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REGULAR | December 01, 2007

Developing the Master Educator: Cross Disciplinary Teaching Scholars Program for Human and Veterinary Medical Faculty

Malathi Srinivasan; Daniel D. Pratt; John Collins; Constance M. Bowe; Frazier T. Stevenson; Stephen J. Pinney; Michael S. Wilkes

Academic Psychiatry 2007;31:452-464.

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Received March 20, 2006; revised June 23 and November 8, 2006; accepted December 15, 2006. Drs. Srinivasan and Stevenson are affiliated with the Department of Internal Medicine at the University of California, Davis School of Medicine; Drs Pratt and Collins are affiliated with the Department of Educational Studies at the University of British Columbia; Dr. Bowe is affiliated with the Department of Neurology at the University of California, Davis School of Medicine; Dr. Pinney is affiliated with the Office of Medical Education at the University of California, Davis School of Medicine; Dr. Wilkes is affiliated with the Department of Orthopedic Surgery, University of California, San Francisco School of Medicine. Address correspondence to Dr. Srinivasan, Dept. of Internal Medicine, UC Davis School of Medicine, 4150 V St., Suite 2400, Sacramento, CA 95833; malathi@ucdavis.edu (e-mail).

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Abstract

Objective: At the University of California, Davis (UCD), the authors sought to develop an institutional network of reflective educational leaders. The authors wanted to enhance faculty understanding of medical education’s complexity, and improve educators’ effectiveness as regional/national leaders. Methods: The UCD Teaching Scholars Program is a half-year course, comprised of 24 weekly half-day small group sessions, for faculty in the School of Medicine and Veterinary Medicine. The program’s philosophical framework was centered on personal reflection to enhance change: 1) understanding educational theory to build metacognitive bridges, 2) diversity of perspectives to broaden horizons, 3) colleagues as peer teachers to improve interactive experiences, and 4) reciprocal process of testing theory and examining practice to reinforce learning. The authors describe the program development (environmental analysis, marketing, teaching techniques), specific challenges, and failed experiments. The authors provide examples of interactive exercises used to enhance curricular content. The authors enrolled 7—10 faculty per year, from a diverse pool of current and near-future educational leaders. Results: Four years of Teaching Scholars participants were surveyed about program experiences and short/longer term outcomes. Twenty-six (76%) respondents reported that they were very satisfied with the course (4.6/5), individual curricular blocks (4.2—4.6), and other faculty (4.7). They described participation barriers/facilitators. Participants reported positive impact on their effectiveness as educators (100%), course directors (84%), leaders (72%), and educational researchers (52%). They described specific acquired attitudes, knowledge, and skills. They described changes in their approach to education/career changed based on program participation. Combining faculty from different educational backgrounds significantly broadened perspectives, leading to greater/new collaboration. Discussion: Developing a cadre of master educators requires careful program planning, implementation, and program/participant evaluation. Based on participant feedback, our program was a success at stimulating change. This open assessment of programmatic strengths and weaknesses may provide a template for other medical institutions that seek to enhance their institutional educational mission.

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"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead

Over the past several decades, a variety of programs have been created for medical faculty, to improve their teaching and leadership skills (¹—⁴). Most programs have been created for medical educators who do not wish to leave their primary job to participate in a 1 or 2 year full-time curriculum (such as programs leading to a masters in medical education) (⁵, ⁶). Therefore, many programs have limited their contact hours with participants (⁷, ⁸). These time-limited programs have had a diverse set of specific goals: improving minority faculty recruitment and retention (⁹—¹¹); creating a cadre of well-trained medical educators in a specialty area (¹²—¹⁶); improving research success (¹⁷—²⁰); stimulating international faculty cross-development (²¹); or rewarding teaching by designing highly selective teaching academies (²²—²⁴). Programs have focused on promoting teaching skills in managed care (²⁵), cultural competency (²⁶), feedback (²⁷), or other clinical teaching skills (²⁸—³⁰). Other programs have taken a more comprehensive approach to influence the way educators conceptualize themselves within their institutions, and have longitudinally provided extensive tools to promote teaching and learning (³¹, ³²).

Building on this body of work, in 2002, we developed a new Teaching Scholars program at the University of California, Davis. Our goal was to develop an institutional network of reflective teachers who could support one another, and collaborate around educational initiatives. In the process, we sought to improve cross-disciplinary work, enhance faculty understanding of medical education’s complexity, and improve faculty effectiveness as educators and regional/national leaders.

The UCD Teaching Scholars Program is a half-year course, comprised of 24 weekly half-days, open to faculty in the Schools of Medicine and Veterinary Medicine. The program was developed by five core on-site faculty. Each year, the program accepts only seven to ten participants, to ensure a small-group format for committed educators.

In this paper, we describe our philosophical framework, program goals, and resultant approaches. We describe our program development—including initial planning (analysis, marketing strategy), programmatic tradeoffs, and examples of creative exercises that formed the core of our program. Finally, we describe participant outcomes, after four years of program development and execution.

Philosophical Framework

Creating significant behavioral changes in one’s practice requires reflection upon that practice (³³, ³⁴). We wanted to stimulate participants’ critical reflection about their educational practices, in the context of what is known about medical education, educational research, and leadership. Four foundational principles guided our program development:

1. Theory

Without an anchoring framework for new ideas, reflection and metacognitive growth is difficult (³⁵). Thus, we centered our program around a general framework for teaching developed by Pratt (³⁶, ³⁷) which values multiple views of effective teaching, acknowledging differences between classroom and clinical teaching. The framework was buttressed by an excellent review of research on cognition and learning by Bransford, Brown, and Cocking (³⁵). Throughout the program we used a "mixed methods" approach to understanding learning, fusing cognitive, developmental, social cognitive, and behavioral approaches. In doing so, we emphasized that what is learned is more important than what is taught. At every step, we encouraged participants to critically reflect on these theories and their practice.

2. Diversity of Perspectives

Expanding individual experiential horizons requires interaction with novel perspectives, to see the familiar from new vantage points. Our program was designed to promote participant/facilitator diversity. First, we enrolled participants from both the School of Veterinary Medicine and School of Medicine faculty. Both graduate schools have similar training structures (2-3 years coursework, 1-2 years clinical rotations, followed by clinical residencies), and learner training issues. However, they have significant cultural/learner/client-patient population differences. Second, we accepted clinical and basic science faculty participants, from all departments within these schools. Third, we included junior and senior faculty in each cohort, promoting cross-fertilization, mentorship, and diversity of thinking about common challenges. Senior faculty were invited to serve as teachers. Fourth, visiting lecturers and facilitators from across the US and Canada complemented our core faculty. Fifth, non-medical lecturers and facilitators (business administration, law, anthropology, education, or conflict resolution) showed how approaches to adult learning transcend specialty and career interest.

3. Colleagues as Peer Teachers: Interactive Adult Learning

Experienced adult learners learn well from each other, especially from individuals with unique perspectives within their "zone of proximal development." In each session, structured exercises encouraged cross-fertilization of ideas, mentorship, and collaboration. For example, we created weekly "check-in periods" during which participants shared interim educational experiences or dilemmas. During the leadership block, participants designed a "virtual" project to address a perceived problem in their environment and applied concepts/theoretical frameworks discussed earlier in the program. These project designs and implementation plans were critiqued by the group.

4. Reciprocal Process of Testing Theory and Examining Practice

Reflection is enhanced and reinforced when learners move between learning theoretical ideas and active experimentation. Thus, we designed out-of-session observational exercises (longitudinal homework) and experiential exercises to help participants learn by doing. We attempted to build habits of "reflection on practice" by asking learners to apply educational principles and theoretical orientations in their educational settings, and report back key experiences.

Program Development

Initial Development

Chances of realizing the Field of Dreams proposition (³⁸) "if you build it, [they] will come" is significantly enhanced by a careful needs assessment (³⁹) and a proper marketing strategy (³⁹—⁴²). In particular, we sought to understand potential barriers to participation, including institutional and departmental cultures and individual perspectives that educators were likely to bring with them (Table 1), before those issues became problems.

Marketing

Social marketing uses commercial marketing strategies for social gain (⁴³). During initial program formation, we spread our vision of improving educational culture and developing a skilled educational cadre through discussion with institutional academic leaders (deans and chairs) and with our target audience—current/near-future educational leaders. We approached each group to solicit input and obtain buy-in. Departments identified faculty whom they saw as current or near-future educational leaders. Deans/chairs were invited to participate. After the first year, past participants were asked to nominate other educational leaders and share their experiences and lessons learned.

Developing Learning Objectives

We reviewed the teaching/leadership development literature, then developed four curricular blocks to meet our learning objectives (Table 2). Block 1 focused on educational theory and cognition—to help participants understand the scope of medical education and how their personal teaching styles (using the Teaching Perspectives Inventory [³⁷]) related to the diversity of theoretical perspectives in education. Block 2 focused on several aspects of curricular design and program planning—the act of conceptualizing, forming, implementing, and evaluating a curriculum. Block 3 focused on educational research, emphasizing the range of research tools used to formulate research questions, design studies, and evaluate outcomes. Finally, Block 4 focused on key concepts in educational leadership—to assist participants to become agents of change within their own educational arena.

Encouraging Skills Application

Skills development research in business (⁴⁴) and health (⁴⁵, ⁴⁶) suggests that people take several years to become adept at new skills, after initial introduction. Skills acquisition improves with repetition, reinforcement, and practice. Whenever possible, we paired content with practical exercises, both in class and between classes (Table 3). For instance, participants made detailed observations for several hours of teaching in two settings: a non-medical setting and an unrelated health care field. Participants then presented their observations for 15 minutes at the beginning of sessions. Participants chose unique educational venues: their children’s middle school or preschool teachers (developmental perspective and mixed methods), ski/snow mobile instructors’ techniques (apprenticeship perspective for physical skills development), or public policy activism instruction (social reform perspective). Participants analyzed each experience, provided in-depth descriptions or videotape footage, and related those techniques to their own teaching and courses.

Tradeoffs

During program planning, developers must deliberately determine trade-offs between competing goals. Explicitly, these tradeoffs include expected time commitment (participants and program faculty), and program breadth/depth. Our choice to run a 24-week course excluded physicians who were primarily clinicians, whose departments could not off-set participants’ clinical workload or whose revenue streams would not accommodate a 5%—10% decrease in clinical revenue generated. A shorter program would have gathered more participants, at the expense of deeper educational experiences. Our Friday morning program excluded outside educators—who may have attended an "executive program" a few times a month over extended weekends. We chose not to pursue offering a masters in education because of participant time restrictions and ethical conflicts in institutions granting degrees to their own faculty. Small group, seminar formats increased faculty and participants’ burden of work—but provided a higher quality participant experience.

Initially, we focused on providing breadth of experience. In the first year, we tried to discuss 2—3 major topics per half day. For instance, in one session, we explored teaching strategies (bedside and small group facilitation) and evaluation techniques using reviews of bedside teaching techniques. In another session, we explored web-based curriculum development and social influences in teaching/learning. While this strategy might have worked in a traditional lecture format, our participants’ thoughtful discussions about the topics extended each segment significantly and suggested more time was needed for each lesson. Thus in subsequent years, we decreased the content per session and pursued each topic in greater depth. Similarly, over the course of 4 years, we changed the nature of outside homework assignments—focusing more on experiential exercises, complementing selected readings for each session.

Specific Challenges

We faced significant resource and other challenges. Locating a dedicated space for our program for a full half year was difficult. The program did not have a funding line, and participants did not pay course fees. Therefore, core faculty and outside speakers volunteered their time. Core faculty negotiated time off through their departments or shifted responsibilities from other endeavors to create additional teaching time. After four years, one faculty received a 5% appointment to direct the course. Participants also found it hard to protect their time. Since program inception, two faculty dropped out of the program due to specific time conflicts. Program attendance was 50-90% per session because faculty’s competing time demands (professional meeting travel, clinical/teaching duties, and personal vacation) often prevented attendance.

Failed Experiments

The selected participants had experience in curriculum development, program administration, and clinical/classroom teaching. While many had a biomedical research background, few had previous experience in educational research. In the program’s second iteration, we attempted to set up a mentoring/advising program to facilitate educational research. We conducted five sessions on educational research methods, including writing for educational journals. Participants were to identify a relevant educational research question, design/perform the appropriate study/intervention to answer the question, and submit the resultant paper for publication. Participants did not have enough time to take on another major project, in addition to participating in program coursework. We therefore eliminated the focus on publishing an educational article. Instead, we strengthened our framework for critiquing educational research and provided methods for participants to obtain resources for future educational projects. Several senior/chief residents with exceptional leadership potential were initially included in the program. However, they were unable to consistently protect their time, and reported that they felt uncomfortable sharing personal experiences with senior faculty.

Program and Participation Outcomes

Over four years, we enrolled between 7 and 10 Teaching Scholars per year. In 2006, we surveyed all participants about their experiences with the program, their perceptions of program effectiveness, and how the program had helped their career (if at all). All surveys were conducted via a web-collection tool (SurveyMonkeyTM), and identifiers were removed once data collection was complete. Here, we report participant demographics, program outcomes, and participant outcomes.

Participant Demographics

Out of 34 current/prior participants, 26 participants completed the survey. Non-responders included participants on extended vacation/sabbatical (N=1), maternity leave (N=1), no longer at the institution (N=2), and participants not responding after four contact attempts by email/pager (N=4). Participants varied in their rank (professor [N=4]; associate professor [N=8]; assistant professor [N=11]; fellow [N=2], center director [N=1]), their educational responsibilities, whom they taught, and their teaching settings (Table 4). Many had participated in educational research. Most participants were in an academic series, with some flexibility in controlling their time. Participants reported that they had joined the Teaching Scholars program to improve their teaching skills, to improve their breadth of knowledge about medical education and education as a discipline, to develop collaborative opportunities, or to become familiar with educational research. Often, participants had been encouraged to apply by their dean/chair, past participants, or program faculty.

Program Outcomes

Like participants in other master educator courses, our participants reported a high degree of program satisfaction. On a five point Likert-like scale, participants reported that they were very satisfied with the Teaching Scholars Program overall (mean=4.64), other scholars (4.82), and facilitators (4.75). They were satisfied with course content (4.71) and tradeoffs made with course length and content (4.64). They strongly liked working with colleagues outside their discipline (4.82), combining the Schools of Medicine and Veterinary Medicine (4.75), inviting outside speakers (4.64). They liked all four different curricular blocks on educational theory (4.64), curriculum development (4.18), educational research (4.18), and leadership development (4.33). Completing out-of-class assignments was viewed less favorably than other program elements (3.96).

Barriers or facilitators to participation

Through open-ended comments, participants reported barriers to participation including competing clinical duties (overnight call scheduling, direct patient care, resident supervision, multiple clinical settings) and previously scheduled teaching duties. Location at the veterinary school was a facilitator/inhibitor. Several veterinarians reported the main campus location (12 miles from the hospital campus) made their attendance easier. School of Medicine faculty reported that the non-medical location facilitated not being consumed with clinical duties but was less convenient in time/distance. Two participants commented that the out-of-class assignments were cumbersome, and too much material was packed into sessions. Individual participation was made easier by the quality of collegial interactions, the intellectual stimulation and creativity of the course material, the half-day format, and internal departmental support.

Participant Outcomes

On a five-point Likert-like scale (strong negative to strong positive impact), faculty reported that participation in the UCD Teaching Scholars Program had a positive or strongly positive impact on their overall effectiveness as an educator (96%). Percentages reflect responses of participants who felt that the item was personally applicable. Specifically, participants felt that the program had a positive or strongly positive impact on their effectiveness as an educator (100%), as a course director or program planner (84%), a collaborator (75%), a leader (72%), or educational researcher (52%). In a series of open-ended questions, participants shared insights about working with diverse faculty, changes in attitudes/knowledge/skills, new educational opportunities, and changes in their educational approach and career.

Working with diverse faculty and other health professions faculty

Participants reported that interacting with faculty outside their field helped them realize similarities and differences between Schools. They commented that cross-disciplinary issues were nearly identical between medical/veterinary learners, with similar educational themes (learner problems, school politics, teaching methods, departmental tensions). Almost all reported greater camaraderie and personal appreciation for struggles/successes of other faculty. Teaching methods used in one School could be applied to the other (home visits in veterinary medicine and problem-based learning in human medicine). Two respondents commented that they had little interaction with program faculty when not in the program. Many reported that idea cross-pollination led to constructive collaboration. Almost all reported that the mix of veterinary/human-medicine faculty was a success; several participants reported that it was a major incentive to have other colleagues participate in the program.

Attitudes, knowledge, skills

Participants were asked to reflect upon specific attitudes, knowledge, and skills that they may have developed as a result of the Teaching Scholars Program. Participants reported a shift in focus from "being a good teacher" to facilitating excellence in their learners and supporting their learner’s growth. Each participant enumerated two to seven specific insights about their personal development (Table 5).

Opportunities

Due to participation in the program, participants reported one or several new opportunities in teaching classes/courses (74%), leadership (56%), collaboration outside their field (52%), collaboration with other Teaching Scholars (52%), educational research (44%), educational publications (38%), funding (19%), or other scholarly work (46%).

Changes in approach and career

Participants also identified how they had changed their approach to medical education, teaching, or their career due to the program (Table 6). Major themes include increased personal reflection; diversification of evaluation methods of learners’ skills; improved confidence in their skills; increased awareness of the impact of their own actions; better systematic planning; more confidence in skills, and willingness to take on new educational projects; more participatory teaching; focus on problem solving and understanding concepts; and improved educational advocacy. Several participants commented that their learner evaluations had improved. Three participants felt that participation had not influenced their career at all, but may have changed their outlook.

Discussion

Creation of a successful Teaching Scholars Program requires a careful, structured approach to program planning, implementation, and evaluation (²², ⁴²). Our course is similar to other part-time teaching academies in its scope, participant commitment, participant satisfaction, and implementation challenges (¹—³²). Our course had several important features: a cohesive educational framework based on reflective practice, a diversity of faculty participants, small group skills-based exercises, and a cross-fertilization of ideas from presenters from around North America. Responding participants reported that multiple educational and leadership opportunities arose as a direct result of program participation. They also reported that the course positively impacted their effectiveness and changed their approach to medical education and program leadership.

Our program, like others, has significant limitations. Given the rich educational milieu in which faculty pursue their careers, it is difficult to quantify the effect of a single course on our participants’ careers. For instance, do we credit promotion or publication of articles to this course alone or an additive effect of all educational interactions? Four of the 34 participants did not respond, and three responders reported that the program had no impact on their career choices. Non-responders may have been dissatisfied, or felt that the program did not impact their professional development. Yet, the majority of participants reported that the program had a positive impact on their careers, and potentially, their institutions. Unfortunately, participant time/resource constraints prohibited significant reinforcing activities after program completion. While we have created some reinforcing educational activities (e.g. monthly education journal club for all prior participants, having many prior participants teach/co-facilitate additional sessions), we have not created daily reinforcers for best practice awareness. Requiring true reinforcing activities (including refresher courses, longitudinal projects, documenting self-directed learning and practice based learning) was beyond the scope of this course, to date. Finally, we have not measured the course’s impact on changing the institutional culture—again challenging, due to the many institutional factors which influence culture.

Despite these limitations, we have evidence from current and prior Teaching Scholars that our program is a success—improving the educational opportunities and skills of most participants. The continued support of the Schools of Medicine and Veterinary Medicine speak to the importance that the Schools place on faculty development, and specifically to this program. In this article, we shared generalizable lessons of potential use to other educators in developing their own Teaching Scholars program. This program has special relevance for psychiatric educators from small or medium-sized psychiatric departments—presenting a model of collaborative faculty development drawing upon the resources of their larger health system. We hypothesize that building relationships with other clinical (surgical, medical, etc.) and non-clinical faculty in both Schools will allow the psychiatric educator to become more effective in internal program building and change advocacy. Additionally, in our program, the psychiatric educator’s perspectives broadened those of other medical and veterinary faculty through exploration of the psychology of the learner, as well as that of the client.

Programs such as the UC Davis Teaching Scholars Program can be used to enhance the skills of current/near-future educational leaders, or develop those faculty who need help in achieving basic competency. Our program demonstrated that the work of five committed faculty can have a major impact on the lives of participants in a master educator’s program. While every educational environment is unique, these lessons may help other educators consider the tradeoffs that they make while developing and implementing a master educators’ course.

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TABLE 1. A Systematic Approach to Faculty Development Planning: Recognizing and Addressing Potential Barriers

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TABLE 2. Examples of Learning Objectives, Linked to Course Content

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TABLE 3. Examples of Participant Exercises per Block

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TABLE 4. UCD Teaching Scholars Survey Participant Demographics

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TABLE 5. Self-Reported Participant Changes After Participation in the UC Davis Teaching Scholars Program

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TABLE 6. Examples of Self-Reported Changes After Participation in the UC Davis Teaching Scholars Program

Acknowledgments

Dr. Srinivasan was funded in part by the Robert Wood Johnson Foundation Faculty Scholars Program.

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