TULANE UNIVERSITY

School of Medicine

New Orleans, Louisiana

Team Contact/Coordinator: Sheila Chauvin, Ph.D.

E-mail: schauvi@tmcpop.tmc.tulane.edu

Phone: 504/988-6600

Fax: 504/988-6601

Faculty Development Needs to Address at the Models That Work Conference

We are implementing a novel curriculum in managed care that includes students, residents and community based faculty. We plan to use the pilot site process for the faculty development component of this project.

Introduction

Our application as a Models That Work pilot site is focused specifically on establishing a comprehensive, community-based faculty development component for our a new ambulatory managed care curriculum at Tulane University School of Medicine, the Tulane Ambulatory Healthcare Curriculum (TAHC). As part of the initial planning, we have submitted a proposal for extramural funding to the Quality Care Research Fund sponsored by the Aetna Foundation and are awaiting a decision of their review panel. Our proposal includes a comprehensive faculty development program for the participating community-based preceptors in general internal medicine, pediatrics and family medicine. Institutional commitment for developing the TAHC, beyond extramural funding that we hope to obtain from the Aetna Foundation, is outlined in the attached letter from N. Kevin Krane, M.D., Vice Dean for Academic Affairs. Aetna Health Plans of Louisiana has agreed to work cooperatively with us.

Proposed Tulane Ambulatory Healthcare Curriculum

The TAHC demonstration project will assign teams of third-year medical students and second or third year primary care residents in medicine or pediatrics* to community-based practitioners who part who participate in Aetna managed care plans. This project creates learning teams of individuals with varying levels of knowledge/skills and experience, emphasizes concepts and principles of effective ambulatory healthcare and utilizes active learning in situated learning environments (small groups, simulations, and hands-on involvement in community-based offices). Preceptors will be selected based on their interest in and enthusiasm for teaching residents and medical students, and their effectiveness in a managed care environment. A core curriculum, will be taught by faculty members in the Tulane School of Medicine and School of Public Health and Tropical Medicine, and community-based preceptors during biweekly, plenary sessions. As our resources allow, curriculum and teaching/learning materials will also be developed in ways that maximize participants' access and appropriate use via the Word Wide Web. Residents will be involved in facilitating small group discussions and case-based learning sessions for each other and participating medical students to extend and apply concepts and principles emphasized in the core curriculum. In turn, residents and students will be expected to extend their learning by applying these concepts and principles appropriately to patients they encounter in preceptors' offices one half day each week.

Faculty development in a critical component of the TAHC demonstration project. Dr. Sheila Chauvin has been actively involved in working with faculty members and residents to enhance their teaching/learning effectiveness since joining Tulane in 1995 to establish the Office of educational Research and Services. In August 1995, Dr. Chauvin surveyed full-time faculty members' priorities for professional development goals and preferences for specific professional development activities. The survey results and Dr. Chauvins's ongoing assessment activities and interactions with faculty members' priorities for professional development goals and preferences for specific professional development activities. The survey results and Dr. Chauvin's ongoing assessment activities and interactions with faculty members and academic departments suggest that faculty are quite open to enhancing their teaching/learning effectiveness. These data continue to be a valuable resource for our ever-expanding faculty development program in the School of Medicine. During the Spring 1998, a survey of Tulane alumni who practice medicine in the greater New Orleans area was conducted by the Office of the Dean in the School of Medicine. Results of the survey revealed considerable interest in teaching residents and medical students' in the community-based clinical setting. Likewise, the respondents indicated enthusiasm for faculty development opportunities, especially to enhance their effectiveness as clinical teachers/preceptors.

Certainly, concerns typically associated with the demands of clinical teaching and faculty development activities are present (e.g., reduced productivity, and the effective use of limited time, personnel, materials, and money). We intend to address these concerns as we develop faculty development activities for community-based preceptors. Also, we anticipate the need to support community-based faculty in ways that minimize isolation (often associated preceptors), and facilitate peer networking among community preceptors and faculty.

Preliminary Plans to Address Faculty Development Needs of TAHC Community Preceptors

Our proposal to the Aetna Foundation includes a comprehensive, three-year plan for developing, implementing, and evaluating a community-based faculty development program. We propose to develop and implement a model of faculty development that builds on the contributions of successful faculty development programs (e.g., Preceptor Education project/Society of teachers in Family Medicine, University of Texas Medical Branch Generalis Physician Initiative, Standardized Ambulatory Teaching Situations/Medical College of Wisconsin). Our community-based faculty development activities and materials will reflect "just-in time," situation-based learning to foster preceptors' use of knowledge, skills, and attitudes in the proposed TAHC curriculum. We believe a unique feature of the TAHC faculty development program will be the involvement of residents as teachers. Since 1996, Dr. Chauvin has developed and implemented a three-tiered curriculum for residents as teachers in the Department of Medicine at Tulane. She has continued to expand and refine this program and it will serve as a foundation on which residents' teaching roles in the ambulatory setting can be built.

We plan to conduct a series of focus group discussions involving community-based practitioners, and a follow-up survey to identify faculty development priorities and preferences. Dr. Chauvin will work closely with Dr. Krane, Dr. Lazarus, and others to identify key needs and appropriate interventions for enhancing community preceptors' effectiveness. For example, Ms. Delia Anderson, the educational director of our standardized patients program, will help us incorporate the use of standardized patients and standardized students in teaching and assessment activities. Similarly, Bruce Bowdish, M.A. (ABD), assistant director in the OERS, will contribute considerable background and experience in developing computer-and network-based multimedia instructional materials. Noteworthy, the OERS has recently secured extramural funding to enhance their Teaching and Learning Technology Center with the addition of a three-camera filming suite and a video editing suite.

A variety of methods will be developed and implemented, including needs assessment, orientation, written handbooks and guidelines, self-directed learning modules, site visits, individual and small group consultation, interactive, hands-on workshops (e.g., teaching skills), mini-sessions at dinner meetings, clinical continuing medical education (e.g., cost-effective practice, ethics and medical/legal issues, quality assurance, and physician/patient communication), faculty evaluation and feedback. Similarly, we intend to take advantage of multimedia (e.g., videotape and computer-based presentations) in our faculty development activities to the extent that the project and institutional resources will allow. In Year II, we plan to begin developing Faculty/Preceptor Associates (train-the-trainer/turnkey model), who can play important roles as participants in various faculty development activities during Year II and III (e.g., conducting workshops, site visits, consultations). Similarly, Faculty Associates can ehlp us refine our model in ways that will facilitate its effectiveness when we move toward large-scale implementation upon conclusion of the demonstration project.

Specific assessment procedures (e.g., performance criteria, direct observation protocols, self-efficacy measures, affective measures) will provide important data for working with individuals an for determining the effectiveness of the program. Similarly, we plan to use standardized patients and students in teaching and assessment activities to provide feedback for professional and program development. For example, to examine the effectiveness of the TAHC, we have included in our demonstration to the AETNA Foundation a variety of program evaluation strategies, including a standardized patient assessment protocol in a quasi-experimental, pretest/post test, single-blind, treatment-by-blocks, 2X2X3 factorial analysis of variance (ANOVA) research design.

Tulane as a Pilot Site for The Models That Work Conference

Tulane University School of Medicine sees the opportunity to participate as pilot team for the Models That Work Conference as an ideal chance to move forward faster and better with a number of high priority and ongoing initiatives. We have the requisite institutional commitment, faculty resources, and groundwork planning already in place and are ready to move forward. Our project impacts all phases of medical education: undergraduate, graduate, and continuing. We have an established and effective multi-disciplinary team that brings to this project a variety of backgrounds and substantial experience. Dr. Krane has been recognized numerous times by Tulane as an outstanding clinical teacher, and most recently participated in the Harvard-Macy Fellowship for Physician-Educators. Dr. Lazarus directs the Foundations in Medicine course in Years I and II of the M.D. curriculum, has chaired several committees focused on developing an ambulatory care curriculum for medical students and residents, and is on the faculty of Bayer Institute for Health Care Communication. Dr. Chauvin is an effective faculty development specialist, whose background in change process, effective teaching/learning, and educational leadership complements the team's composition. Mr. Bowdish brings to the team strengths in the areas of cognition and instruction, with an emphasis in instructional design and technology. Dr. Chauvin and Mr. Bowdish are educational researchers with backgrounds and experiences in program and performance evaluation models, and in quantitative and qualitative methods. Ms. Anderson is well known for her effectiveness and contributions in the training and use of standardized patients for teaching and assessment.

While we have enjoyed considerable success with our faculty development initiatives within the academic medical center, we have less hands-on experience implementing such programs in the community-based, ambulatory settings. We believe the conference foci and consultation opportunities with faculty members comprising the Models That Work Conference can help us implement a state-of-art, community-based faculty development program for the Tulane Ambulatory Healthcare Curriculum.