he Department of Psychiatry and Behavioral Sciences at Temple University School of Medicine doubled its faculty in 2003. As a result of an expansion of clinical services, we incorporated clinicians from affiliated hospitals and hired our own new resident graduates. At the recommendation of departmental leadership, we established a group forum to enhance the abilities of the new faculty to teach medical students. Inspired by Schuster’s (1) model of group supervision for faculty who supervise psychiatry residents, we called it "Supervising the Supervisors." Schuster described a weekly group process for faculty who supervised residents in individual psychoanalytic psychotherapy. This tape-recorded process mimicked the resident/faculty dyad and allowed for feedback. Our group, focusing on undergraduate medical education, used a more experiential model of faculty discussion and disclosure about our educational encounters. Since then, a clear purpose and culture has evolved in the context of our monthly meetings. We have built curricula, developed forms and standards, evaluated trainees, and, over time, began a "case-based" approach to students and their problems. We have addressed challenges in the medical school, the department of psychiatry, and at all levels of trainees. In the process, we mentored one another, and in the words of an early group member, we "developed a faculty." We will now discuss some of the fruits of our labor, a literature review, and our future direction.

"Tangible" Products

Early in our group process, we addressed our concerns about equivalency of rotations and clinical encounters at our diverse clinical sites and campuses. Coincident with the Liaison Committee for Medical Education’s (2) amended Educational Objective "ED2" encounter requirements, we instituted a process for all students to chart their clinical encounters contemporaneously over the rotation. Together we designed an encounter log that helped to set the nationally proposed standards for psychiatry through the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) (3). Remediation videos and encounters are now being developed with members of the ADMSEP task force. In addition, we designed the form and format for the mandatory observation and assessment of student interviews, suicide assessment, and written and oral evaluations and presentations. This "product" development early in our group process helped establish teaching standards and consensus among members and developed an educational culture.

"Intangible" Products

Along with this "product" development, we began to talk about specific student issues, unique scenarios between faculty and students, and our personal supervisory challenges. We began to see that these could serve as cases upon which to make educational generalizations and to help solve vexing student-supervisor dilemmas. Williams et al. (4) proposed that case-based instruction and learning allows a student to acquire content knowledge simultaneously with developing problem-solving skills. This theory remains at the center of modern case-based medical education. In Appendix 1 and Appendix 2 , we demonstrate a few specific and unique challenges that helped to form our case-based supervision model.

Becoming a new faculty member can be a difficult and stressful experience. Many residency programs still do not train residents to become teachers (5). Instead, they rely on the traditional model of "see one, do one, teach one." Difficult supervisory situations and how to address individual student problems are not typically addressed in the literature. Considerable attention has been given to the development of teaching skills of medical educators. A survey of North American academic departments of internal medicine (6) found that approximately one-third have programs for faculty development. Many unique models have been established to enhance the effectiveness, skill, and satisfaction of both teachers and learners. Most are in nonpsychiatric disciplines, are classroom based, and focus on specific teaching skills. For example, Boston University School of Medicine (7) employs a "paired peer" learning model in which participants partner to share their experiences and receive iterative cycles of teaching, debriefing, and planning. At East Tennessee State University (8), participants critique videos of faculty teaching small groups of students, allowing real-time reviews and feedback from students. Another model used by several schools is designed to share teaching techniques and experiences across schools and disciplines; an example is the Academy of Masters’ collaborative between Harvard and the University of California, San Francisco (UCSF) (9). Additionally, UCSF has instituted a "Teaching Scholars Program" (10) that uses a mentoring model to teach techniques and work on academic projects and presentations. Johns Hopkins (11) studied faculty participants who met weekly for didactics and feedback sessions for 9 months. They found improved attitudes and behaviors toward students compared with nonparticipants. There are many additional models of faculty development around the world. We were unable to find a report of an unstructured group model such as ours, focusing on specific tasks and cases. Our tangible and intangible "products" exemplify our group process.

Our group, which met monthly, discussed and debated individual cases and created a format that shaped the educational philosophy and approach of all the faculty participants. These group meetings produced a process, or model, to approach educational challenges. Part of our method was to use the literature when possible, but often there was little to specifically help us. What made our experience so positive was the climate of support, validation, diversity of culture, and educational background. What emerged was not a teacher-student hierarchy. Rather, we began to learn from one another, helped one another navigate through complicated and troubling student problems, developed a mechanism of open discussion, reviewed the literature, and supervised one another. A single, authoritative directive from a supervisor was not mandated; rather, a participatory method of solving problems emerged.

Other cases, not discussed here, included helping students who were victims of sexual harassment, exploring limits of personal self-disclosure during clinical encounters, and managing a mentally ill medical student. We did not always reach an initial consensus on how to manage the cases. However, with the benefit of our spirited debate and discussion, we were always able to agree upon a course of action. This experience also helped us recognize some missing elements of our own curriculum for medical students surrounding death and religious practices. We also worked together to build our academic portfolios by embarking on scholarly projects, including a national presentation and manuscripts.

One area for future improvement will be to develop a structured outcome instrument because unfortunately we did not do that at the start. We have received only anecdotal feedback from the students that included their appreciation for our efforts and their successful completion of their education. We plan to develop a method to survey the faculty regarding their comfort with educational and supervisory challenges and to try to determine the effect on the students’ learning experience in psychiatry. We offer our case-based approach as a novel model of faculty development.

This material was presented at the 2006 APA Annual Meeting in Toronto, Ontario. The authors wish to acknowledge other past and present members of the Temple Workgroup for Medical Student Education in Psychiatry, including Drs. Kim, Miazzo, Ning, Paul, Volkman, Weisman, Zilbering, and Zitek; the departmental vice chair, Dr. William Dubin, for proposing this project, editing the manuscript, and "buying lunch," which was the initial glue of the process; and the department chair, Dr. David Baron, for allowing the senior member to establish her own culture.