide teaching expertise in the areas of health promotion, evidence-based medicine and community/population based approaches to medical practice. The Department of Pediatrics has developed an educational strategic plan with faculty development as its foundation. Leadership for the strategic plan is coming from Dr. Larrie Greenberg, a nationally recognized teacher/educator. With all these resources recently being created, this is the optimal time to have a team of faculty expertly trained to lead the way to improving the teaching skills of all our faculty, and in making George Washington Medical Center a model for the surrounding region.
Proposed Strategies For Meeting Faculty Development Needs
The faculty leadership of the POM Course have initiated several faculty development workshops for its numerous mentors and tutors, as well a series of workshops for senior students participating in a medical education elective. In addition, the Department of Pediatrics has been holding 2-3 faculty development workshops each year. These workshops were well received by those attending but appropriate information was not collected to document that teaching effectiveness was improved. Also due to clinical pressures, only a few "faculty trainers" have been available making the number of workshops offered limited. if George Washington University is chosen as a pilot site, the capability of our trainers who attended the workshop to train other full-time and volunteer faculty would be enhanced and then complemented by the institutional commitments mentioned above. Our pilot interdisciplinary team will be composed of a representative from the Department of Internal Medicine, four from Health Care Sciences (primary care including general internal medicine, family practice, primary care pediatrics, and allied health programs) and two from the Department of Pediatrics at Children's National Medical Center. One of the representatives from the Department of Health Sciences is a non-physician, specialist in medical education. These departments provide the majority of primary care and of the ambulatory training experience for undergraduate and graduate programs. Our pilot team would train an additional five full-time or volunteer faculty members from each department who would then be capable of training larger number of volunteer faculty in primary care.
A major issue is finding time to carry out a series of workshops for the large ambulatory care faculty in these three departments. We propose to work closely with our informatics and distance learning staff to create interactive teleconferencing capability allowing more faculty to participate with minimal travel time. The School of Public Health and Health Services already offers self-directed courses in evidence-based medicine, epidemiology and behavior modification over the Internet which could be incorporated into our faculty development process. We also plan to experiment with other strategies to bring faculty development to the practice setting, such as using standardized students and scenarios observed by a faculty peer to strengthen one-to-one teaching interactions in the ambulatory setting.
We plan to evaluate the effectiveness of our faculty development process, working closely with Professor Christine McGuire who is a national expert in educational evaluation and a member of our faculty. Our evaluation process will include self-assessment and ratings by trainees and peers of faculty teaching skills. We will ask attendees' to complete a pre and post workshop self-assessment of teaching effectiveness using standardized instruments. the self-assessment will use the critical incident technique and identify criteria into four categories specific to the teaching skills we wish to promote. To establish the reliability of the peer evaluation system we will videotape some teaching sessions and have them rated by an independent observer.
If our team is chosen as a pilot team we have a firm commitment from the dean of the George Washington University School of Medicine and Health Sciences and the Department Chairs to devote faculty time and other needed resources to achieve our goals. George Washington University is institutionally ready to make the commitment to teaching excellence. Also due to the Medical Center's location within 40 miles of four other medical schools it is perfectly situated to be a model for the surrounding medical schools and the East Coast/Mid-Atlantic Region.
