Improved recruitment of medical students into child and adolescent psychiatry (CAP) has been a goal to address the child and adolescent psychiatry workforce shortages dating back more than four decades (1). However, child and adolescent psychiatry workforce shortages continue today unabated. Recent American (2) and Canadian (3) CAP physician workforce studies have once again reiterated the importance of CAP undergraduate medical education in the mix of CAP physician recruitment strategies. While the evidence supporting attempts to impact recruitment through a professional development program is limited, there is a rationale for continuing to pursue this approach. Medical students respond to effective teaching and mentoring often by considering that specialty more favorably (4). Exposure to enthusiastic and engaging role models who are able to carefully inform students that child psychiatry is a field with effective assessments, treatments, and exciting areas of discovery is critical for recruitment (5, 6). Furthermore, early career child and adolescent psychiatrists noted mentors as an important component of their medical school experience (7).
One approach which capitalizes on the use of state-of-the-art educational principles is the American Academy of Child and Adolescent Psychiatry’s (AACAP) creation of the AACAP-Harvard Macy Teaching Scholars Program (HMTSP). The AACAP-HMTSP was initiated by an AACAP presidential initiative in 2004. This program is a combined educational initiative of AACAP and the Harvard Macy Program for Healthcare Educators. The Harvard program’s primary goal is to enhance the professional development of physicians, basic scientists, and other health care professionals (8). The program provides a selected international group of 55–60 health care professionals per year, including physicians, dentists, doctoral level educators, and advanced practice nurses, with the knowledge base and skills to enhance their expertise in both conducting an educational project of their own design and taking a leadership role in the educational activities at their home institutions. The AACAP-HMTSP goal is to enhance the professional development of CAP academic faculty as educators. Interested academic CAP applicants submitted the Harvard application for review by an AACAP committee. A financial commitment of about 50% of the cost of the program by the applicant’s home institution was required for application to this competitive scholar award.
The program is a 3-year pilot program funded in part by the applicant’s home institutions and by AACAP presidential initiative funds. These funds are time limited and available only for the term of the president. Continued enrollment through AACAP is contingent upon identifying new funding sources. The expectation is that the graduating teaching scholars will continue to disseminate the knowledge, skills, and attitudes about state-of-the-art teaching to their institutions and within the larger academy.
Several Teaching Scholar programs or longitudinal faculty development programs have been developed in the United States and Canada and several strategies to document the effectiveness of these programs have been reported. The most consistent methodology was assessment of participant satisfaction (9–14). Many also document career changes for participating scholars (10, 11). Some teaching scholar programs assessed changes in teaching by tracking student ratings and by blinded videotapes of classroom teaching pre- and post-program involvement (12). Armstrong and Barsion (13) used an outcomes logic model to assess the Harvard Macy Physician Educator Program utilizing a variety of sources of information. More recently a teaching scholars program assessment strategy employed interviews of secondary beneficiaries (students) of the teacher scholar programs (14). It noted the value of this program’s scholars’ educational projects. Enhanced recruitment of students into the professions of the teaching scholars has not been studied.
In an effort to evaluate the effectiveness of the AACAP-HMTSP for the first 13 program graduates in meeting its stated goals, a follow-up survey was developed by one of the authors (DS) to assess the impact after 2 years. Three teaching scholars conducted this survey and the data interpretation for this study (JH, DS, MH).
The Harvard Macy Program for Healthcare Educators
The program consists of two sessions in residence at Harvard Medical School: an 11-day winter session and a 6-day spring session. The program combines five major themes: learning and teaching, curriculum, evaluation, leadership, and information technology. There is an emphasis on understanding Kolb’s experiential learning theory (15) and implementing a cycle of learning (16). The overall course and each seminar attempts to engage students by activating prior learning, defining what is to be learned, observing how the new knowledge is implemented, and then challenging students to use the new knowledge in novel ways (17). Learning formats include large-group presentations, interactive exercises, problem-based learning, observations, reflective use of journals, and discussion in large and small groups. A variety of faculty-facilitated small-group formats are used to support learning from observation, to draw together scholars with common interests, and to further the development of each scholar’s individual project for educational change.
Scholars bring to the program a presubmitted educational project for consultation and assistance in its development. This project is based within the scholars’ home institution.
The faculty is from the Harvard Medical School, the Harvard Graduate School of Education, and universities across the United States and Canada. Graduating scholars are invited back to participate as small group facilitators. AACAP instituted one significant adaptation to this program format for the AACAP-HMTSP. Participants were asked to make a 2-year commitment, with all scholars returning for a second year to participate as project leaders.
The selection process included a written application that was identical to the application for the Harvard program, with the AACAP stipulation that the required Harvard medical education project address the issue of child and adolescent psychiatry recruitment. Six AACAP members per year were to be selected over a 3-year period. Thus it was expected that 18 scholars would each complete a 2-year program. In the final year, a private foundation funded two more positions selected by the AACAP. In addition, three child and adolescent psychiatrists (one in 2005 and two in 2007) applied to Harvard independently and were supported by their home institutions.
Participant Follow-up Survey
A survey was developed for distribution to all of the AACAP-Harvard Macy Teaching Scholars of the 2005 and 2006 classes who had completed the first-year winter and spring sessions’ components of the program. Areas queried included: overall satisfaction with the program as helpful in improving teaching skills and advancing professional development; utility of the Harvard Macy project in terms of program development, teaching, and recruitment skills and research; and professional teaching activities to undergraduates, medical students, postgraduates (psychiatry residents and child and adolescent psychiatry fellows), and colleagues. The survey was reviewed by the authors (DS, JH, and MH) and the responses were logically categorized.
Participants, Educational Projects, and HMTS Attendance:
The AACAP selection committee chose 20 participants over the 3-year time span from over 50 applicants (six in 2005 and 2006, eight in 2007). The independent scholar from 2005 is also included in this study. This review is focused on the scholars from the first 2 years only as a pilot for future study of the initiative. The accepted projects have predominantly focused on medical student education (9 of 13), with others focused on residency and fellowship training (4 of 13). Examples of project topics are “Learner-Centered Teaching: Impact on Third-Year Medical Students’ Perception of Child Psychiatry” and “‘ChildPsychNet’ Web Resource for Medical Students and Residents.”
The scholars from the first 2 years (2005 and 2006) include three men and 10 women. Scholars were mid-career faculty and academically affiliated with medical schools from both the United States (12 scholars) and Canada (one scholar). Ten of the 13 selected scholars completed all or part of the 2-year program. Three scholars attended 1 year only.
Scholar Satisfaction with Program
All of the 13 scholars submitted responses to the survey. The overall satisfaction with the Harvard Macy Program for Healthcare Educators is highlighted in Table 1
. All participants indicated a high degree of satisfaction with the Healthcare Educators program and with the overall usefulness of the concepts learned. All but one of the scholars reported that the program enhanced their teaching effectiveness.
Each of the scholars was asked to identify three strengths and three weaknesses of the Healthcare Educators program. The 13 respondents reported a total of 39 strengths and 31 weaknesses.
Strengths of the Healthcare Educators program reported by the scholars separated out into four general topics:
1. Protected time/immersion in an educational environment (6);
2. Projects were viewed as valuable (6);
3. Relationships and networking with other educators (11);
4. Educational theory and teaching methods (12).
Weaknesses of the program reported by the scholars separated out into four general topics:
1. Difficult to take that much time off; too long (7);
2. Too theoretical/not enough concrete skill-building and relevance (7);
3. Not enough focus on measurement and assessment (6);
4. Variability in the quality of teaching and groups (3).
Scholars reported that the Harvard Macy program was useful in enhancing effectiveness in teaching. Scholars reported a range of responses to the question relating to whether the program led to an increase in teaching opportunities (seven participants reported a clear increase, four reported some increase, and two reported no increase).
The open-ended question, “How did the Harvard Macy program change your practice in terms of medical education?” produced answers that basically segregated into two categories: more reflective teaching and using new techniques (10 of 13 answers), and more involvement in teaching and curriculum development (4 of 13 answers).
All scholars were much or very much satisfied that their Harvard Macy project contributed to the enhancement of education. Eleven scholars reported making progress on their project. Nine of 13 participants reported that their project made a contribution to medical education. These scholars’ projects were incorporated into nine workshops and symposia presented at the annual AACAP and American Association of Directors of Psychiatry Residency Training (AADPRT) meetings since the inception of the AACAP-HMTSP initiative.
summarizes the change in teaching activities of the Harvard Macy scholars within the 2 years of starting the Harvard Macy experience. This was a self-report from the individual scholars relating to teaching activities. The survey did not ask for specific details of the teaching activities. Nine teaching scholars reported increased teaching of medical students, and six scholars reported increased teaching of psychiatry residents after the program. Over one-third of respondents described an overall increase in all teaching activities. Twelve of the 13 teaching scholars’ questionnaires included statements indicating increased involvement in medical student education. Ten of the 13 scholars have participated in workshops or symposia at national meetings. This was an increase in scholarly activity after AACAP-HMTSP for all but one of the scholars.
The AACAP-Harvard Macy Teaching Scholars Program (HMTSP) reported high levels of satisfaction with the overall program. Identified strengths included the opportunity to reflect upon teaching and learning and to develop new knowledge and practical tools for teaching. New involvement with high-level educational and curriculum committees within their medical school was a notable outcome for a number of scholars. Scholars identified the opportunity to develop relationships and to network with other educators as a strength of the AACAP-HMTSP. The scholars have translated this networking opportunity into group-based scholarship with multiple presentations at the annual AACAP and AADPRT conferences since 2006 (Table 3
). Individual scholarship in the form of scholars’ projects is advancing with 69% of scholars (n=9) reporting completed projects and 31% reporting projects as works in progress (n=4).
Scholars noted various weaknesses in the program. Some considered it too lengthy a time commitment. Weak educational components included teacher and group variability and insufficient topic coverage of assessment and measurement matters. Curricular emphasis on learning theory was favored by some scholars, but felt to be excessive by others.
An appreciation of the “hidden curriculum” (18) within medical education may provide insight into the possibility for success of this program. Hidden curriculum refers to the obstacles to change within educational systems. Limited resources have been available for medical education. Importantly, this presidential initiative addressed this financial issue by its required cost-sharing arrangements. The ACAAP-HMTSP’s success to date may therefore relate to the identification and selection of child and adolescent psychiatrists with strong commitments to scholarship in education. The program’s funding requirements may also have selected for deans, departments of psychiatry, and medical schools open to a larger role of child and adolescent psychiatrists in medical education. In essence, this initiative may positively influence aspects of the “hidden curriculum” leading to enhancement of medical education.
Limitations of this study must be noted. Three teaching scholars who are the first authors of this article (JH, DS, and MH) conducted this survey and the data interpretation for this study. The follow-up survey provides descriptive data based solely upon scholars’ self-report and is meant to be a pilot for future study of this initiative. Furthermore, three scholars reviewed the surveys and summarized the results. Data from students or colleagues, which could have provided an external validity check, were not available. In addition, the follow-up survey was not piloted prior to its use. The study involved a selected group of child and adolescent psychiatrists with previous interest in medical education. A comparison group was not available. Our study findings may therefore be more reflective of the knowledge, skills, and interests in medical education for which this group of child and adolescent psychiatrists were selected versus the added value of the AACAP-HMTSP. Future evaluation of the program should use external outcome measures such as interviews of stakeholders (e.g., medical students, residents, or colleagues). Investigation of medical students’ matches to psychiatry and CAP residency programs at medical schools with AACAP teaching scholars compared to schools without scholars may also be of interest. Another limitation is that there may have been a bias in the deans and/or department chairs prior to the development of the program that led them to fund the position.
The future of the AACAP-Harvard Macy Teaching Scholar Program is an issue of some import. It is funded by means of an AACAP presidential initiative, which ends in 2008 with the return of the current 2007 class. One option is to obtain continued support from a philanthropic foundation. Another option, irrespective of the success in garnering foundation support, is the development of an AACAP Teaching Academy to harness the membership’s burgeoning interest in medical education. Such an academy would be inclusive to all qualified CAP educators and provide opportunities to enhance members’ professional development in medical education.