The culture change for medical educators at the Medical College of Wisconsin (MCW) began almost one hundred years ago. In February 1910, another Carnegie Foundation employee, Abraham Flexner, visited the two Milwaukee-based medical schools which later became MCW and reported that they "are without a redeeming feature. Neither of the schools meets the most lenient standards in respect to laboratory outfit or teaching" (²). From this inauspicious historical legacy, MCW emerged as the first U.S. medical school to establish a society designed to benefit the teacher when it created the Society of Teaching Scholars (STS). Conceptualized in the late 1980s by Herbert M. Swick, M.D., then an MCW Associate Dean for Academic Affairs, the Society’s mission was to "by example and action, stimulate innovation in medical education and represent excellence in education in faculty forums." Since its 12 charter members were installed at the college-wide convocation exercises in September 1990, the Society has elected three new members annually over its 15 year history, with 57 installed members drawn from 15 different specialties/disciplines as of December 2005.

Since its inception, the Society has sponsored an annual symposium on medical education inviting nationally recognized experts as visiting professors. In the early years, these visiting professors were associated with key topics under discussion at MCW including problem-based learning, standardized patients, and educational scholarship. More recently, in an effort to focus on teaching excellence, our visiting professors have been national Alpha Omega Alpha (AOA) teaching award recipients. During the one-two day visit, each AOA recipient makes a formal presentation at a major conference associated with their specialty/discipline (e.g., Grand Rounds).

To overcome the perception that only "bad" teachers have questions or problems with their practice (³), the AOA visiting professor visit also focuses on the AOA professor’s teaching as a trigger for critical discussion. It begins by having each visiting professor teach a group of medical students in their content area (e.g., M-1 Neurosciences lecture, M3 Pediatrics Clerkships core curriculum, M3 Medicine Clerkship case conference). Society members then sponsor a post-session debriefing with the AOA visiting professor, focused on instructional decisions that s/he made during the teaching session.

Since MCW established the Society in 1990, at least 20 additional U.S. medical schools have established societies, academies, or equivalent organizations of teaching faculty to recognize faculty members’ excellence as teachers (²). In Flexnerian tradition, a number of authors have summarized the facilities, resources, and methods associated with these societies from a single school’s perspective (⁴—⁶) and in aggregate (⁷, ⁸). With the emergence of this literature, MCW’s Society members were stimulated to think about the next steps in continuing to advance the recognition of teaching and teaching excellence. This article chronicles our Society’s evolution through an intentional process of revision and restructuring to reframe our activities and roles as we continue to strategically advance education and educators at MCW.

To guide and inform our evolution from a Society composed of excellent teachers to a Society that advances teachers and the scholarship of teaching, we have drawn heavily on the recent work of Lee Shulman and colleagues at the Carnegie Foundation for the Advancement of Teaching. While Society members recognize that teachers and teaching are undervalued in U.S. medical schools (⁹), we take solace and find strength in antiquity, building on Aristotle’s view that teaching is the highest form of understanding (¹⁰).

Reframing teaching at the apex of a teacher’s pyramid (¹¹, ¹²) has helped Society members to clarify their thinking and stimulate discussion regarding our roles and responsibilities as educators and scholars at MCW (Figure 1). At the base of the pyramid, and at the foundation for excellence as a teacher, is content/subject matter expertise. However, subject matter expertise is a necessary but not sufficient element for teaching excellence. Teaching expertise requires its own unique content expertise—pedagogical content knowledge—organized in the form of teaching scripts (¹³, ¹⁴). Like movie scripts, which contain detailed information about dialogue, character traits, and staging, teaching scripts contain detailed information about the instructional scene. Developed over time and integrated with one’s discipline/specialty-specific knowledge, an experienced teacher’s scripts include information about common learner errors associated with the subject matter, specific objectives by level of learner, and associated teaching strategies (e.g., questions, mini-lectures) and resources (e.g., reference material, case book). These scripts allow an experienced educator’s teaching to look effortless, as the teacher is teaching from memory. As a result, the teacher is able to focus on the unique attributes of the immediate teacher-learner interaction and adapt teaching strategies to match the interaction. These are characteristics associated with expert teachers.

At the succeeding levels of the pyramid, Shulman argues that "… if we (teachers) are to take learning seriously, we must profess teaching and take our profession as teachers seriously. At the heart of the concept of a profession is a public and moral commitment to learning from pedagogical experience and (emphasis added) exchanging that learning in acts of scholarship that contribute to the wisdom of practice across the profession" (¹⁵). Indeed, MCW’s Society of Teaching Scholars and other academies are well positioned to profess teaching and contribute as scholars to the profession by providing forums for teachers at each level in the pyramid (¹⁶).

How might a society or academy achieve this culture change to a community of teachers? Again, Shulman and colleagues (¹⁷) provide guidance on how to return teaching to its place of prominence at the apex of the pyramid. First, teaching must be reconnected to its basis in each discipline, given that excellence in teaching is intertwined with subject matter expertise (pyramid levels 1 and 2). Second, teaching must be made visible so that its best creations are not lost (pyramid level 3). Third, these visible creations must be judged by members of its community (e.g., a society or academy) if they are to be valued (level 4).

When MCW’s Society began, it started at the foundation of the pyramid by providing a forum for individuals who were recognized as excellent teachers. Recently the Society’s activities are moving toward the apex of the pyramid as we now provide peer review for educational initiatives proposed by members of MCW’s educator community. To explore and share our evolution toward a Society strategically positioned to advance teachers and the scholarship of teaching by making teaching community property, our case history is divided into three sections highlighting the pyramid levels.

Prior to the establishment of the Society, two individuals per year were recognized by the graduating senior medical students as outstanding teachers: one for basic science teaching and the other for clinical teaching. Selected departments had also created teaching awards for faculty members to recognize individuals who demonstrated excellence as teachers, usually over a specific period of time (e.g., March-April Golden Apple or annual Outstanding Teacher Awards). Laboring in isolation, these individuals rarely gathered as a community of award winning teachers to discuss teaching and/or learning, nor was their work formally judged by peers for high-stakes evaluation (e.g., rank and tenure) (¹⁸).

In recalling the culture associated with education at MCW prior to the formation of the Society, an early member of the Society stated, "In the late 1980s education was an activity that faculty participated in and some faculty cared passionately about, but education was not strongly valued as an activity for academic promotion, fiscal incentives, or a common topic of conversation around the lunch table" (E. Brenner-Cohen, personal communication, 2005). With the formation of the Society of Teaching Scholars, faculty members were recognized across the college for their excellence using a consistent criterion: sustained excellence in teaching.

During its early meetings, the Society began to shift the culture of education to the next level in the pyramid by providing a forum in which expert teachers could associate with like-minded faculty members who thought "teaching was fun." "We talked about what we were doing in our teaching labs and sought guidance about what to do about a teaching problem. By getting to know each other better, we could also solve logistical problems. What it did initially was to make cooperation much easier because we knew each other… the first step in creating a culture for educational change at MCW focused on student learning" (E. Brenner-Cohen, personal communication, 2005).

As leaders in education, STS members were often members or leaders of medical student-related committees (e.g., Curriculum and Evaluation, Academic Standing, Admissions, and Rank and Tenure committees). Over time, the perspectives of these educators were increasingly recognized by educational administrators and leaders, adding more and stronger voices advocating for a culture of educational change aimed at optimizing student learning. As individuals, Society members continued to advocate change. In 1995, MCW became one of the first schools to approve tenure for faculty in a clinician educator track. In 1997, MCW reorganized its faculty governance system and the STS was allocated one of the two non-departmentally based seats on MCW’s Faculty Council. In 2000, promotion guidelines explicitly recognizing the activities and products of educators consistent with the criteria for scholarship were approved for clinician educators.

During this time, the Society began its formal sponsorship of the annual AOA Teaching Symposium, a mentorship program for selected junior faculty, and development (and subsequent selection of recipients) of new college-wide awards to recognize teaching excellence among junior clinical faculty and community preceptors. Informally, small groups of Society members met to discuss teaching, seek guidance, and collaborate on educational projects, faculty development programs, grant applications, publications, and presentations, expanding membership in the community of educators at MCW.

Over the next decade Society members began to make their mark as scholars of teaching, authoring papers, serving as a journal editor, assuming leadership positions in regional/national education-oriented specialty groups, securing major funding for education oriented initiatives (e.g., Robert Wood Johnson Foundation, Donald W. Reynolds Foundation, U.S. Department of Health and Human Services), and/or receiving national recognition as educators from their professional societies (e.g., American Geriatrics Society, Ambulatory Pediatrics Society, American Academy of Hospice and Palliative Medicine, Society of Teachers of Family Medicine, Parker Palmer Award from ACGME). As scholars, these members encouraged the Society to move to the apex of the pyramid—toward a true Society of Teaching Scholars.

To explicitly address teaching scholarship, the Society began a strategic planning process in November 2004. To begin the process we revisited our original charter and mission, reviewed selected data regarding the effectiveness of MCW’s educational programs, and examined the missions, structure, functions, and service expectations of newer teaching academies based on information presented at the 2004 Academies Collaborative meeting. This annual collaborative meeting is jointly led by Academies of Medical Educators at the University of California at San Francisco School of Medicine and Harvard Medical School and is dedicated to developing and sharing, at a national level, strategic approaches for valuing teaching and education (¹⁹).

Over the next several months, the STS revised its mission, clarified, and made transparent its criteria for membership, its functions, and organizational structure. In May 2005, the Society’s first set of formal by-laws were approved (²⁰) including a refined mission statement: To recognize and advance excellence in education through leadership, innovation, and educational scholarship. The 43 active members formalized the Society’s governance structure, creating a steering committee composed of the elected STS Director (or co-directors), the treasurer, the STS Representative to MCW’s Faculty Council, a membership chair, and the chairs/co-chairs of the Society’s programmatic committees.

The criteria and process for new member nomination, consistent with the Society’s updated mission, were posted on the Society’s webpage (Figure 2) (²¹). To promote evolution toward a Society of teachers who were contributing scholars to the profession of teaching, the nomination criteria were deliberately expanded to include a sustained record in two categories: educational scholarship, educational leadership, and excellence in direct educational activities, including teaching. These criteria mirror the elements needed to return teaching to prominence: connecting to the teacher’s discipline, making activities and products visible, and accepting peer-review of teaching and educational scholarship.

Once selection criteria were revised, the Society’s members reexamined programmatic activities. The newly formed steering committee recognized that activities developed over previous years each contributed to at least one of the three elements needed to evolve toward making teaching community property and, hence, widely recognized and valued at MCW. By strategically modifying established activities and taking advantage of new opportunities, the STS further enhanced the visibility of teaching as community property (Table 1). For example, an opportunity to present at the Department of Pediatrics Grand Rounds in March 2004 was used by the Society to illustrate the interdisciplinary and discipline-specific pedagogical content knowledge associated with expert clinical teachers. A panel composed of award winning teachers, two pediatricians and one internist, were presented with a series of critical teaching incidents authored by departmental faculty. Each panelist revealed components of his or her "teaching scripts" (e.g., objectives, anticipated learner errors, teaching methods, and associated resources). The lively and highly interactive session, grounded in the science of teacher education, served to model and demonstrate the value of making teaching community property.

Following the Blue Cross & Blue Shield United of Wisconsin’s decision to dedicate the proceeds from their conversion into a stock insurance corporation to Wisconsin’s two medical schools, MCW developed the Advancing a Healthier Wisconsin (AHW) initiative. A portion of these endowed funds are designated for improving health through education in one of eight priority areas: curriculum development for public and community health, library services, faculty development, clinical skills and learning center, student scholarships, educational outreach through CME, patient education, and masters of public health program (²²).

In 2005, the Society was invited by the Dean to propose guidelines and criteria as well as serve as the first level of reviewers for these education-related proposals. The Society’s mission to advance educational scholarship resulted in the selection of review criteria synonymous with established criteria for scholarship (clear goals, adequate preparation, appropriate methods, an evaluation plan, and effective presentation and dissemination of results) (²³). Consistent with the Society’s strategy to create a community of educators and expand dialogue about education, the Society recommended incorporating collaboration into the request for proposal (RFP) as a selection criterion. The request for proposals was issued by the Dean in July 2005 explicitly recognizing the Society’s role as merit reviewers along with a funding preference for collaboration between specialties/disciplines to expand the dialogue about education.

During the AHW education proposal application period, Society members provided guidance to faculty members regarding general grant writing strategies, key proposal elements, and alignment of proposal topics with the criteria for scholarship, thereby emphasizing the public nature of education and teaching as community property. The ratings and narrative review for each of the 25 submitted proposals were discussed during the steering committee proposal ranking meeting, providing an opportunity for dialogue among the members about education and scholarship. (Note: One proposal was submitted by the Society and was reviewed by non-Society members.)

Following score review by two additional advisory bodies and MCW’s Board of Trustees, six proposals were approved for funding for $125,000-$150,000 over either a 2 or 3 year award period. The primary author on each of the 26 submitted proposals received the scholars’ overall rating and detailed proposal critique, with the goal of assisting those not funded in refining their proposal for resubmission. Seeking to use the lessons learned through the proposal review process as an opportunity to continue to recognize and advance excellence in MCW’s education community, the Society and the Dean now cosponsor a proposal writing workshop as part of the AHW-Education RFP process.

Teaching societies and academies have emerged in the last 15 years as a means to make teaching and its products (curriculum, teaching methods, learner assessment tools) community property. MCW’s Society of Teaching Scholars began modestly with an annual budget of less than $5,000 and 12 members. Initially the Society served as a place to bring educators from various disciplines together to form a common identity as members of the teaching profession through the informal sharing and exchange of ideas. Over time the Society has evolved, growing in numbers and programmatic initiatives, including selection of college-wide award recipients, sponsorship of visiting education oriented professors, establishing a focused dialogue with national AOA awardees about teaching, initiating and selecting additional college-wide teaching awards, and serving as mentors to others who are pursuing educational scholarship.

As with excellence in teaching, periodic reflection and strategic planning has resulted in a more focused and systematic approach to making education visible and valued at MCW. Grounded in the principles of educational scholarship and committed to recognizing and advancing excellence in education by making teaching community property, MCW’s Society is reframing itself. The initial core of individuals has expanded to include other members of MCW’s community of teachers, made teaching visible, and provided peer review that is respectful of the unique aspects of discipline-specific and interdisciplinary teaching. As we continue to pursue these strategies, we hope to expand the growing culture of teaching scholars who will have frequent discussions and leave tangible products of their work. In other words, teaching will achieve its place of prominence and faculty will be explicitly valued as teachers.