Microsoft Word - ReviewofanIntensiveFacultyDevelopmentArticle.docx Published by University of Minnesota Libraries Publishing Review of an Intensive Faculty Development Program Conducted at a Regional Medical Campus Steven R Craig, MD, Hayden Smith, PhD, MPH and Marcy Rosenbaum, PhD Journal of Regional Medical Campuses, Vol. 3, Issue 3 (2020) z.umn.edu/JRMC All work in JRMC is licensed under CC BY-NC Steven R. Craig, MD is an Adjunct Clinical Professor of Internal Medicine and Assistant Dean at the Des Moines Branch Campus of the University of Iowa Carver College of Medicine, Des Moines, Iowa. Hayden Smith, PhD, MPH is a Senior Research Scientist at UnityPoint Health-Des Moines, Des Moines, Iowa, ORCID: https://orcid.org/0000-0002-2354-3468. Marcy Rosenbaum, PhD is a Faculty Development Consultant for the Office of Consultation and Research in Medical Education and Professor in the Department of Family Medicine at the University of Iowa, Iowa City, Iowa. Corresponding author: Steven R. Craig, MD, Assistant Dean (Des Moines Branch Campus), 1415 Woodland Avenue, Suite 130, Des Moines, Iowa 50309; telephone; 515-241-4455; email: steven.craig@unitypoint.org All work in JRMC is licensed under CC BY-NC Volume 3, Issue 3 (2020) Journal of Regional Medical Campuses Review of an Intensive Faculty Development Program Conducted at a Regional Medical Campus Steven R Craig, MD, Hayden Smith, PhD, MPH and Marcy Rosenbaum, PhD Abstract Purpose: The process of attracting, training, and retaining volunteer clinical faculty can be a challenge for regional medical campuses. It is important to have a faculty development program that addresses the specific needs of community-based faculty members. However, there is a shortage of literature on how to best develop and deliver such programs at regional campuses. Objective: to describe the development and implementation of a comprehensive faculty development program at a regional medical campus. Method: An intensive faculty development program was developed at the regional medical campus of a large US Midwestern medical school. The faculty development program was created and directed by a senior faculty member at the regional medical campus working with a senior educator from the medical education office on the main campus. The program expanded the number of yearly faculty development workshops offered to all volunteer faculty at the regional campus and included an additional intensive 2-year certificate program for 12 faculty Teaching Scholars. The 2-year Teaching Scholars program was designed to provide more intensive training for faculty members interested in taking on leadership duties in medical education at the regional campus. Results: Additional workshops were administered across the reported 2-year period. The Teaching Scholars cohort was constructed and maintained regular session attendance. Self-assessed knowledge and skills in completing common teaching activities improved for the Teaching Scholars across the study period. These faculty members rated the certificate program good (18%) to excellent (82%) and all indicated they would recommend the program to colleagues. Conclusions: The described program can be accomplished by any regional medical campus working with faculty experts at the main campus. The financial costs of the program were minimal and data from the program supported its benefits. INTRODUCTION Many medical students receive clinical training at a regional medical campus. A challenge for these campuses is attracting, training, and retaining adjunct clinical faculty, who are generally unpaid volunteers often located at considerable distances from the main medical school. An element regularly cited as important to these adjunct community-based preceptors is having opportunities for faculty development to help them acquire and advance their teaching skills.1-3 In particular, there has been a documented need for local approaches to faculty development which address the specific needs of these community-based members.4-7 A key component of local faculty development is providing information on topics of interest to the community-based faculty members delivered by content experts.6,8 Funding to support these efforts is usually limited.9 A review of the literature indicates only a few published studies examining how faculty development has been implemented at regional campus sites. Previously published studies reporting interventions at regional campuses point to the need for identification of local administrative champions as well as content experts to help direct faculty development efforts at the regional campuses.8,10-12 In this paper, we describe the development and implementation of expanded faculty development opportunities at one regional medical campus using existing resources to direct these efforts. METHODS Setting An intensive faculty development program was developed at the regional medical campus of a large US Midwestern medical school. The regional campus consists of 2 community Journal of Regional Medical Campuses, Vol. 3, Issue 3 teaching hospitals, a children’s hospital, a county hospital, and a Veterans Affairs hospital, all located in the same metropolitan area 110 miles from the main medical school campus. The regional medical campus is recognized and accredited by the Liaison Committee for Medical Education. There is an Assistant Dean overseeing the regional campus who reports to the Senior Associate Dean for Medical Education at the main campus. The 5 teaching hospitals on the regional medical campus are active in both undergraduate and graduate medical education. Between the facilities, the 5 hospitals sponsor 8 ACGME-accredited residency programs including 2 transitional year residency programs, 2 family medicine residency programs, 1 internal medicine residency program, 1 pediatric residency program, 1 psychiatry residency program, and 1 general surgery residency program. These programs train over 140 residents annually. In addition, residents in several specialty areas from the main campus rotate to the regional campus to complete part of their clinical training. In a typical year, 35 to 40 resident physicians from the main campus complete some training at the regional campus. Medical students from the main campus complete basic and advanced clinical training at the regional campus. Over 1/3 of third and fourth-year medical students from the main campus complete part of their clinical training at the regional campus. This includes 24 students (16% of the class) who complete all of their core clinical clerkship training at the campus. In a typical year, this represents more than 100 medical students from the main campus completing at least part of their clinical training at the regional campus. Prior to 2017, faculty development at the regional campus was limited to twice yearly workshops provided by educational experts from the main campus. In early 2017, the regional medical campus Assistant Dean and other educational leaders at the campus approached leaders at the medical school main campus about the need for additional faculty development at the regional campus. There was a desire to expand programming for all regional medical campus faculty beyond the 2 annual programs. In addition, there was a desire to provide more intensive training for faculty interested in taking on leadership duties in undergraduate and/or graduate medical education at the regional campus. The Senior Associate Dean for Medical Education of the medical school directed the regional campus dean to work closely with a senior educator in the medical education office on the main campus to address these 2 needs. Together, they developed a plan to expand faculty development opportunities for all volunteer faculty at the regional campus from 2 workshops annually, to quarterly faculty development workshops throughout the year. Regional medical campus faculty were surveyed to help determine what topics should be covered in these programs. An email survey was sent to all faculty involved in resident and medical student education at the regional campus with a list of 25 possible faculty development workshop topics. Respondents were asked to list their top 3 choices and they were also able to write in additional topics they would like to see addressed. The 8 topics presented in the 2-year program were from the top 10 nominated by the faculty respondents. See supplemental files for a copy of the survey instrument (Supplemental Digital Appendix 1). The regional campus dean and senior faculty development expert also developed plans to provide more intensive faculty development to key faculty educators at the regional campus. These 2 individuals co-directed a new 2-year Teaching Scholars certificate program, which was initiated in the fall of 2017. Plans for the new Teaching Scholars program were developed during the first half of 2017 and included intensive faculty development for educators at the regional medical campus looking to take on future medical education leadership roles. Over the summer, information was distributed to all faculty educators at the regional campus and they were invited to apply for one of 12 positions in the first Teaching Scholars cohort. Curriculum Applicants to the Teaching Scholars program were informed that the program would build and expand on the quarterly faculty development programming planned to be implemented at the regional campus. Specifically, participants were asked to make a 2-year commitment to attend all of the quarterly faculty development workshops with additional work assignments before and after each workshop. These quarterly workshops were offered to all regional campus faculty regardless of participation in the cohort and were 90-minute interactive sessions on key topics requested by regional campus faculty (Table 1; list of provided faculty development workshops). Speakers for 6 of the 8 workshops were experts from the medical education office on the main campus and 2 speakers were senior educators from the regional campus. Directly after each workshop, participants in the Teaching Scholars intensive faculty development program were asked to email the course directors on how they planned to apply information and methods taught in the quarterly workshops into their teaching activities over the next quarter. Approximately 2 weeks prior to the next quarterly workshop, Teaching Scholars were then asked to submit a one to 2-page reflection on lessons learned from applying the information during the prior quarter. They were asked to address 3 questions in these reflections: 1) What Happened: when you tried out the new teaching methods learned from the session; 2) So What: what did you observe about the effectiveness of the new methods you tried; 3) What Now: how did this experience guide your use of the new methods going forward. Immediately prior to each quarterly workshop, the course co- directors facilitated a 75-minute discussion with the Teaching Scholars participants. An open discussion was conducted to Journal of Regional Medical Campuses, Vol. 3, Issue 3 focus on the participants’ reflections and experience applying the new methods taught at the prior workshop. Robust discussions were solicited from the entire group addressing what had worked and what had not worked, and why, when applying the new methods. Discussions also focused on overcoming barriers that participants had identified in effectively implementing specific skills into their teaching practices. At the end of these discussions, each Teaching Scholar self-reported how they planned to apply these teaching methods going forward. Since the Teaching Scholars program was developed for faculty members interested in taking on future medical education leadership duties, another component of this training was leadership training. Each participant completed a DISC® Personality Inventory Profile. These individual profile reports allowed them to reflect on their leadership style. One of the group meetings was then devoted to discussing how educators with different leadership styles can best work with learners with the same, similar, or very different styles. Program Assessment Several measures were used to assess the impact of the Teaching Scholars program on the cohort. These measures were consistent with the first 3 levels of the Kirkpatrick model used to assess the effectiveness of faculty development efforts. First proposed by Donald Kirkpatrick in the 1950’s, the 4 stage model includes assessing: 1) learner satisfaction, 2) new learning (knowledge, attitudes, and skills), 3) behavior changes, and 4) subsequent impact on trainees.13 Regional campus faculty in the Teaching Scholars cohort were surveyed at baseline, and on completion of the 2-year program. See supplemental files for a copy of these program instruments (Supplemental Digital Appendices 2-5). Participants were asked to self-assess their competence in performing 17 different common teaching activities before and after completing the 2-year program using a 4-point Likert scale: 1 = generally not able to perform; 2 = somewhat able to perform; 3 = quite competent performing; 4 = highly competent performing, N/A = Not Applicable, do not engage in this teaching activity. Cohort participants were also asked at baseline and at the end of the program to list the 3 most common settings in which they taught and to describe their perceived strengths and areas for improvement when teaching in these 3 settings. After completing this assessment at the end of the 2-year program, participants were provided assessments of the strengths and needed improvements they had originally reported on their entry into the program. They were given a worksheet allowing them to compare these pre and post assessments which asked if they observed changes in what they would now list as strengths and areas for improvement in the 3 teaching settings to assess for new learning. They were also asked to set goals for how they would approach making these needed improvements. On the completion of the 2-year program, the cohort was also asked to complete an evaluation survey that included a series of questions about the intensive faculty development program. The survey instrument included what the cohort considered highlights and what improvements they recommended to the program. The survey also queried participants about program logistics (e.g., frequency and length of the meetings) and the value of different components of the program. The study of the Teaching Scholars program was classified as Exempt by the Institutional Review Board at the regional medical campus (#EX2019-077). RESULTS A primary goal of the new faculty development program was to increase the number of faculty development workshops for all regional campus faculty from 2 to 4 programs per year. For the 2 years prior to this expansion (2015-2017), a total of 129 teaching faculty (representing 72 unique faculty) attended the faculty development programs at the regional campus. During the first 2 years of quarterly workshops (2017-2019), a total of 273 teaching faculty (representing 111 unique faculty) attended the faculty development programs at the regional campus. The second change was the implementation of an intensive 2- year Teaching Scholars program. The program was successful in attracting 12 faculty members, with at least one faculty member from each of the 5 regional campus-affiliated teaching hospitals and an equal number of men and women. Four participants had been teaching for less than 5 years, three for 5-10 years, and five had been teaching for 11-16 years. All of these participants were volunteer faculty and they received no compensation for their participation in the Teaching Scholars program. Hospital and practice group leaders were supportive and provided protected time so these faculty members could participate in the activities. Although 12 faculty members were accepted into the Teaching Scholars program, one dropped out of the program after 2 meetings due to practice relocation. Of the remaining 11 participants, 9 maintained 100% attendance and the other 2 attended 7 of the 8 workshops and Teaching Scholars meetings. Every participant completed the reflection assignments for the workshops they attended. Participants were asked to self-assess knowledge and skills in completing 17 common teaching activities before and after the 2-year program. The number of faculty indicating they were not able (1), somewhat able (2), quite competent (3) and highly competent (4) to perform each of these activities before (Pre) and after (Post) completing the Teaching Scholars program is presented in Table 2. Participants’ self- assessment of competency performing the 17 teaching activities tended to improve for all activities across the program. Improvement in 6 of the teaching activities was statistically significant (p < .05). Although improvement was not significantly improved for the other 11 activities, in all but Journal of Regional Medical Campuses, Vol. 3, Issue 3 one activity 7 or more participants rated themselves as quite competent or highly competent performing these activities at the end of the 2-year program. The activity with the lowest post-program ratings was an area not specifically addressed during the 2-year program (i.e. writing effective test questions). This activity was included as a control item to see if improvement in skills occurred even if the activity was not addressed in the program. Participants were also asked at baseline and program completion to list the strengths and areas for improvement in teaching for the 3 most common settings in which they taught. At the end of the program, when comparing their pre and post descriptions of strengths and areas for improvement in common teaching settings, participants noted positive changes in both strengths and in areas they had identified as needing improvement on entry into the program. Participants were asked to identify 2 to 3 goals to further improve their teaching skills in those settings in which they most commonly taught. Table 3 summarizes the goals the 11 Teaching Scholars identified to further enhance their teaching skills after completing the 2-year program. There was considerable overlap in responses resulting in a total of 12 unique goals/areas for further improvement identified by the 11 program participants. Table 4 summarizes the anonymous program evaluation data provided by the 11 participants in this first Teaching Scholars cohort. As shown, when participants were asked to assess the value of the Teaching Scholars Program, 82% rated it as excellent and 18% good. All participants indicated they would definitely recommend the program to colleagues. Finally, participants were asked to list what aspects of the program they found most valuable and what aspects of the program could be improved. Table 5 summarizes all unique free text response categories received. Networking with other Teaching Scholars was cited as the most valuable aspect of the program. The 75-minute Teaching Scholars interactive sessions were also noted by all participants to be of value. Learning from others’ experience trying to implement the teaching methods taught at the workshops was considered valuable, including learning what worked and did not work for others. Completing the leadership style surveys and the session devoted to reviewing how faculty with different leadership styles can work with learners who have similar or different styles were also seen as valuable. Participant suggestions for improving the program included reducing occasional redundancy of content, incorporating instruction on use of new teaching technologies, and developing a way for Teaching Scholars to electronically submit their critical analysis reflections to an online site that would allow all scholars to review the reflections from each other prior to each meeting. DISCUSSION This study describes a program that provided expanded faculty development at a regional medical campus. In particular, the program focused on providing more intense instruction to a cohort of faculty Teaching Scholars participating in a 2-year certificate program. The program addresses an area of great importance to all regional medical campuses, given there are few reports in the literature describing such types of training without major expenditures, such as hiring a new faculty development expert at the branch campus.8-12 The program also increased the number of overall faculty development workshops for regional campus faculty from 2 to 4 workshops per year. This change increased the number of general faculty at the regional campus participating in these development sessions. The total attendance at these workshops more than doubled and the number of unique faculty members participating in workshops increased by more than 50% during the first 2 years of the program. As for the 2-year Teaching Scholars program, it was successful in attracting at least one faculty member from each of the 5 regional campus-affiliated teaching hospitals. Each of the participants expressed interest in taking on future medical education leadership roles at the regional campus. A key component of the Teaching Scholars program was having participants commit to applying session information and methods taught in the quarterly workshops into their teaching activities during the next quarter. Immediately prior to the following meeting, each participant submitted a written reflection discussing lessons learned from applying the new teaching methods. These assignments were action- oriented reflections, similar to the Rolfe et al. model, which have been demonstrated to help learners incorporate new knowledge and skills into their practice.14 Another key component of the program was having each participant complete a DISC® Personality Inventory Profile. This instrument identifies an individual’s behavioral style based on their personality. It has been used in the corporate sector since the 1960s to assist with hiring and advancement decisions.15-16 It is being used more extensively in healthcare in a variety of ways.17-19 One newer application is to help educational leaders better understand their leadership priorities and preferences and how to best connect with people whose priorities and preferences may be different. Participants in the Teaching Scholars program agreed that reviewing their individual profile report provided them great insight into their particular leadership style and how they can work with learners with the same, similar, or very different behavioral styles. Evaluation of the Teaching Scholars program by participants was positive. The number of Teaching Scholars meetings and the length of these meetings was assessed as appropriate by the majority of participants. Networking with other Teaching Scholars and learning from their experience applying the information and new methods taught at the quarterly workshops were cited as the most valuable aspects of the Journal of Regional Medical Campuses, Vol. 3, Issue 3 program. At the end of the 2-year program, the majority of participants rated it excellent, with the rest rating it as good. All participants indicated they would definitely recommend the program to colleagues. Feedback from the first cohort of Teaching Scholars is being used to make improvements to the program for the next cohort that is being recruited. The 2 key components cited above will be continued: having participants complete leadership surveys and getting a commitment from each participant about how they will apply new methods taught at the workshops and then asking them to write an action- oriented reflection for discussion at the next Teaching Scholars meeting. Efforts are also in place to create a method for scholars to submit their required reflection papers to a secure electronic site and to provide access to these reflections to all Teaching Scholars participants. There is broad support for continuing the 2-year intensive Teaching Scholars program. Participants from the first cohort have helped recruit the next cohort of 12 Teaching Scholars by reaching out to colleagues who teach in the same discipline and/or at the same institution where they teach. All regional campus faculty and the first cohort of Teaching Scholars have been resurveyed to determine what topics will be addressed at the quarterly faculty development workshops for the next 2 years. This included reviewing the list of teaching activities that the first cohort of Teaching Scholars rated the lowest competence in performing at the end of the 2-year program. Limitations The described program represents the outcomes from one main medical school campus with a single regional campus. The degree of trust and support between the 2 campuses was strong. It is unknown how well the program may work when the main campus has multiple regional campus sites and/or the degree of trust and support between the 2 campus sites is not as strong. This study reports on only one cohort of 12 Teaching Scholars and thus may be limited in generalizability. We chose to limit the program to 12 participants to allow for a large enough group to share different perspectives, but small enough to get to know each other well and to interact in an efficient manner. Future research could assess the program’s success across several cohorts. There were initial plans to have each cohort participant video record themselves in educational settings of their choosing. They would have then reviewed the video recordings with a senior faculty development expert to provide feedback. This task proved difficult to arrange for a variety of reasons and a new method of observing participants in teaching settings with feedback is planned for the next cohort. Objective structured teaching exercises (OSTEs) are planned for the second cohort as well. These participants will be videotaped interacting with simulated learners in the settings where they normally teach. They will then review the video recordings with a senior faculty development expert and receive feedback. Finally, data used in this study was based solely on participant self-report and self- assessment. Future studies could include assessment questions focused on knowledge acquisition. Additionally, we were unable to determine if self-reported changes in teaching behaviors reflected actual behavioral changes. Future research could collect observational data on teaching behaviors through pre-post video review, OSTEs and/or direct observations to determine the impact of the program on actual behaviors. To address Kirkpatrick’s level 4, pre-post data could also be collected on trainee perceptions and evaluations of faculty teaching. Conclusion This report describes a successful model for providing needed faculty development to regional campus faculty with the assistance of educators from the faculty development office of the main medical school campus. The program was simple in structure and successful in advancing the self-reported teaching abilities of busy clinical teachers at the regional campus. There were no additional costs incurred by the regional campus. The program achieved its stated goals of increasing faculty development opportunities for all volunteer faculty at the regional campus and providing more intensive training for a small cohort of faculty interested in taking on medical education leadership duties at the regional campus. References 1. Langlois JP. Support of community preceptors: what do they need? Fam Med. 1995;27(10):641-645. 2. Levy BT, Gjerde CL, Albrecht LA. The effects of precepting on and the support desired by community-based preceptors in Iowa. Acad Med. 1997;72(5):382-384. 3. Brink D, Simpson D, Crouse B, Morzinski J, Bower D, Westra R. Teaching Competencies for Community Preceptors. Fam Med. 2018;50(5):359-363. 4. Skeff KM, Stratos GA, Bergen MR, Sampson K, Deutsch SL. Regional teaching improvement programs for community-based teachers. Am J Med. 1999;106(1):76-80. 5. Langlois JP, Thach SB. Bringing faculty development to community-based preceptors. Acad Med. 2003;78(2):150-155. 6. Drowos J, Baker S, Harrison SL, Minor S, Chessman AW, Baker D. Faculty development for medical school community-based faculty: a Council of Academic Family Medicine Educational Research Alliance study exploring institutional requirements and challenges. Acad Med. 2017;92(8):1175-1180. 7. Nuss MA, Cervero R, Hill JR, Gaines J, Middemdorf B. The development of newly recruited clinical teachers Journal of Regional Medical Campuses, Vol. 3, Issue 3 at a unique regional medical campus. J Regional Med Campuses. 2018;1(4). https://doi:10.24926/jrmc.v1i4.1041 . 8. Trowbridge RL, Bates PW. A successful approach to faculty development at an independent academic medical center. Med Teach. 2008:30(1):e10-e14. 9. Sicat BL, O'Kane Kreutzer K, Gary J, et al. A collaboration among health sciences schools to enhance faculty development in teaching. Am J Pharm Educ. 2014;78(5):102. 10. Akins R. Evidence-based faculty development programming for regional medical campuses and the BASK framework. J Reg Med Campuses. 2019:2(4). https://doi:10.24926/jrmc.v2i4.1304. 11. Hoffmann-Longtin K, Torbeck L, Nalin P, Cico S. Tailoring the professional development of volunteer clinical faculty at regional medical campuses: :a needs analysis and targeted interventions. J. Reg Med Campuses. 2019:1(6). https://doi.org/10.24926/jrmc.v2i2.1635. 12. Jefferson KL, Shultz M, Heiselt A, Jefferson KL et al. Serving community faculty through a dedicated liaison. Med Ref Serv Q. 2018;37(1):1-9. 13. Kirkpatrick DL. Techniques for evaluating training programs. Am Soc Train Direct. 1959;13:3-9. 14. Rolfe G, Jasper M, Freshwater D. Critical reflection in practice: generating knowledge for care. 2nd Ed. London, Palgrave Macmillan; 2011. 15. Bhardwaj CA, Mishra M, Hemalatha S. An automated compatibility prediction engine using DISC theory based classification and neural networks. Int J Eng Technol Sci Res. 2017;4(8):1-9. 16. Jordan, PJ, Troth AC. Managing emotions during team problem solving. Hum Perf. 2004;17(2):195- 218. 17. Keogh TJ, Robinson JC, Parnell JM., Keogh TJ et al. Assessing behavioral styles among nurse managers: implications for leading effective teams. Hosp Top. 2019;97(1):32-38. 18. Ogunyemi D, Mehta S, Turner A, Kim D, Alexander C. Emotional intelligence characteristics in a cohort of faculty, residents and medical students. J Reprod Med. 2014;59(5-6):279-284. 19. Ogunyemi DA, Mahller YY, Wohlmuth C, Eppey R, Tangchitnob E, Alexander CJ. Associations between DISC assessment and performance in obstetrics and gynecology residents. J Reprod Med. 2011;56(9- 10):398-404. Journal of Regional Medical Campuses, Vol. 3, Issue 3 Journal of Regional Medical Campuses, Vol. 3, Issue 3