Search

Context: Despite the pace and intensity of the in-patient clinical setting, physicians carve out time for teaching medical students and residents., Objectives: The goal of this study was to explore what it means for physicians to teach students and residents in the in-patient setting., Methods: We conducted semi-structured interviews with 15 practising physicians from the departments of internal medicine, surgery and paediatrics in three university teaching hospitals at McGill University, using an interpretive phenomenological methodology., Results: Five themes elucidated the meaning of teaching for physicians in the in-patient setting: (i) teaching was perceived as an integral part of their identity; (ii) teaching allowed them to repay former teachers for their own training; (iii) teaching gave them an opportunity to contribute to the development of the next generation of physicians; (iv) teaching enabled them to learn, and (v) teaching was experienced as personally energising and gratifying. Participants were morally and socially motivated to give time and effort through teaching (e.g. to pay forward their own privilege and thereby help to develop the next generation); teaching also gave them a sense of personal fulfilment (e.g. by allowing them to mould young minds and leave a legacy)., Conclusions: This study holds a number of implications for medical education with relevance to the recruitment and retention of clinical teachers, recognition of clinical teaching, and evidence-informed faculty development. The findings also suggest that teaching in an academic setting can bring joy and fulfilment to practising physicians., (© 2015 John Wiley & Sons Ltd.)

Objectives: Traditional student feedback questionnaires are imperfect course evaluation tools, largely because they generate low response rates and are susceptible to response bias. Preliminary research suggests that prediction-based methods of course evaluation - in which students estimate their peers' opinions rather than provide their own personal opinions - require significantly fewer respondents to achieve comparable results and are less subject to biasing influences. This international study seeks further support for the validity of these findings by investigating: (i) the performance of the prediction-based method, and (ii) its potential for bias., Methods: Participants (210 Year 1 undergraduate medical students at McGill University, Montreal, Quebec, Canada, and 371 Year 1 and 385 Year 3 undergraduate medical students at the University Medical Center Groningen [UMCG], University of Groningen, Groningen, the Netherlands) were randomly assigned to complete course evaluations using either the prediction-based or the traditional opinion-based method. The numbers of respondents required to achieve stable outcomes were determined using an iterative process. Differences between the methods regarding the number of respondents required were analysed using t-tests. Differences in evaluation outcomes between the methods and between groups of students stratified by four potentially biasing variables (gender, estimated general level of achievement, expected test result, satisfaction after examination completion) were analysed using multivariate analysis of variance (manova)., Results: Overall response rates in the three student cohorts ranged from 70% to 94%. The prediction-based method required significantly fewer respondents than the opinion-based method (averages of 26-28 and 67-79 respondents, respectively) across all samples (p < 0.001), whereas the outcomes achieved were fairly similar. Bias was found in four of 12 opinion-based condition comparisons (three sites, four variables), and in only one comparison in the prediction-based condition., Conclusions: Our study supports previous findings that prediction-based methods require significantly fewer respondents to achieve results comparable with those obtained through traditional course evaluation methods. Moreover, our findings support the hypothesis that prediction-based responses are less subject to bias than traditional opinion-based responses. These findings lend credence to prediction-based as an accurate and efficient method of course evaluation., (© Blackwell Publishing Ltd 2013.)

One of the impediments to teaching professionalism is unprofessional behavior amongst clinical teachers. No method of reliably assessing the professional behavior of clinical teachers has yet been reported. The aim of this project was to develop and pilot such a tool. Thirty-four desirable professional behaviors in clinical teachers were identified. Medical students (n = 13) and medical educators (n = 30) rated their importance and validity. Based on the ratings, 16 behaviors in 4 dimensions were included in an assessment form that was piloted in the Department of Pediatrics at McGill University, with medical students (n = 94) rating the professionalism of their clinical faculty (n = 20). One hundred and ninety forms were returned with between 1 and 22 evaluations per faculty member. Scores ranged from 25 to 48 (maximum rating = 48, mean score = 42.7, SD = 6.29). A generalizability analysis was conducted; internal consistency was 0.89, and reliability for a mean of 8.23 ratings per faculty member was 0.53. Inter-rater reliability for one item was 0.11, potentially due to the context specificity of behavior or low frequency of unprofessional behaviors. Exploratory factor analysis revealed 3 factors with eigen values over 1. Assessment of the professionalism of clinical teaching faculty appears to be feasible, acceptable and reasonably reliable. The explicit evaluation of professional conduct in clinical faculty could encourage the maintenance of professional behaviors and potentially decrease the effects of negative role modeling and positively affect the hidden and informal curricula.

Objectives: The goals of this study were three-fold: to explore the reasons why some clinical teachers regularly attend centralised faculty development activities; to compare their responses with those of colleagues who do not attend, and to learn how we can make faculty development programmes more pertinent to teachers' needs., Methods: In 2008-2009, we conducted focus groups with 23 clinical teachers who had participated in faculty development activities on a regular basis in order to ascertain their perceptions of faculty development, reasons for participation, and perceived barriers against involvement. Thematic analysis and research team consensus guided the data interpretation., Results: Reasons for regular participation included the perceptions that: faculty development enables personal and professional growth; learning and self-improvement are valued; workshop topics are viewed as relevant to teachers' needs; the opportunity to network with colleagues is appreciated, and initial positive experiences promote ongoing involvement. Barriers against participation mirrored those cited by non-attendees in an earlier study (e.g. volume of work, lack of time, logistical factors), but did not prevent participation. Suggestions for increasing participation included introducing a 'buddy system' for junior faculty members, an orientation workshop for new staff, and increased role-modelling and mentorship., Conclusions: The conceptualisation of faculty development as a means to achieve specific objectives and the desire for relevant programming that addresses current needs (i.e., expectancies), together with an appreciation of learning, self-improvement and networking with colleagues (i.e., values), were highlighted as reasons for participation by regular attendees. Medical educators should consider these 'lessons learned' in the design and delivery of faculty development offerings. They should also continue to explore the notion of faculty development as a social practice and the application of motivational theories that include expectancy-value constructs to personal and professional development.

Background: Faculty development activities in medical schools regularly target teaching behaviours but rarely address basic pedagogic principles underlying those behaviours. Although many teachers have an intuitive or tacit knowledge of basic pedagogic principles, overt knowledge of fundamental educational principles is rare., Aims: We conducted a short-term pilot study designed to transform teachers' tacit knowledge into explicit knowledge of pedagogic principles. We hypothesized that conscious awareness of these principles will positively influence their teaching effectiveness., Methods: The intervention included a workshop, provision of a workbook on pedagogic principles and free access to educational consultants. For the intervention, we chose a purposive sample of experienced teachers at our medical school., Results and Conclusions: Evaluation of the impact of the intervention using questionnaires and semi-structured interviews revealed three notable findings; 1. Participants were surprised to discover the existence of an extensive body of pedagogic science underlying teaching and learning. 2. They were enthusiastic about the intervention and expressed interest in learning more about basic pedagogic principles. 3. The knowledge acquired had an immediate impact on their teaching.

Faculty development includes those activities that are designed to renew or assist faculty in their different roles. As such, it encompasses a wide variety of interventions to help individual faculty members improve their skills. However, it can also be used as a tool to engage faculty in the process of institutional change. The Faculty of Medicine at McGill University determined that such a change was necessary to effectively teach and evaluate professionalism at the undergraduate level, and a faculty development program on professionalism helped to bring about the desired curricular change. The authors describe that program to illustrate how faculty development can serve as a useful instrument in the process of change. The ongoing program, established in 1997, consists of medical education rounds and "think tanks" to promote faculty consensus and buy-in, and diverse faculty-wide and departmental workshops to convey core content, examine teaching and evaluation strategies, and promote reflection and self-awareness. To analyze the approach used and the results achieved, the authors applied a well-known model by J.P. Kotter for implementing change that consists of the following phases: establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, generating short-term wins, consolidating gains and producing more change, and anchoring new approaches in the culture. The authors hope that their school's experience will be useful to others who seek institutional change via faculty development.

The Teaching Scholars Program for Educators in the Health Sciences at McGill University, in Montreal, Quebec, was designed to promote the professional development of health science educators by increasing their expertise in developing and implementing educational programs and taking on leadership roles in education. This program, which was initiated in 1997 and is tailored to the individual needs of the participants, consists of participation in: two university courses; a monthly seminar; a research study or an educational project, consisting of curriculum design and evaluation; and faculty-wide faculty development activities. As of 2006, 34 scholars have completed this program. Outcome data indicate that the majority of teaching scholars have taken on new roles and responsibilities in medical education; maintained the changes implemented in their teaching practices; continued to participate in faculty development activities; and presented their work at educational meetings. A number of scholars have also applied successfully for educationally related grants and have published their educational projects. Five of the scholars have pursued advanced studies. This program, which aims to move beyond the improvement of teaching skills by providing a foundation for educational leadership and scholarship, resembles many others in its emphasis on independent study, peer support, and the maintenance of ongoing responsibilities. It is innovative in that scholars participate in university courses and are encouraged to attend an "outside" conference or course. The overall benefits of this program, as noted by the scholars, include increased knowledge and skills, introduction to a "community of practice," and new career paths and opportunities.

Teaching awards are commonly regarded as an incentive to encourage pedagogic excellence. Inasmuch as their effectiveness depends on how they are perceived by faculty, the authors investigated the impact of a teaching award in the Faculty of Medicine (Faculty Honor List for Educational Excellence) on the attitudes of award recipients and departmental chairs. A questionnaire was designed to sample opinion on the extent to which the Honor List program was publicized, whether the award contributed to recognition and/or stature in the academic unit, and whether it was personally valued by recipients. The questionnaire was sent to all 23 departmental chairs and to all 43 faculty members who had received the award between 1998 and 2002; 78% of the chairs and 77% of the recipients responded. The results revealed marked discrepancies between the perceptions of chairs and recipients. Chairs, although uncertain of the effect on quality of teaching, largely regarded the award as prestigious and well publicized within their departments. A notably smaller percentage of award recipients shared these views. Nonetheless, 93% of recipients valued the award highly, and 45% of recipients indicated that the award inspired them to enhance the quality of their teaching.

Feedback plays an important role in Postgraduate Medical Education and is indispensable in surgical training. Improvement in operating skills, for example, requires constant feedback between teacher and learner to promote reflection on performance. Prior to providing workshops on giving effective feedback, the goal of this study was to assess the perceptions of attending surgeons and residents on feedback practices in our program. We show a startling disparity in perceptions of feedback frequency and skills. The results were used in planning a Workshop on Giving Feedback for our faculty. The effectiveness of this Workshop will be assessed at a later date by administering the same questionnaire.

The authors describe a year-long faculty development initiative to develop leaders in medical education. The Teaching Scholars Program for Educators in the Health Sciences at McGill University enables faculty to improve their educational knowledge and skills while maintaining their clinical, teaching, and research responsibilities. The program, tailored to the participant's individual needs, consists of five main components: two university courses; independent study; participation in faculty-wide faculty development workshops and medical education rounds; a monthly seminar; and attendance at a national or international conference or course. Since its inception in 1997, 22 faculty members have completed the program; four are currently participating in it. This report discusses the experience of 15 scholars who completed the program by September 2000. Evaluations indicate that the scholars achieved most of their stated objectives. The university courses provided a foundation in educational principles and methodology; independent study allowed them to work on educational projects relevant to their disciplines; and the monthly seminars, faculty development workshops, and outside courses offered opportunities for skill acquisition and reflection. Participants also appreciated the opportunity to meet others interested in medical education and to become aware of available educational resources. A year after completing the program, many had joined new educational committees, taken on new leadership roles in medical education, and developed new courses for students and residents. Some of their projects had been presented at national meetings and were being prepared for publication. Two scholars had pursued further study at a master's level. Despite the ongoing challenge of protecting time for educational pursuits, this program has been beneficial in helping to develop educational leaders in the Faculty of Medicine.

Purpose: To investigate stress in medical students, law students, and graduate students at McGill University using a well-validated measure, the Derogatis Stress Profile (DSP)., Method: The DSP was administered to the medical students in November and December 1994. For comparison, the DSP was also administered to the undergraduate law students and the graduate students. In November 1995 the DSP was administered to the first- and second-year medical students. Results were analyzed with a number of statistical methods., Results: The response rates for the medical students, the law students, and the graduate students in 1994-95 were 70%, 96%, and 43%, respectively. The response rate for the first- and second-year medical students in 1995-96 was 57%. The medical students had subjective feelings of stress that are marginally above population norms, but their total-stress scores (related to environmental factors, personality mediators, and emotional responses) were below those of the general population, the law students, and the graduate students. Elevated depression scores in a minority of the students did not seem to be related directly to the stresses associated with medical school. The transition from basic science training to clinical training was associated with an increase in stress and depressed mood., Conclusion: Medical students are not greatly stressed relative to other groups, hence other explanations must be sought for the elevated levels of depression in some students. One situation in which stress appears to be particularly important is in the transition from basic science training to clinical training. Targeted interventions may be an effective way of dealing with this problem.

Objective: To evaluate the ability of doctors in primary care to assess risk patients' risk of coronary heart disease., Design: Questionnaire survey., Setting: Continuing medical education meetings, Ontario and Quebec, Canada., Subjects: Community based doctors who agreed to enroll in the coronary health assessment study., Main Outcome Measure: Ratings of coronary risk factors and estimates by doctors of relative and absolute coronary risk of two hypothetical patients and the "average" 40 year old Canadian man and 70 year old Canadian woman., Results: 253 doctors answered the questionnaire. For 30 year olds the doctors rated cigarette smoking as the most important risk factor and raised serum triglyceride concentrations as the least important; for 70 year old patients they rated diabetes as the most important risk factor and raised serum triglyceride concentrations as the least important. They rated each individual risk factor as significantly less important for 70 year olds than for 30 year olds (all risk factors, P < 0.001). They showed a strong understanding of the relative importance of specific risk factors, and most were confident in their ability to estimate coronary risk. While doctors accurately estimated the relative risk of a specific patient (compared with the average adult) they systematically overestimated the absolute baseline risk of developing coronary disease and the risk reductions associated with specific interventions., Conclusions: Despite guidelines on targeting patients at high risk of coronary disease accurate assessment of coronary risk remains difficult for many doctors. Additional strategies must be developed to help doctors to assess better their patients' coronary risk.

This paper describes the use of innovative teaching techniques in clinical teaching. Advantages proposed include increasing teacher and learner enthusiasm, improving participation and developing techniques that are most appropriate to learning goals. Examples of different innovative techniques are provided which are grouped into the categories of experiential learning, role-playing, competition and games, stimulus materials, brain-storming and sub-grouping. Finally, practical guidelines to develop and utilize innovations are suggested. The use of innovative techniques requires time, planning, a commitment to the teaching process and a belief that the resulting learning will be both more enjoyable and productive.

Sexual health is an important component of the individual's total health picture. The primary physician, however, is often ill-prepared to deal with issues around sexuality and sexual dysfunction, and family medicine units need to structure programs for teaching in this area. This article describes a teaching program on human sexuality in a family medicine setting. Its major goals were the transmission of information, the teaching of skills, and the desensitization of the health care professional in this area. The program consisted of a series of four seminars and ongoing teaching. The seminars focused on the human sexual response, sexual myths, sexual history taking, and sexual dysfunction and treatment. Ongoing teaching included case discussion, consultation, and joint interviews. It is hoped that the description of this program will serve as a model and/or impetus to other family medicine training programs.