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Coaching in medical education is increasingly used for trainee development for a variety of skills, including improving trainee teaching skills through resident-as-teacher programs. Faculty who serve as coaches commit significant effort to the coaching role, often without protected time or support. Little is known about faculty motivations to participate in coaching programs or how the coaching experience affects the faculty. This study explored faculty coaches' motivations to participate as coaches in a resident-as-teacher rotation and the impacts they experienced as a result of their participation.In this qualitative study, authors conducted 14 semistructured interviews in 2019 with faculty coaches from a single resident-as-teacher program in Boston, Massachusetts. Authors analyzed the transcripts using thematic analysis to develop a conceptual framework.Faculty coaches' motivations for initial participation included a sense of honor; a sense of duty; perception of competence; interest in promoting medical education; and desire for increased connectedness. These motivations all related to a larger theme of educator identity. Coaches identified 3 main impacts from participation: improvement in their own teaching, personal satisfaction from helping others and seeing improvement in their learners, and increased connectedness. These impacts affirmed the coaches' educator identity and led to ongoing motivation to participate. They also contributed to the coaches' well-being at work.Faculty were initially motivated to participate as coaches in a resident-as-teacher rotation based on their identity as educators. The benefits achieved-improvement in own teaching, personal satisfaction, and increased connectedness-affirmed their educator identity and led to ongoing participation and increased well-being at work. These motivations and impacts are important to consider as future programs are developed and coaches are recruited for programs across undergraduate, graduate, and continuing medical education settings.

BACKGROUND: There are limited training opportunities for pediatricians in caring for children with medical complexity (CMC) in the home and community. Prior studies have described a lack of comfort caring for CMC among pediatric residents. OBJECTIVE: 1) To evaluate the impact of participation in a virtual home visit curriculum on pediatric residents’ confidence, knowledge, and application of knowledge in complex care; 2) to explore changes in perspectives relating to the care of CMC after participation in the curriculum. METHODS: This was a prospective pre-post intervention study in 2019 with first-year pediatric residents, using quantitative and qualitative methods. The intervention, co-created with a family partner, was an online video-based curriculum followed by an in-person seminar. Pre- and post-assessments were compared using paired t-tests. Follow-up interviews and focus groups were performed 5–8 weeks after training. Transcripts were analyzed using inductive thematic analysis. RESULTS: Twenty-four residents (100%) participated. Residents reported increased confidence in all aspects of complex care presented in the curriculum, with significant increase in knowledge and application of knowledge (all p

Background Previous studies of pediatric residents have identified educational gaps in caring for children with medical complexity. Training opportunities in complex care vary across residency programs. Defining core curricular topics in complex care is a priority in medical education. Objective To identify core topics to include in a standard complex care curriculum for pediatric residents. Methods An initial topic list was generated through literature review and proceedings of national meetings. Expert panelists were identified based on experience in complex care and residency education. A modified Delphi method was used to determine group consensus by asking participants to rate the importance of complex care curricular topics for pediatric residents. Consensus was defined as >70% of experts identifying a topic as essential. There was a predetermined maximum of 3 iterative, electronic survey rounds, with feedback provided to participants between each round. Results Sixteen experts participated. Response rate was 100% for all rounds. Experts were from the United States (44%) and Canada (56%); most were affiliated with an academic medical center (96%) involved in both inpatient and outpatient care (69%). Eleven topics were identified as essential across 3 rounds: feeding difficulties, pain/irritability, transition, feeding tube management, difficult discussions, team management/care coordination, dysmotility, aspiration, safety/emergency planning, neuromuscular/skeletal issues, and advocacy. Essential topics were organized according to the International Classification of Functioning, Disability and Health. Conclusions Eleven curricular priorities in complex care were identified across multiple domains of the International Classification of Functioning, Disability and Health framework, serving as a guide for standardized curriculum development for future pediatricians.

Background Consensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking. Objective Use modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, nonspecialty teaching rounds and pilot the checklist. Design/Methods One hundred and forty-one initial candidate behaviors were identified through literature review and narrowed by local stakeholders. Forty-one behaviors were submitted to national experts identified through purposive sampling to be refined using the modified Delphi method. Participants indicated agreement with behaviors’ inclusion in the checklist and whether any were nonobservable. Measures of central tendency and dispersion were used to identify consensus with a behavior's inclusion in the next cycle. A criterion was eliminated if >25% of experts felt it was not observable. Cycles continued until consensus was reached on ≤20 behaviors. The resulting checklist was piloted at 2 hospitals. Results After 2 modified Delphi cycles, consensus was obtained on 18 behaviors for inclusion in the final checklist. These were spread across 3 subcategories: teaching, leadership, and patient safety. In the pilot, the checklist of behaviors discriminated between residents with differing levels of competency in supervising trainees on inpatient rounds. For residents who had the checklist completed by 2 faculties, there was 75% agreement in behaviors observed. Conclusion(s) Based on literature review, local stakeholder input, and consensus of national experts through the modified Delphi method, we created and piloted a checklist of observable behaviors characteristic of effective clinical supervision by pediatric residents leading trainee teams on inpatient, non-ICU, nonspecialty rounds.

To identify gaps and opportunities in complex care training for pediatric residents.Residents in an academic pediatric residency program were surveyed about: training experiences in complex care; self-entrustment in key clinical activities in complex care; educational strategies that would increase preparedness; and recommendations for curriculum development. We used descriptive statistics for quantitative data and content analysis for free-text responses.Of the 160 residents surveyed, 110 (69%) participated. Most participants reported prior clinical exposure to children with medical complexity (CMC; 106, 96%) during both inpatient (82, 75%) and outpatient (88, 80%) clinical rotations. Mean self-entrustment was at or below "somewhat confident" for all clinical activities in complex care, for residents in all postgraduate years. Clinical activities with highest reported self-entrustment included evaluating aspiration into the airway, nutritional issues, care coordination, and evaluating pain. Lowest self-entrustment was reported for facilitating transition to adult care, managing medical technologies, and safety/emergency planning. In terms of educational strategies, participants recommended inpatient encounters with an expert preceptor teaching about evaluating aspiration, pain/irritability and dysmotility (50%); discussions with patients/families for advocacy, difficult discussions, and transition to adult care (40%); and hands-on practice for medical technology care (40%).Pediatric residents report limited self-entrustment in performing key clinical activities in complex care, including for residents at the end of their last postgraduate year. Future curriculum development should prioritize direct observation of clinical encounters with CMC by expert preceptors, partnership with patients and families of CMC, and hands-on simulation.

Background Sexual and reproductive health (SRH) is an important disease-specific concern for adolescent and young adult (AYA) women that is not consistently addressed in cystic fibrosis (CF) centers. This study identifies educational needs and preferences of interprofessional CF providers regarding SRH in AYA women with CF. Methods Interprofessional CF providers participated in an anonymous survey regarding general and CF-specific SRH knowledge and skills, factors for optimizing SRH care, and preferred approaches for SRH training. We calculated descriptive statistics for all respondents and stratified by provider type. Results A total of 523 providers completed the survey (39% physicians/advanced practice providers, 19% nurses, 20% social workers, and 22% other disciplines). Half reported comfort responding to female AYA SRH concerns; however, only one-third were comfortable asking appropriate questions and confident taking a sexual history. Only 29% were comfortable with their current CF-specific SRH knowledge. Respondents' preferred SRH topics for further training included: pregnancy/parenthood planning, sexual functioning, urinary incontinence, intimate partner violence, and taking a sexual history. Nearly two-thirds felt having connection to women's health specialists familiar with CF would facilitate SRH care. Approximately one-third desired SRH educational materials for providers to view at point-of-care or through online case-based learning; Conclusion Many interprofessional CF providers lack comfort and skills in addressing SRH with AYA women with CF. Provider training needs and approaches identified in this study can be used to develop tailored educational interventions to improve comprehensive CF care.

Background: Evaluation of applied ethical behavior and professionalism in pediatric and pediatric sub-specialty trainees remains challenging yet crucial, not only for learner growth and development, but for milestones evaluation and effective feedback. Objective: To develop and validate a pediatric ethics and professionalism assessment tool (Pedi-EPAT) that effectively and reliably assesses pediatric …

While there has been increasing demand for online education over the past decade, social distancing recommendations during the COVID-19 pandemic have accelerated the transition from the physical to the virtual classroom. Staples of clinical education, such as grand rounds, noon conferences, case conferences and chalk talks, have been abruptly forced to shift into the digital world. There is an immediate need for guidance on synchronous virtual teaching, especially since health professional educators may lack familiarity with the technologies available and theories that guide their use. The following framework can help educators plan, develop and deliver their virtual teaching sessions to optimize student engagement and produce meaningful learning outcomes.

Dear EditorAs a group of senior medical educators and Harvard Medical School professors, we call into question the article by Masters (2020) about ethics in medical education digital scholarship, i...

Background Teaching practice is presumed to have significant overlap with clinical skills, yet few studies to date have assessed how residents' teaching skills influence their clinical performance. Objective We examined the relationship between the professional roles of residents as teachers and as practicing clinicians as well as how learning about teaching contributes to enhanced skills in the clinical realm. Methods Using the framework method, the authors performed a 2-phased (exploratory and confirmatory) qualitative analysis on the data sets to characterize the relationship between resident teaching and clinical skills. To investigate the relationship between teaching and clinical work, we extracted qualitative data from 300 evaluations of clinical performance for residents in a large, urban, academic internal medicine residency program submitted over a 3-year period. Informed by the preliminary framework that evolved from this analysis, we conducted a focus group of 6 residents in a dedicated clinician-educator track to examine how teaching was related to clinical work. Results We identified attributes and skills of good resident teachers that enhance clinical skills, categorized as 18 subdomains within 4 domains: relationships, communication, relation to self, and relationship with knowledge. Conclusions Themes that link clinical and teaching skills are similar for both patient-physician and learner-teacher relationships. Improving residents' teaching skills may not only benefit the education of learners but also improve the care of patients.

To pilot a short video-based resident-as-teacher training toolkit and assess its effect on resident teaching skills in clinical settings.A video-based resident-as-teacher training toolkit was previously developed by educational experts at Beth Israel Deaconess Medical Center, Harvard Medical School. Residents were recruited from two academic hospitals, watched two videos from the toolkit ("Clinical Teaching Skills" and "Effective Clinical Supervision"), and completed an accompanying self-study guide. A novel assessment instrument for evaluating the effect of the toolkit on teaching was created through a modified Delphi process. Before and after the intervention, residents were observed leading a clinical teaching encounter and scored using the 15-item assessment instrument. The primary outcome of interest was the change in number of skills exhibited, which was assessed using the Wilcoxon signed-rank test.Twenty-eight residents from two academic hospitals were enrolled, and 20 (71%) completed all phases of the study. More than one third of residents who volunteered to participate reported no prior formal teacher training. After completing two training modules, residents demonstrated a significant increase in the median number of teaching skills exhibited in a clinical teaching encounter, from 7.5 (interquartile range 6.5-9.5) to 10.0 (interquartile range 9.0-11.5; P.001). Of the 15 teaching skills assessed, there were significant improvements in asking for the learner's perspective (P=.01), providing feedback (P=.005), and encouraging questions (P=.046).Using a resident-as-teacher video-based toolkit was associated with improvements in teaching skills in residents from multiple specialties.

Background Dermatology residents routinely teach junior co-residents and medical students. Despite the importance of teaching skills for a successful academic career, no formal teaching instruction programs for dermatology residents have been described to our knowledge, and the extent of teaching opportunities for dermatology residents is unknown. Objective We sought to describe the range of teaching opportunities and instruction available to dermatology residents and to assess the need for additional teaching training from the perspective of dermatology residency program directors nationwide. Methods A questionnaire was administered to 113 US dermatology residency program directors or their designees. Descriptive statistics were used to analyze questionnaire item responses. Results The response rate was 55% (62/113). All program directors reported that their residents teach; 59% (33/56) reported offering trainees teaching instruction; 11% (7/62) of programs offered a short-term series of formal sessions on teaching; and 7% (4/62) offered ongoing, longitudinal training. Most program directors (74%, 40/54) believed that their residents would benefit from more teaching instruction. Limitations Response rate and responder bias are potential limitations. Conclusion Dermatology residents teach in a broad range of settings, over half receive some teaching instruction, and most dermatology residency program directors perceive a need for additional training for residents as teachers.

Introduction Cognitive learning strategies are strategies that improve a learner's ability to process information more deeply, transfer and apply information to new situations, and result in enhanced and better-retained learning. Methods We developed an interactive workshop for a national conference of pediatric educators to teach five cognitive learning strategies. The specific strategies were (1) spaced retrieval practice, (2) interleaving, (3) elaboration, (4) generation, and (5) reflection. Each strategy was taught using an active learning exercise. We evaluated the effectiveness of the workshop through a commitment-to-change exercise in which we asked participants to commit to making a change in their teaching as it related to the workshop and then queried them 6 weeks later about their implementation successes and barriers. Results Of the 161 participants registered for the workshop, 52 completed the voluntary workshop evaluation. All 52 participants committed to making a change in their teaching as a result of the workshop. Of those 52 participants, 24 completed the 6-week follow-up survey. Eighty-two percent of those respondents (n = 18) reported implementing a change based on the workshop, with 77% of respondents implementing a change that they had committed to directly after the workshop and 55% implementing a change that they had not originally committed to at the end of the workshop. Discussion This workshop successfully led to behavioral change in the teaching of cognitive learning strategies. We anticipate that this will lead to improved learning among the trainees whom participants teach.

BACKGROUND: Previous studies of pediatric residents have identified educational gaps and lack of comfort caring for children with medical complexity (CMC). There is variable clinical exposure and training opportunity in complex care across residency programs. Defining core curricular topics in complex care is a priority in medical education. OBJECTIVES: The purpose of this study is to identify essential topics to be included in a standard complex care curriculum for pediatric residents. DESIGN/METHODS: An initial topic list was generated through literature review and proceedings of national complex care special interest group meetings. Expert panelists were identified based on experience in complex care and residency education. Using the Delphi method to determine group consensus, an electronic survey was developed asking expert panelists to identify 10–15 curricular topics as essential for pediatric residents. Consensus was defined as >70% identifying a topic as essential. There was a predefined maximum of three rounds with an iterative approach and feedback provided to participants between each round. RESULTS: Sixteen experts were approached and agreed to participate. Response rate was 100% for all three rounds. Experts were from Canada (56%) and the United States (44%), most were affiliated with an academic center (96%) and practiced in both inpatient and outpatient settings (69%). Topics identified as essential in the first round were feeding difficulties, pain and irritability, transition, feeding tube management, difficult discussions, and team management/care coordination. Topics identified by 50–70% of participants as being essential were included in the second round, with revisions based on participant comments. Topics identified as essential in the second round were dysmotility, aspiration and safety/emergency planning. Topics that did not meet consensus were included in a third and final round with additional revisions. Two additional topics were identified as essential in the third round: neuromuscular and skeletal issues and advocacy. Essential topics were organized using the International Classification of Functioning, Disability and Health (ICF). CONCLUSION: Eleven curricular priorities in the care of CMC were identified across multiple domains of the ICF framework. These topics can be used as a guide for curriculum development for pediatric residents. The Delphi method can be replicated to establish educational priorities for other health professions who care for CMC. [Image: see text]

Introduction In a flipped classroom, students learn basic concepts before class, allowing them time during class to apply newly gained knowledge to problem sets and cases. Harvard Medical School (HMS) has introduced a form of flipped classroom, called case-based collaborative learning (CBCL), during preclinical curricula. Finding few published resources, the HMS Academy's Peer Observation of Teaching Interest Group developed a guide for observations and feedback to CBCL facilitators. Methods After conducting an extensive literature search, speaking to flipped classroom methodology experts, and observing 14 facilitators using CBCL methods, the interest group identified specific teaching behaviors that optimize student interaction and knowledge application. The group next engaged in several rounds of the modified Delphi method to develop the CBCL peer observation worksheet and compendium and then tested these materials' effectiveness in capturing CBCL teaching behaviors and providing feedback to CBCL faculty facilitators. Results Seventy-three percent of faculty rated the worksheet and compendium as extremely helpful or helpful in identifying new teaching techniques. Moreover, 90% found the CBCL peer observation and debriefing to be extremely helpful or helpful, and 90% were extremely likely or likely to incorporate peer suggestions in future teaching sessions. Discussion Medical schools have begun to embrace flipped classroom methods to eliminate passive, lecture-style instruction during the preclinical years of the MD curriculum. This tool identifies specific in-classroom approaches that engage students in active learning, guides peer observers in offering targeted feedback to faculty on teaching strategies, and presents consensus-based resources for use during CBCL faculty development and training.

When healthcare professionals provide feedback to peers after a teaching observation, there are benefits for both parties. In this article, we outline strategies to use before, during, and after teaching observations to engage in mutually-beneficial conversations that highlight best practices, identify solutions for teaching dilemmas, and initiate teaching relationships. We discuss the importance of choosing words wisely; giving feedback about teaching skills, not the teacher as a person; recognizing how colleagues view their teaching identities; and ensuring peers are emotionally ready for a post-observation conversation. We also explain how to use pronouns, questions, and active listening during feedback conversations. Finally, we explore the impact of biases on observations, how to establish peer observer credibility, and how to make the teaching observation process and feedback discussion valuable experiences for both parties so that it leads to long-lasting partnerships in the quest to improve educational quality.

Importance Optimal approaches to teaching bedside procedures are unknown. Objective To identify effective instructional approaches in procedural training. Data sources We searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014. Study selection We included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review. Data extraction and synthesis Two independent reviewers extracted data from full-text articles. Main outcomes and measures We included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes. Results We found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p

Objective To design and implement a teaching skills curriculum that addressed the needs of an ophthalmology residency training program, to assess the effect of the curriculum, and to present important lessons learned. Design A teaching skills curriculum was designed for the Harvard Medical School (HMS) Residency Training Program in Ophthalmology. Results of a needs assessment survey were used to guide curriculum objectives. Overall, 3 teaching workshops were conducted between October 2012 and March 2013 that addressed areas of need, including procedural teaching. A postcurriculum survey was used to assess the effect of the curriculum. Setting Massachusetts Eye and Ear Infirmary, a tertiary care institution in Boston, MA. Participants Overall, 24 residents in the HMS Residency Training Program in Ophthalmology were included. Results The needs assessment survey demonstrated that although most residents anticipated that teaching would be important in their future career, only one-third had prior formal training in teaching. All residents reported they found the teaching workshops to be either very or extremely useful. All residents reported they would like further training in teaching, with most residents requesting additional training in best procedural teaching practices for future sessions. Conclusions The pilot year of the resident-as-teacher curriculum for the HMS Residency Training Program in Ophthalmology demonstrated a need for this curriculum and was perceived as beneficial by the residents, who reported increased comfort in their teaching skills after attending the workshops.

Promoting professional development is a challenging but vital component of residency training. We created resident academies (scholarly homes) that aimed to develop academic skills, enhance mentorship, and create a sense of community based on scholarly interest.

Purpose: Critical thinking is central to the function of health care professionals. However, this topic is not explicitly taught or assessed within current programs, yet the need is greater than ever, in an era of information explosion, spiraling health care costs, and increased understanding about metacognition. To address the importance of teaching critical thinking in health professions education, the Shapiro Institute for Education and Research and the Josiah Macy Jr. Foundation jointly sponsored the Millennium Conference 2011 on Critical Thinking. Summary: Teams of physician and nurse educators were selected through an application process. Attendees proposed strategies for integrating principles of critical thinking more explicitly into health professions curricula. Working in interprofessional, multi-institutional groups, participants tackled questions about teaching, assessment, and faculty development. Deliberations were summarized into consensus statements. Conclusions: Educational leaders partic...

The authors share twelve practical tips on writing a case that engages learners in active learning and discussion. They first advise that, during the initial preparation of the case, authors should (1) identify the case goals and objectives, and (2) identify the level of the learners. When writing the case, authors should (3) use active and colorful language; (4) use patients' own descriptions rather than medical language; (5) allow the learners to interpret data themselves; (6) allow for natural discovery rather than presenting information chronologically; and (7) be realistic about interruptions in patient care. In addition, case authors should pay attention to methods that enhance discussion by (8) creating barriers to diagnostic or treatment options; (9) promoting questions and discussion over answers; (10) using cues to assure discussion flow and knowledge exploration; and (11) omitting details or inserting informational distractors. Finally, well-crafted questions are essential during the case presentation to engage learners in higher-order thinking; and to (12) stimulate curiosity and reflection.

Frame-of-reference (FOR) training has been used successfully to teach faculty how to produce accurate and reliable workplace-based ratings when assessing a performance. We engaged 21 Harvard Medical School faculty members in our pilot and implementation studies to determine the effectiveness of using FOR training to assess health professionals' teaching performances.All faculty were novices at rating their peers' teaching effectiveness. Before FOR training, we asked participants to evaluate a recorded lecture using a criterion-based peer assessment of medical lecturing instrument. At the start of training, we discussed the instrument and emphasized its precise behavioral standards. During training, participants practiced rating lectures and received immediate feedback on how well they categorized and scored performances as compared with expert-derived scores of the same lectures. At the conclusion of the training, we asked participants to rate a post-training recorded lecture to determine agreement with the experts' scores.Participants and experts had greater rating agreement for the post-training lecture compared with the pretraining lecture. Through this investigation, we determined that FOR training is a feasible method to teach faculty how to accurately and reliably assess medical lectures.Medical school instructors and continuing education presenters should have the opportunity to be observed and receive feedback from trained peer observers. Our results show that it is possible to use FOR rater training to teach peer observers how to accurately rate medical lectures. The process is time efficient and offers the prospect for assessment and feedback beyond traditional learner evaluation of instruction.

Issue: Healthcare costs have spiraled out of control, yet students and residents may lack the knowledge and skills to provide high value care, which emphasizes the best possible care while reducing unnecessary costs. Evidence: Mainly national campaigns are aimed at physicians to reconsider their test ordering behaviors, identify overused diagnostics, and disseminate innovative practices. These efforts will fall short if principles of high value care are not incorporated across the spectrum of training for the next generation of physicians. Implications: Consensus findings of an invitational conference of 7 medical school teams consisting of academic leaders included strategies for institutions to meaningfully incorporate high value care into their medical school, residency, and faculty development curricula.

While current emphases on operative teaching focus on "virtual" education, residents and faculty engage most intimately in the operating room. The utilization of intraoperative teaching techniques, drawn from adult education principles, is understudied.A survey with both quantitative and qualitative elements was administered to surgical residents and their faculty. Thirty-eight analogous questions regarding teaching techniques, populating four general domains, were rated for frequency of application. Respondents were asked to rank best teaching practices and identify other effective educational approaches using open-ended questions.University-based general surgical residency (5 institutions).General surgical residents and their faculty.46 residents (77%) and 37 faculty (63%; mean 17 yrs experience) completed the survey. There was significant disagreement between residents and faculty in how frequently 32 of the 38 teaching techniques were applied (all p0.032). Faculty rated the technique "I set and communicate high standards" as the most frequently applied strategy, while residents rated "The faculty demonstrate technical consistency" the highest. The least employed approach, acknowledged by both groups, was "The faculty ask how they might improve their teaching." There were few differences between perceptions and preferences of junior vs. senior learners, and junior vs. senior faculty. Resident and faculty appreciation of most-effective teaching approaches was similar. Qualitative analysis of the open-ended questions yielded themes which resonate with both learners and teachers: communication processes, time pressures, optimization of the work/teaching environment, teacher engagement, patience/tolerance, autonomy, feedback, learner preparedness, and patient advocacy.The perceptions of residents and faculty regarding the frequency of using effective approaches for operative teaching are disparate. While faculty appear to value adult learning principles and perceive that they are employed regularly, residents have a discrepant viewpoint. However, themes that were identified by both residents and faculty through qualitative analysis provide the foundation for educational process improvements.

This review presents a systematic approach to curriculum development, divided into five steps: 1) perform a needs assessment, 2) define the goals and learning objectives, 3) identify resources, 4) develop educational strategies and implement the curriculum, and 5) evaluate and modify the curriculum. Although the curriculum developmental stages are presented in five ordered steps, curriculum development is actually a dynamic, interactive process, in which development of one step naturally affects other steps. Learners are central to this process, and with each step, the instructor needs to be mindful of the learners' needs and prior experiences, using a variety of educational strategies to reach trainees with different learning styles.

Research in medical education is stymied by a variety of methodological, logistical, and institutional challenges. Multicenter collaboration may advance the current state of medical education research by increasing subject sample size, harnessing the power of collective expertise, and garnering visibility for issues of national importance.We convened the "Millennium Conference 2007: A Collaborative Approach to Educational Research" in May 2007 to consider the role of national initiatives in addressing challenges in educational research. We selected 9 medical schools through a competitive application process to participate as school teams. We led participants through structured discussions about the challenges of educational research and the opportunities offered through national collaboratives. School teams also met to refine their current local educational research initiatives.A group of committed stakeholders met to consider a national educational research agenda. The recommendations from this conference proceed from consensus reached by the participants.

Faculty development is essential to fostering excellence in medical education and desired learning outcomes. Little is known, however, about the personal and professional impact of faculty development programs on participants, learners, and institutions. We explored the perspectives of medical education fellowship graduates on their skills, self-perceptions, participation in learning communities, and reflective practice. We also explored the results of the implementation of a scholarly medical education project.The study was a qualitative analysis of semistructured interviews with 40 faculty from multiple disciplines who, between 1999 and 2005, had completed a yearlong fellowship in medical education.Through qualitative analysis, we identified 11 themes. Study participants described postfellowship changes in knowledge, self-perceptions, and behaviors and institutional changes that resulted from education projects. With a foundation of principles and skills, the Fellows' confidence and identity as educators were strengthened by their sense of self-efficacy, others' perceptions of their credibility, and support from a community of peers and mentors. This change affected the graduates' professional career trajectories.Common themes in this and other studies suggest that enhancement of knowledge about medical education and teaching skills, protected time, a supportive learning environment, relationships with peers and mentors, validation of educational expertise by others, community building and networking, and emphasis on self-reflection and awareness are essential elements of faculty fellowships in medical education. This analysis suggests that these elements foster the evolution of identity, confidence, and self-efficacy among fellowship graduates. This personal development promotes the professional development of the medical educator.

Peer assessment of teaching can improve the quality of instruction and contribute to summative evaluation of teaching effectiveness integral to high-stakes decision making. There is, however, a paucity of validated, criterion-based peer assessment instruments. The authors describe development and pilot testing of one such instrument and share lessons learned. The report provides a description of how a task force of the Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center used the Delphi method to engage academic faculty leaders to develop a new instrument for peer assessment of medical lecturing. The authors describe how they used consensus building to determine the criteria, scoring rubric, and behavioral anchors for the rating scale. To pilot test the instrument, participants assessed a series of medical school lectures. Statistical analysis revealed high internal consistency of the instrument's scores (alpha = 0.87, 95% bootstrap confidence interval [BCI] = 0.80 to 0.91), yet low interrater agreement across all criteria and the global measure (intraclass correlation coefficient = 0.27, 95% BCI = -0.08 to 0.44).The authors describe the importance of faculty involvement in determining a cohesive set of criteria to assess lectures. They discuss how providing evidence that a peer assessment instrument is credible and reliable increases the faculty's trust in feedback. The authors point to the need for proper peer rater training to obtain high interrater agreement measures, and posit that once such measures are obtained, reliable and accurate peer assessment of teaching could be used to inform the academic promotion process.

The authors present 10 strategies, plus challenges and opportunities, that have informed three well-established, yearlong medical education fellowships (defined as single cohorts of medical teaching faculty who participate in extended faculty development activities) during the period 1998 to 2008. These strategies include (1) defining an operating philosophy, values, and goals, (2) establishing a curriculum that reflects the roles and responsibilities of fellows and faculty, (3) employing a basic approach to adult learning, (4) striving to achieve a balance between stated objectives and openness of discussion, (5) creating optimum learning opportunities for the fellows to acquire and practice skills delineated in the curriculum, (6) fostering interdisciplinary communication, team development, and the creation of a learning community, (7) developing mindfulness and critical self-reflection, (8) systematically reviewing each session, (9) evaluating fellowship outcomes, and (10) planning for the future. This in-depth look presents both curricular content and process, providing a useful starting point from which those who develop and conduct educational faculty development activities at medical schools and academic medical centers may fashion and implement a local curriculum.

Musculoskeletal problems including both rheumatologic and orthopaedic pathologies are the primary reason for physician office visits across the United States, with approximately 92.1 million encounters reported annually, according to the 2004 National Ambulatory Medical Care Survey1. Despite the impact that musculoskeletal diseases have on society and the wide range of medical practitioners who treat these conditions, there is compelling evidence that undergraduate medical curricula do not adequately prepare physicians in musculoskeletal medicine2-5. In 2005, the Association of American Medical Colleges (AAMC) issued a Medical School Objectives Project Report on musculoskeletal medicine highlighting the need for medical schools to improve the education of future physicians in this area6. The report outlined educational guidelines to establish a more coherent undergraduate musculoskeletal curriculum. We conducted a study at our medical school during the 2005-2006 academic year that substantiated the need for improving the musculoskeletal curriculum. Students lacked cognitive mastery, demonstrated low clinical confidence, and were dissatisfied with the amount of time spent learning musculoskeletal medicine. Findings of the study suggested the need to improve the integration of musculoskeletal medicine into the curriculum3. Data from the 2005 Step-1 United States Medical Licensing Examination at our institution also revealed that performance on the musculoskeletal section was the lowest of all the subsections. Thus, both national as well as institutional concerns prompted us to lobby for, develop, and begin implementation of a four-year integrated musculoskeletal curriculum. We focused our initial reform endeavors on the preclinical (first and second-year) curriculum. The process of curriculum reform and development differs among various medical schools. As such, the purpose of this study was to provide a framework that may assist educators in achieving the adoption of an integrated musculoskeletal curriculum into the preclinical curriculum at their own school. We offer …

Although faculty development programs in medical education have increased over the past two decades, there is a lack of rigorous program evaluation. The aim of this study was to determine quantifiable outcomes of Harvard Medical School's (HMS's) Fellowship in Medical Education and evaluate attainment of its goals.In 2005 and 2009 the authors collected curricula vitae (CVs) and conducted within-subject analysis of 42 fellowship graduates and also conducted comparison analysis between 12 academic year 2005 fellows and 12 faculty who did not participate in the program. The authors identified 10 metrics of academic advancement. CV analysis for the 42 graduates started 2 years prior to fellowship enrollment and continued for 2-year intervals until June 2009 (10 years of data collection). CV analysis for the comparison group was from 2003 to 2009. The authors also analyzed association between gender and academic outcomes.Fellowship graduates demonstrated significant changes in 4 of 10 academic metrics by the end of the fellowship year: academic promotion, educational leadership, education committees, and education funding. Two metrics-educational leadership and committees-showed increased outcomes two years post fellowship, with a positive trend for promotions. Fellowship graduates significantly outpaced the comparison group in 6 of 10 metrics. Women did significantly more committee work, secured more education funding, and were promoted more often than men.Findings indicate that the HMS Fellowship in Medical Education meets programmatic goals and produces positive, measurable academic outcomes. Standardized evaluation metrics of longitudinal faculty development programs would aid cross-institutional comparisons.

Introduction The medical education literature shows that residents spend at least 25% of their time teaching, enjoy teaching, consider it important, and agree that teaching improves their clinical knowledge and clinical skills. However, in today's busy training environments, there is limited time to formally train residents as teachers. Methods We developed a multidisciplinary, resident-as-teacher curriculum that includes a DVD series and accompanying self-study and facilitator guides to help program directors, medical educators, and residents take the first step in implementing cross-departmental teacher training. The entire curriculum was presented to all Beth Israel Deaconess Medical Center (BIDMC) residency program directors and at the Harvard Medical School's Resident-as-Teacher Curriculum Showcase. To date, the departments of medicine, obstetrics and gynecology, surgery, emergency medicine, dermatology, anesthesiology, neurology, and radiology have used the facilitator's guide to lead small-group resident-as-teacher sessions or have engaged their residents in self-study using the guide and videos. The DVD series may be used as part of a resident self-study program, as the basis of a facilitator-led teaching series for house staff, or as preparatory material for “flipped” classroom-type sessions. Results Eleven senior residents, from across departments, and three junior faculty members piloted and assessed the quality of the series. All found the series to be “Quite” or “Extremely Useful” in terms of introducing the skills of clinical teaching and all found the overall quality of the series to be “Excellent.” We also conducted an assessment of the effectiveness of presenting the series in AY2014 and 2015 as part of a “Fourth-Year Boot Camp” to senior Harvard Medical students (n = 22) who were about to start surgical or obstetrics and gynecology residencies. Pre− and post-evaluation of the large-group sessions using the DVD modules, PowerPoint, pocket guide, and facilitator's guide showed that the students perceived significant improvements in several areas in terms of their teaching comfort and confidence. Discussion We are currently conducting a multidisciplinary, clinical teaching observation study to determine the extent to which the series and accompanying guide have an impact on the residents' clinical teaching skills, regardless of department. Preliminary data from this study indicate that during the post-intervention observation, residents are more likely to ask students about their learning goals, encourage more student questions, inquire about the student's perspective on a case, encourage self-directed learning, and provide specific learner feedback.

There is a growing appreciation of the need for educational faculty development within medical education. The authors describe the establishment and subsequent expansion of one such fellowship in medical education that arose from the cooperative efforts of Harvard Medical School, Beth Israel Deaconess Medical Center, and Mount Auburn Hospital. Three resultant fellowships are outlined that share the common goals of enhancing the skills of the faculty as educators, providing an opportunity to conduct scholarly educational research, supporting the fellows as change agents, and fostering the creation of a supportive community dedicated to enhancing the field of medical education. Curricular structure and content are outlined as well as current approaches to curricular and programmatic evaluation. The fellowships have been well received and are widely perceived as transformative for the faculty, many of whom have assumed increased roles of organizational and educational leadership. Lastly, future directions for these fellowships are presented.

Musculoskeletal complaints are a common reason for primary care visits; however, many essential physical examination, diagnostic and treatment skills are not adequately taught. The objectives of the study were to create and implement a comprehensive clinical skills teaching model, and to evaluate its effects on residents' knowledge and diagnostic skills. A comparison of cohorts who participated and did not participate in a musculoskeletal curriculum was undertaken. Second and third year medical residents participated in comprehensive curricula to teach and evaluate musculoskeletal skills. Sixty-seven attended the first of three lectures on the painful shoulder; 61 attended all three lectures and completed pre- and post-self assessment forms and tests. Three months later 26 of these residents and 10 controls participated in an OSCE examination. Thirty-nine medical residents attended the first of three lectures on the painful knee; 32 attended all three lectures and completed pre- and post-self assessment forms and tests. Seven of these residents and eight controls participated in an OSCE examination three months later. Both the shoulder and knee curricula were associated with a significant improvement in test scores (p < 0.0001), in self-assessment of physical examination, diagnostic and procedural skills (p < 0.0001), and in OSCE results (p < 0.005). It was concluded that the skills required for the diagnosis and treatment of common musculoskeletal complaints can be effectively taught and assessed using inexpensive and simple methods.

Introduction As medical schools increasingly move toward student-centered, interactive learning approaches that promote active student engagement and critical thinking skills, there is a clear trend to employ teaching methods that emphasize collaborative, case-based instruction. Small-group teaching offer students the opportunity to build upon their existing knowledge by becoming active participants in the examination of a clinical topic or patient case. To be skilled at small group facilitation involves planning and design, managing learning during the discussion, and feedback and reflection after each session. Faculty training is essential for developing the skills necessary to be an effective small-group facilitator. Methods The teaching case and accompanying facilitator's guide included in this module provide a comprehensive set of skills and resources that can be readily used by those charged with leading a faculty development session about small-group facilitation. Participants of such a faculty development session work through the problem-based teaching case, and, by addressing common small-group discussion dilemmas, learn the skills needed to facilitate an effective discussion. The resources are intended to be used during a stand-alone, live, interactive training session. The case is structured using a problem-based learning format so that participants can experience small-group teaching in the role of the learner. The intended audience for the faculty development session is junior faculty or novice facilitators as well as senior faculty or facilitators, who will more than likely value the opportunity to share their own experiences in leading small-group discussions. Results This small-group teaching session and case has been presented 13 times at Boston Children's Hospital, as part of faculty development efforts at Harvard Medical School, at a national subspecialty conference, and at the national Harvard Medical School CME Course “Principles of Medical Education.” Group size has ranged from four to 40 and participants have included residents, fellows, physicians, and health care professionals from a wide variety of specialties. Discussion Through the experience of presenting this session on multiple occasions, we have learned that it is best to start by asking the audience members to assume the role of participant-observers; in other words, to participate in the exercise, but at the same time take a mental step back and observe the teaching strategies the facilitator models during the session. It is also helpful to mention that the facilitator will be modeling, and then stopping to point out, certain teaching behaviors, strategies, and nonverbal gestures/cues throughout the session.

Few medical school electives include longitudinal patient care across clinical specialties and environments. Systemic lupus erythematosus represents a disease process with complex pathophysiology for students to learn from providers across medical fields, including dermatology, rheumatology, nephrology, and cardiology, in both pediatric and adult patients. Diagnosis, understanding, and management of lupus also rely heavily on basic science and clinical immunology, providing a link to the preclinical curriculum. In 2009, Harvard Medical School introduced a one-month elective course "Understanding Lupus: A Multidisciplinary Approach to Systemic Disease," designed to provide students with both outpatient and inpatient care experiences in dermatology, rheumatology, and multidisciplinary clinics at Brigham and Women's Hospital and Boston Children's Hospital. Core components of the elective include a continuity experience that allows students to attend one patient's multiple specialist visits; didactics from dermatology, rheumatology, and immunology covering evidence-based medicine and basic sciences; and clinical immunology laboratory exposure to teach serologic and auto-antibody testing methods. The authors provide lessons learned in the development of this interdisciplinary, multi-institution elective rotation, which may serve as a model at other medical schools for incorporating basic sciences into the clinical curriculum and using multidisciplinary care and varied educational settings.

Objective Although cataract surgery is one of the most commonly performed surgeries in the country, it is a microsurgical procedure that is difficult to learn and to teach. This study aims to assess the effectiveness of a new method for introducing postgraduate year (PGY)-3 ophthalmology residents to cataract surgery. Setting Hospital-based ophthalmology residency program. Design Retrospective cohort study. Participants PGY-3 and PGY-4 residents of the Harvard Medical School Ophthalmology Residency from graduating years 2010 to 2012. Results In July 2009, a new method of teaching PGY-3 ophthalmology residents cataract surgery was introduced, which was termed "the stepwise introduction to cataract surgery." This curriculum aimed to train residents to perform steps of cataract surgery by deliberately practicing each of the steps of surgery under a structured curriculum with faculty feedback. Assessment methods included surveys administered to the PGY-4 residents who graduated before the implementation of these measures ( n = 7), the residents who participated in the first and second years of the new curriculum ( n = 16), faculty who teach PGY-4 residents cataract surgery ( n = 8), and review of resident Accreditation Council for Graduate Medical Education surgical logs. Resident survey response rate was 100%. Residents who participated in the new curriculum performed more of each step of cataract surgery in the operating room, spent more time practicing each step of cataract surgery on a cataract surgery simulator during the PGY-3 year, and performed more primary cataract surgeries during the PGY-3 year than those who did not. Faculty survey response rate was 63%. Faculty noted an increase in resident preparedness following implementation of the new curriculum. There was no statistical difference between the precurriculum and postcurriculum groups in the percentage turnover of cataracts for the first 2 cataract surgery rotations of the PGY-4 year of training. Conclusions The introduction of cataract surgery to PGY-3 residents in an organized, stepwise manner improved resident preparedness for the PGY-4 year of residency. This surgical teaching method can be easily applied to other surgical specialties.

This resource is a handbook designed to help individuals prepare for and conduct an effective teaching observation and feedback session. The handbook presents 10 steps that observers can follow to ensure they identify critical instructional moments during the teaching encounter and then engage in a mutual exchange of ideas with their colleagues at the conclusion of the session. It also suggests ways to avoid common peer observation pitfalls and describes the benefits of partaking in an observation pairing or buddy system. A number of references and sample peer observation of teaching forms are included at the end of the handbook. Creation of this resource originated from the need to translate the theory of peer observation into actual practice. While there have been recent calls from the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education for regularly scheduled feedback to medical education program faculty members about their clinical teaching abilities, there is little guidance on how that feedback should be collected and delivered. To provide individualized instructional development and feedback to the faculty members at our institution, we created the Peer Observation of Teaching Handbook for faculty members to follow in order to conduct effective teaching observations that would inform meaningful feedback to their peers. After each peer teaching observation, we send a brief feedback form to both the observer and the faculty member to collect comments and suggestions about the peer observation of teaching experience. Quantitative and qualitative feedback collected from the forms has been positive.

The current, so-called "Millennial" generation of learners is frequently characterized as having deep understanding of, and appreciation for, technology and social connectedness. This generation of learners has also been molded by a unique set of cultural influences that are essential for medical educators to consider in all aspects of their teaching, including curriculum design, student assessment, and interactions between faculty and learners. The following tips outline an approach to facilitating learning of our current generation of medical trainees. The method is based on the available literature and the authors' experiences with Millennial Learners in medical training. The 12 tips provide detailed approaches and specific strategies for understanding and engaging Millennial Learners and enhancing their learning. With an increased understanding of the characteristics of the current generation of medical trainees, faculty will be better able to facilitate learning and optimize interactions with Millennial Learners.

For peer review of teaching to be credible and reliable, peer raters must be trained to identify and measure teaching behaviors accurately. Peer rater training, therefore, must be based on expert-derived rating standards of teaching performance. The authors sought to establish precise lecture rating standards for use in peer rater training at their school.From 2008 to 2010, a panel of experts, who had previously helped to develop an instrument for the peer assessment of lecturing, met to observe, discuss, and rate 40 lectures, using a consensus-building model to determine key behaviors and levels of proficiency for each of the instrument's 11 criteria. During this process, the panelists supplemented the original instrument with precise behavioral descriptors of lecturing. The reliability of the derived rating standards was assessed by having the panelists score six sample lectures independently.Intraclass correlation coefficients of the panelists' ratings of the lectures ranged from 0.75 to 0.96. There was moderate to high positive association between 10 of the 11 instrument's criteria and the overall performance score (r = 0.752-0.886). There were no statistically significant differences among raters in terms of leniency or stringency of scores.Two relational themes, content and style, were identified within the instrument's variables. Recommendations for developing expert-derived ratings standards include using an interdisciplinary group for observation, discussion, and verbal identification of behaviors; asking members to consider views that contrast with their own; and noting key teaching behaviors for use in future peer rater training.