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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

29. Reading the Future