Section I

Developing a Program to Improve
the Teaching Skills of Faculty and Residents

Richard Sarkin, M.D.

Faculty and residents have significant teaching responsibilities.Their knowledge, skills,professional attitudes and behaviors are essential for development of future health care professionals.While medical teachers are experts in their fields, most have had limited training in ways of teaching effectively.Many programs have been developed and successfully implemented for faculty and residents to improve teaching skills.The purpose of this description is to assist those interested in initiating a program to improve the teaching skills of faculty and residents in a third-year pediatric clerkship.

Although each department of pediatrics will have unique needs, there are several general principles and guidelines for developing programs to improve teaching skills that may be applicable.Many of the existing faculty and resident development programs are quite structured and well established at institutions with significant budgets and staff^1,2,3.For the pediatric clerkship director interested in starting such a program, successful implementation might initially appear unattainable.Rather than focus on the dynamics of these existing programs, the remainder of this description will discuss how departments without an existing program to improve teaching skills might begin to develop one.

The first requirement is for someone to take the leadership of such a project.Although the pediatric clerkship director is usually in the position of most fully understanding the teaching needs for medical students on a particular pediatric clerkship, any faculty member with a strong interest in this activity would be acceptable.A few committed members of the department faculty to serve on a committee or even one additional person would be helpful for ideas and support.The person assuming the leadership for this project or one of those willing to assist need not be a physician, but could be someone with a background in education.

As with any project, goals need to be established from the onset.While these goals may change as the program develops, it is helpful to begin with a set of objectives.A needs assessment of a particular department or clerkship might also be useful toward setting appropriate goals and gaining a better understanding of specific problems.Directly asking the medical students what areas they think need to improve can be quite insightful.

The person assuming the faculty and resident development program's leadership role needs to have support from the department chair.An active role by the department chair is highly desirable for a successful program, but not essential.At the very minimum, a department chair needs to at least encourage the development of such a program and be supportive of its goals.If teaching accomplishments are significantly emphasized in promotion and tenure decisions within a department or institution, this may have a profound impact on a program's success.

Many individuals might feel uncomfortable beginning a program to improve teaching skills with very little, if any, formal training in education.A plethora of information exists to serve as a resource dealing with ways to improve teaching skills including reference books ^4,5, articles and videotapes.The Council on Medical Student Education's (COMSEP) Task Force on Teaching Methods has compiled many of these resources in the form of several manuals that can be obtained from the COMSEP Resource Clearinghouse⁶.These manuals include annotated bibliographies, descriptions of how to present effective faculty development workshops and listings of meetings, conferences and institutions where programs to improve teaching skills are offered. Participating insuch a teaching skills session can be a first step to conducting local workshops modeled on these programs and materials.

Nearly every medical school has individuals in the Dean's office or office for medical student education with a formal background in education who can assist with the development and implementation of a program.Many departments use the expertise of individuals in their affiliated university's department of education.In addition, there are a number of medical educators with considerable expertise who travel to institutions as consultants and offer workshops to improve teaching skills.

The person leading the faculty development effort will needto slowly work to modify the teaching climate in the department. At an early stage it is necessary to begin a dialogue in their department concerning teaching and ways to improve it.Having faculty members and/or residents meet to discuss what they teach, how they teach and how they evaluate the results of their teaching is an appropriate beginning.Such sessions lasting 30 to 60 minutes could be held at the beginning ofattending rotations or at regularly scheduled intervals.Residents could be included in these sessions with faculty or have sessions scheduled independently.One effective method is to review the institution's medical student evaluation form and have clinical preceptors discuss what they think are the most important aspects of student performance.Useful questions to be asked might include how performance expectations are communicated to students, what teaching methods have been particularly successful in the past, what difficulties have previously existed with regard to teaching and how feedback is given to students.After this input, specific workshops can be offered on a wide variety of topics including creative teaching methods, providing feedback, utilizing problem-based learning and presenting more effective lectures.

There are options other than formal workshops to enhance faculty and resident teaching skills. Resident-directed sessions on teaching can be part of their conferences. Some residency programs have targeted interns during orientation week, others have targeted the house staff in the spring before they shift to new supervisory roles, or during resident retreats. Other programs include discussions about providing effective feedback to students about their performance.Regular resident teaching awards by the students can beaccompanied by a description of the successful teaching techniques.Teaching can also be made more visible with regular student education updates at departmental faculty meetings. The clerkship director can use cases of problem students as a teaching skills consult, by reporting what methods were used to deal with the problem and thus expand the faculty or resident's repertoire. When teaching both residents and students in clinic, the residents may be given the responsibility of teaching the student. The faculty member can reviewthe interaction and help the resident improve their teaching.Similar opportunities exist in the inpatient setting for the attending to Council the resident about teaching methods observed, not just clinical content. These are just a few examplesand each program will findother unique ways to incorporate teaching skills development into their environment.

In order to effectively change the environment regarding teaching within a particular department, a comprehensive program needs to be gradually developed consisting of a variety of short discussions, longer workshops as well as consistent reinforcement of teaching principles. Perhaps the most important feature of successful programs to improve teaching skills is the continued reinforcement of the topics being presented and discussed.To have a workshop about a particular topic with no follow up, will have little impact.The reinforcement methods can be modest, but they will serve to keep faculty aware that teaching skills can continually improve.The results of a successful faculty and resident program to improve teaching skills will undoubtedly be an enhanced educational experience for medical students during their pediatricclerkships.

REFERENCES

1. Dewitt TG, Goldberg RL, Roberts KB.Developing community faculty: Principles, and evaluation.Am.J.Dis.Child. 147:49-53. 1993
2. Skeff KM, Stratos GA, et al.Improving clinical teaching: Evaluation of a national dissemination program.Arch. of Int. Med.152:1156-1161.1992.
3. Stritter FT, Herbert WNP and Harward DH.The teaching scholars program: Promoting teaching as scholarship.Teaching Learning Med. 6: 207-209.1994.
4. Edwards JC and Marier RL. Clinical Teaching for Medical Residents. Springer Publishing, New York, NY. 1988.
5. Westberg J, Jason H.Collaborative Clinical Education.Springer Publishing, New York, NY. 1993.
6. "Resource Manual for Faculty Development," "Resources to Enhance Resident Skills for Teaching Medical Students" and "Teaching Medical Students in the Ambulatory Setting," COMSEP Resource Clearinghouse, c/o Jennifer Johnson, M.D., U. Cal - Irvine, 101 The City Drive, Building 27, Route 81, Orange, CA 92668.