IAMSE Fall 2019 WAS Session 5 Highlights

[The following notes were generated by Andrea Belovich, PhD.]

IAMSE Webinar Series, Fall 2019

Speaker: Valerie O’Laughlin and Teri Turner
Title: “Beyond See one, Do one, Teach one – Developing Trainees as Medical Educators”
Series: Re-imagining Faculty Development in Health Professions Education

The final installment of the IAMSE Fall 2019 Web Seminar series, “Re-imagining Faculty Development in Health Profession Education,” was presented on October 3rd by Valerie O’Loughlin PhD and Teri Turner MD, MPH, M.Ed. Dr. O’Loughlin is a Professor of Anatomy and Cell Biology and Assistant Director of Undergraduate Medical Education in the Medical Science program at Indiana University School of Medicine, and Dr. Turner is an Associate Professor, Associate Program Director of House Staff Education, and Vice-Chair of Education of the Pediatrics Department at Baylor College of Medicine. In this webinar, “Beyond See one, Do one, Teach one – Developing Trainees as Medical Educators,” Dr.’s O’Loughlin and Turner discussed the necessity, challenges, and strategies associated with training both graduate (PhD) students and residents to become future medical educators.

Dr. O’Loughlin began the seminar by discussing the need to train PhD graduate students as medical educators. As modern PhD programs continue to shift their focus towards molecular and cellular biology research, graduate expertise shifts away from the whole-organism knowledge needed to effectively teach a medical curriculum. This trend, combined with the retirement of existing faculty, is contributing to shortages of qualified educators in many disciplines, including Anatomy, Physiology, and Pharmacology. In addition, the retirement of experienced faculty and the growing number of medical programs being established underscores the need for future faculty who are well-versed in education methodologies, effective pedagogy, and assessment of curricular change. Since medical education is time-intensive and research faculty time is limited, the development of PhD-level training programs specific to Medical Education arises as a solution.

Elements of medical education training that can be incorporated into new or existing PhD programs include providing opportunities for developing teaching experience and discussions about pedagogy, learning theories, curricular development, and education frameworks. Consortia such as the Center for Integration of Research, Teaching and Learning (CIRTL) can provide resources and support for Medical Education training. The CIRTL consortium is comprised of numerous R1 institutions and provides tools such as online resources and classes, national meetings, and learning communities to promote graduate-through-faculty preparation for STEM teaching programs and the assessment of teaching as research.

As an example of a formal medical educator PhD programs, Dr. O’Loughlin presented the Education Track in Anatomy PhD at Indiana University School of Medicine¹. Established in 2008, this program accepts 1-4 students per year and trains students in all of the anatomical disciplines essential to teaching undergraduate, graduate, and professional students. Coursework includes biomedical sciences, education and statistics, along with supervised teaching experiences in the anatomies (funded through graduate teaching assistantships). The research component and doctoral thesis is focused on a medical education or anatomy education topic and provides students with the skills to produce scholarship necessary for tenure and promotion. Graduates of the Education Track in Anatomy PhD program are in high demand, with many receiving job offers prior to graduation.

While Medical Educator PhD programs have demonstrated value, there are challenges to developing and implementing them. Perceptions of educational research as “non-science,” bureaucratic hurdles, availability of qualified advisors/mentors, and availability of funding to support graduate student training can be sources of resistance. However, using examples of successes of other programs and highlighting the rewards of such programs can help promote acceptance of Medical Education PhD programs, especially considering the desirability of graduates from these programs and their ability to serve in place of adjunct faculty during training. Emphasizing the research component of these programs can also demonstrate their value to institutions—PhD thesis projects can be used to evaluate institutional curricular reform and help advance the field of medical education.

After Dr. O’Loughlin addressed PhD Medical Education training programs, Dr. Turner discussed strategies and innovations in the training of residents as clinical faculty. These strategies leverage role-modeling and observational learning as effective teaching modalities in the clinic, as well as more formal teaching methods. Residents especially play a particularly important role in teaching medical students and need professional development both in being effective role models and in being effective educators.

Contrary to the notion that the teacher identity forms after the physician identity, a survey conducted by Dr. Turner and her colleagues suggested that the teacher identity forms earlier than previously thought (unpublished data). This supports the implementation of teaching experiences, rotations, and fellowships relatively early in training—even as early as the third year of medical school. Further examination of residents’ attitudes and motivations to teach also informs which approaches should be taken to provide training as medical educators. As a majority of residents are either intrinsically motivated to teach or wish to teach but view clinical duties as an external barrier to teaching, the focus of teaching programs should be on removing as many barriers as possible and providing professional development opportunities in teaching skills.

Best practices in developing medical education training programs for residents include the development of a year-long spiral curriculum rather than using a one-time workshop. Use of a logic model also helps to maintain the program’s focus by tracking objectives and competencies of the program, and provision of flipped classroom and practice applying learned principles is encouraged. Dr. Turner provided an extensive list of resources to aid in the development of a curriculum for training residents as teachers. Training programs can also offer electives, rotations, tracks, or degrees in medical education. As an example, Dr. Turner’s program offers a fellowship in Medical Education with the option to obtain an M.Ed. or equivalent.

Dr. Turner also provided a survey of innovative ideas for resident medical education training. Innovative motivation strategies include implementation of coached medical student teaching competitions, TED talk master classes, criterion-based and peer-reviewed membership in an Academy of Distinguished Resident Educators, and academic designation as “Clinical Instructors.” Mentored teaching approaches for junior learners such as “Teaching Up” and “Teaching Across” promotes confidence by teaching core knowledge “up” to more experienced learners and encouraging residents to teach “across” to other disciplines, medical professions, and community faculty. Role modeling and “near-peer” teaching has been observed to be effective in teaching, especially in terms of professionalism and quality improvement, as senior peers are viewed as approachable by their juniors, better able to understand their juniors’ perceptions, and can offer focused guidance.

Dr. Turner concluded the seminar with an emphasis on the importance of providing feedback as an integral part of learning and teaching. Techniques such as the objective structured teaching encounter (OSTE), observation checklists, audiotape or videotape teaching, and peer coaching are all helpful methods for evaluating teaching skills and providing feedback. Dr. Turner concluded with a list of evaluation tools and references, including several sources through the MedEdPORTAL and IAMSE designed for many different levels of learners.

References:

1. Brokaw JJ, O’Loughlin VD. 2015. “Implementation of an education-focused PhD program in anatomy and cell biology at Indiana University: Lessons learned and future challenges.” Anat Sci Educ. 8:258-265.