Faculty Development

Faculty development material developed for and by COMSEP members:

• The "Nuts and Bolts" of a Successful Student Experience in the Office
  Ardis Olson, M.D., Dartmouth Medical School
  Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach, Florida, March 1996
• New Clerkship Director's Workshop
  Fred McCurdy, M.D., Ph.D., University of Nebraska
  Susan Marshall, M.D., University of Washington
  Bruce Morgenstern, M.D., Mayo Medical School
  Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach, Florida, March 1996

Faculty development internet sites that provide relevant information to Pediatric medical educators:

Models that Work:
The Nuts and Bolts of
Faculty Development
For
General Internal Medicine,
Family Medicine and
General Pediatrics
December 2 - 4, 1998
U.S. Department of Health and Human Services
Health Resources & Services Administration
and The Ambulatory Pediatric Association

This site provides extensive and relevant information for faculty development activities. Many of the authors of these articles are leaders in medical education and even a few COMSEP members. However, you will need the Adobe Acrobat Reader to read the files.

The Asociation of Program directors in Internal Medicine
The Educational Clearinghouse for Internal Medicine is a peer-reviewed compendium of articles, books, and locally produced materials for education in Internal Medicine. The internal medicine clearinghouse contains excellent material for faculty development.

Center for Instructional Support
This site presents information and resources for helping educators in all the health professions enhance their instructional, leadership/management, and research skills, with additional resources that can help them with career development.

The Office of Medical Education Research and Development
The Office of Medical Education Research and Development is a unit within the College of Human Medicine at Michigan State University. Its mission is to improve medical education and related service programs through evaluation and research, consultation, relevant instruction, and programs of faculty development. Established in 1966, OMERAD is the oldest continuously operating office of medical education in the United States.

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1. The "Nuts and Bolts" of a Successful Student Experience in the Office
Ardis Olson, M.D., Dartmouth Medical School
Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach, Florida, March 1996

Before, During, and Afterwards: Suggested Tasks for the Practitioner

Beginning

Before the student comes to the office (1-2 weeks)

• clarify what is expected of you
• Determine what supports are available to you from the medical school
• Learn personal details of the student
• Review the "Student Profile and Skills" pages (below)
• Check you office schedule for surprises (days away from the office, trips, etc.)
• Look for scheduled patients, meetings, or events from which the student could benefit
• If planned routinely, arrange outside community experiences for students

The student's first day in the office

• Meet and establish ground rules and expectations
• Orient student to office staff, procedures, and routines
• Establish a plan to have:
  • student work progressively more independently during the time in the office
  • student identify ambulatory care areas of special interest

The Middle

Setting the learning climate

What are we teaching

• Medical issues
• Role models of primary care physicians and type of care given
• Interplay between professional and personal lives

Who are the teachers

• The role of community experiences options used by practitioners how to prepare the student
• Teaching by office staff: nursing and office staff options
• The patients home visits, phone follow up, extended visits

How teaching is structured

• Number and type of patients students are involved in
• Focused teaching points
• Student's use of a learning list
• Options for reviewing patients seen
• How to relieve the daily teaching burden
• Student learning responsibilities

Checking in

• One week fine tuning
• Midway feedback, student self review
• Trouble shooting: typical student problems

The End

Wrapping up the experience

• Review progress since midway
• Student feedback to preceptor
• Comments of parents and staff about the student
• Share written evaluation with the student

Practice reflection

• Review with colleagues and staff how would do different and jot down ideas in teaching file
• Write down personal goals that want to focus on next time

Afterwards- Between Student Experiences

• Contact with Program Coordinator
• Solve logistic issues
• Feedback how students could be better prepared
• Opportunities for enhancing teaching skills
• National meetings
• Local workshops
• Seminars in the practice from the program

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Student Profile

Name: __________________

Nickname (if any):__________________

Home telephone (other telephone if applicable):__________________

1. What other types of clinical/ambulatory care experiences have you had?

Medical Interests

1. What aspects of medicine do you find most interesting or appealing? Why?

2. What aspects of medicine do you find least interesting or appealing? Why?

3. What are your major career interests? (Primary Care? Subspecialty? Undecided?)

Learning Style

Based on your experience and knowledge of appropriate teaching and learning styles in clinical medicine, please answer the following:

1. Describe the qualities of an effective teacher.

2. What stifles or hinders your learning?

3. What are your responsibilities as a student?

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Clinical Inventory Skills

This inventory is intended to help monitor development of your skills essential to ambulatory pediatrics. Present this to your community preceptor on your first day and discuss areas in which you would like or need more practice. It is beneficial for you to also be aware of situations where you can either learn a new skill or continue to develop competence in ones you have already learned.

Please rate your mastery of the following skills/procedures using the scale below. (Circle one)

0 = no previous experience, skill, or competence

1 = some experience but still require supervision

2 = much experience, require little or no supervision

Procedure	No Experience	Some Experience	Much Experience
1. Growth charts(charting/analyzing)	0	1	2
2. Hematocrit	0	1	2
3. Stool test-blood	0	1	2
4. Throat culture	0	1	2
5. Urinalysis	0	1	2
6. Vision/hearing screening tympanometry	0	1	2
7. X-ray - extremity	0	1	2
8. DDST	0	1	2
9. Finger/heel stick	0	1	2
10. Immunizations	0	1	2

Are there other procedures with which you feel you need specific instructions? What are they?

Please rate your mastery of the following examinations in the same was as above.

Procedure	No Experience	Some Experience	Much Experience
1. Newborn	0	1	2
2. Infant/toddler	0	1	2
3. Preschool	0	1	2
4. School	0	1	2
5. Adolescent	0	1	2
6. Illness or acute problem	0	1	2
7. Assessment of minor trauma	0	1	2
8. Ear exam with oreumatic otoscopy	0	1	2

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Getting Organized: Suggested Guidelines

This section may be helpful to the preceptor in organizing time and responsibilities for staff and student.

1. A Good Start

Read through the student profile and clinical skills inventory to become acquainted with the student

Review the patient log with student and identify particular outpatient readings or clinical experiences at your site (Outpatient Reading Binder) which may be helpful to the student.

Review the ambulatory curriculum, noting seasonal variations.

2. Establishing Ground Rules

Introducing the student to office staff and providing a tour are essential first day experiences in making a student feel welcome . Giving students written guidelines and discussing these at the beginning of the rotation is important for both of you. It establishes your expectations of the student and eliminates confusions which waste time for everyone. These guidelines should include

• Days and hours the student is expected to be in the office, including evening clinics
• Who else in the office will the student be responsible and how often
• What role do students have in the hospital and can they write in hospital charts? What about admissions and newborns?
• Student on-call responsibilities
• Preceptor's days off and who the student should report to on those days.
• Specific expectations - such as presentations, specific readings, etc.
• Discuss when feedback and evaluation will occur.
• Community activities of the preceptor in which the student will participate in.
• Other office policies and procedures of which the student should be aware
• Other logistical information which the student needs to know, i.e., parking at site and hospital, telephone numbers, pager systems, etc.

3. Orientation

The student should have an understanding of how the office works, as well as any particular information for the hospital.

• Establish ground rules (see above)
• Office staff and responsibilities
• Standard office procedures (appointments, chart information, etc.)
• Individual practitioner's interests
• Office lab procedures
• Hospital logistics including chart information, paging systems, location of specialty areas (x-ray, nursery, etc.)

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Sample Schedule

(Based on a two week rotation)

First Week

• Review the above and orient the student to the practice.
• Set specific feedback sessions for each day and a wrap up for the week.
• Integrate student interests with your plans for him/her.
• Have the student watch as you see patients until he/she is familiar with the routine and flow.
• Have the student see patients.
  • See patient alone
  • Present to you after seeing patient
  • Have the student observe or participate while you examine the child
  • discuss observations after the patient has left
  • For selected patients, have the student write the SOAP notes - if these are good perhaps the student can write the assessment and plans, as well.

Second Week

• Have the student see patients collecting history and exam data.
• have the student discuss present findings to you
• See the patient together allowing the student to demonstrate specific clinical skills.
• Include teaching of procedures by you or your staff.
• Help the student clarify why patient problems are not the same in this setting as what would be seen on other services/tertiary care center. Help student understand how continuity in patient care changes treatment.
• Help the student develop problem solving skills.
• Set up specific feedback times for each day and a wrap up evaluation session at the end of the week.

For sites having students longer than two weeks, continue to expand on the above ideas.

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2. New Clerkship Director's Workshop
Fred McCurdy, M.D., Ph.D., University of Nebraska
Susan Marshall, M.D., University of Washington
Bruce Morgenstern, M.D., Mayo Medical School
Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach, Florida, March 1996

Structure and strategies

I. How do you fit? What is your departmental and institutional clerkship governance? Are you the capo di tutti capi or is there a more diffuse committe structure?

II. What do you want? What is your personal philosophy/goal/vision/mission for the clerkship? Where do you want the students to be after they complete the rotation?

III. How can you implement your vision?

A. (see I above). If you are really in charge, you have a head start. If you are but a cog in a slow-moving wheel, you have to get allies. Seek them out. Proselytize.

B. Get a feel for where your clerkship is now (notice, you are taking ownership, it is yours!!). Devise a plan to get from point a (here) to point b (perfection). Break the plan down into pieces. Act on several small pieces at a time. Don't pick on the same people to assist, unless their enthusiasm is infectious

IV. So, you've got a vision: Don't labor under the illusion that your vision is unique. Others, in your school, or in the pediatric clerkship directors' community may share your vision and have been along this path before. Network. Learn from your peers. Learn how your vision fits into the structure of your particular setting.

A. What are you students expected to know by the time they get to your clerkship? What's in the Medical School curriculum? How much pediatric contact will they have had?

B. Where can you put your students? How many sites for ambulatory care do you have? How much in-patient time? What about newborn care? What about care of the indigent? The disabled?

C. Who's going to care for your students when they're not under your watchful eye? You will need helpers in the "remote" sites. They may need to be physicians, or may need to be secretaries, this depends upon your circumstances. Remember, people need time, and time equals $$!

V. Budget: How much yak got? How much ya need? Who controls the purse strings? Realize there is a study in the literature (Academic Medicine 1991;66:348-353) which demonstrates a 30-40% decrease in productivity (read: patient through-put) and a consequent $25,000 loss in revenue when students are taught in an ambulatory setting. Be careful what you ask for, and whom you ask!

VI. Your needs: Pediatricians tend to be a self-deprecating lot. Remember to protect yourself. This requires: 1) adequate FTE allotment for you to do the job, 2) appropriate secretarial resources, 3) a computer - you've got to be in cyberspace to do this job well, 4) administrative assistance (especially with class sizes in excess of 60-70 students at the least). You will also need to learn the language of education - basic terms are essential, esoteric stuff sounds good. Become familiar with the educator's portfolio - you're going to work hard and deserve credit for your work.

VII. Your target audiences (AKA the students and your colleagues) Check them out. Find out from the admissions office a little about the class. They'll have some basic data to give you a little overview. Assume that they are adults, and they will usually act accordingly, but don't count on it.

A. How do adults like to learn? This goes back to your needs (VI above). Go to some faculty development workshops. Learn what adult learning about. See how you can implement these things at your school. Remember IV above. As you network, you will find others who have tried to implement adult-oriented teaching and learning processes (maybe even your predecessor). Many wheels have been created, you may just need to add the hubcap specific to your school. That's a lot easier than starting from scratch. See appendix for some resources

VIII. A little more structure

A. Orientation: You will need one or two (at the least) orientation sessions with your colleagues on the faculty. They won't be able to give you what you want or need unless you let them know. Written communications can be iffy, they may not be read, they may not be understood. The students will also need to be oriented at the beginning of their clerkship. They need to hear what is expected of them and what they can expect. They need an overview of the clerkship, the way they are to be evaluated and the complaint process (i.e., who do they call if there's a problem during the rotation - what if one of them is the victim of harassment?). If the students are to be spread out over multiple sites during the clerkship, consideration should be given to a joint orientation prior to the dispersion. If this is impossible, you will need to assign an official orienter at the other sites and make certain the message is consistent. If you are relying on the residents as educators (and who doesn't?), you cannot forget to include them in your orientation process. They need to understand what the students are expected to do, what they are to so with the students, etc.

B. Evaluations: Everyone ought to be evaluating everyone else, but there is a limit, or you'll be inundated in paper. The students can evaluate the faculty (those critiques can be sent to the school, thence to the chair, with you copied). The students can evaluate the residents, with the critiques going to the residency program director. The residents and faculty will evaluate the students, of course, but you need to be sure these evaluations are useful. This is easier said than done. Find out what the dean considers to be helpful in an evaluation (for school progress or for the Dean's letter) and try to get input along these lines. Try to get objective information whenever possible. Do not be afraid to point out a student's weakness, just have data to back it up. Learn more about evaluation processes and keep refining what you want. If you can create a simple form, so much the better.

C. Assessments: What will you use for student assessment? How will you weight the different aspects? Will you use standardized tests? OSCEs? Locally developed tools? Students like to know this before the course. It will also make your life easier as you do the students' final evaluations.

D. Plan for failure: Yours and the students. If you try something, put into place a tool to monitor it, so if it works you'll know why, and if it doesn't you'll know that too, before it's too late. When a student is doing poorly, you will need to have a mechanism in place so that you are made aware of the fact as soon as possible, and that the student also gets this feedback. There's nothing worse (for you or a student) than being told after the fact that you've done badly. Have a plan for remediation. Decide if the student would need to repeat the course if he or she does not improve. The mediocre student will be your most difficult challenge.

IX. Basic teaching strategies (a primer only)

• Lectures: enough said, although, having the student lecture can be effective at times.
• Case-based conferences: interactive, the student gets to participate
• Problem based learning
• Observation and shadowing
• OSCEs as teaching tools can be much like a case-based conference
• Hands on patient care: it's where everything is immediately relevant. All context-based. The real world, but there has to be some teaching to accompany the learning, or the learning can be wrong (e.g. bad habits, poor technique)