[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.

[The following notes were generated by Will Brooks, PhD.]

IAMSE Webinar Series, Fall 2019

Speaker: David Rogers MD, MHPE, FACS, FAAP and Melissa Klein MD, MEd
Title: Innovative Faculty Development Programs: Two Case Studies
Series: Re-imagining Faculty Development in Health Professions Education

The IAMSE 2019 Fall Webinar Series, Re-imagining Faculty Development in Health Professions Education, continued on September 26, 2019 with a presentation by Dr. David Rogers, Senior Associate Dean for Faculty Affairs and Professional Development at the University of Alabama at Birmingham, and Dr. Melissa Klein, Professor of Pediatrics at the University of Cincinnati College of Medicine. Their webinar entitled “Innovative Faculty Development Programs: Two Case Studies” provided listeners with a close look at two longitudinal faculty development programs directed by the presenters.

Dr. Rogers led the webinar off with a description of the University of Alabama at Birmingham Healthcare Leadership Academy (HLA), which is co-sponsored by the UAB School of Medicine and Collat School of Business. The HLA was developed to provide leadership training to both faculty and staff who had the potential to take on leadership roles within the institution – emergent leaders. The program is funded through a philanthropic gift, which has prevented participants from needing to fund their own participation. The HLA operates with four educational goals:

• Teach participants about the history and operations of the health system and academic health centers.
• Enhance and develop the leadership abilities of the participants.
• Facilitate the development of strategic thinking skills, focusing on opportunities and challenges facing academic health centers.
• Activate participants’ evaluation of their own individual aspirations, strengths, weaknesses, and commitment to leadership.

Participants are selected by an advisory group from among nominations across multiple units within the academic medical center including the Schools of Medicine, Dentistry, Health Professions, Nursing, Optometry, and Public Health. Each cohort of participants represents a diverse group of faculty and staff including emergent and established leaders. Dr. Rogers noted that the diversity of each group is an enriching element of the program. To date, 260 individuals have taken part in the HLA in its first decade (2009-2019).

The HLA is a seven-month program that includes an opening weekend retreat held off-campus, monthly day-long sessions, individual readings, and small group projects. The opening weekend includes participation in physical challenges as part of a high-ropes course, which allows participants to step away from their professional identity and build trust and teamwork. Monthly meetings include a range of topics including leadership and strategic planning, communication, negotiation, building a vision, and academic medical center finance and operations. Time is also allocated at each monthly meeting for small group work and networking. Each small group conducts a project throughout the program that culminates in a group presentation and submitted white paper. Rather than scholarship, most projects address a practical problem faced by the medical center or one of its units. Individual readings are taken from the assigned book, The Leadership Challenge by James Kouzes and Barry Posner as well as journal articles.

Dr. Klein continued the webinar with a description of the Academic Pediatric Association’s Educational Scholar’s Program (ESP). The ESP was developed to provide training to academic pediatricians in the area of educational scholarship, which Dr. Klein defined as the dissemination of curricular innovations, evaluation tools, and teaching methodologies. Because the ESP is housed within a national professional association, mentorship, collaboration, and networking between individuals at different institutions have become an important element of the program.

The Educational Scholars Program was initiated in 2006. Scholars enrolled in the 3-year program complete a longitudinal curriculum and mentored educational research projects. Four key components comprise the ESP: educational scholarship skills, mentorship, an educator portfolio, and networking. The first year of the curriculum focuses on educational scholarship and includes a day-long session at the Academic Pediatric Association’s annual meeting, asynchronous online coursework, and monthly calls with peer groups. During this year scholars will identify their scholarly project. In year 2, the focus shifts to the nuts and bolts of educational research. Instruction in both quantitative and qualitative methodology occurs at the annual meeting and through online coursework. Year three focuses on scholarly dissemination, leadership, and networking; it includes a third full-day session at the annual meeting and additional online coursework.

After 10 years (2006-2016), participants from 80 institutions had taken part in the first 8 cohorts of the ESP. Most of the 170 scholars were women and were at junior faculty ranks. The scholarship output from program participants has included research publications, publications in MedEdPORTAL, national presentations, and educational grants. 98% of graduates have reported at least 1 publication, funded grant, or educational leadership position.

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

IAMSE Webinar Series, Fall 2019

Speaker: Bonny Dickinson, PhD and Maria Sheakley, PhD
Title: Congratulations! You’ve been promoted! Introducing the IAMSE Educator Toolkit
Series: Re-imagining Faculty Development in Health Professions Education

The third installment of the Fall 2019 IAMSE Web Seminar Series, “Re-imagining Faculty Development in Health Professions Education,” was presented on September 19, 2019 by Dr. Bonny Dickinson, Associate Dean for Faculty Affairs and Professor of the Department of Biomedical Sciences at Mercer University School of Medicine and Dr. Maria Sheakley, Professor of Physiology and Vice Chair of the Department of Biomedical Sciences at the Western Michigan University Homer Stryker M.D. School of Medicine. In this webinar, “Congratulations! You’ve been promoted! Introducing the IAMSE Educator Toolkit,” Dr.’s Dickinson and Sheakley provided an overview of IAMSE resources available to medical educators who are looking to create and strengthen their educational portfolios for promotion and tenure applications.

The first portion of the presentation was given by Dr. Dickinson, who provided the background for the creation of the IAMSE Educator Toolkit. The Toolkit was developed by the Committee for the Advancement of Medical Science Educators (CAMSE), a subcommittee of the IAMSE Professional Development Committee. Instituted in 2015, CAMSE is charged with supporting the efforts of educators, facilitating communication about critical issues affecting medical education and educators, and examining the current state of institutional operationalization of guidelines for the recognition, reward, and promotion of educators. The work of CAMSE in developing the IAMSE Educator Toolkit, was, in part, a response to the widespread lack of knowledge surrounding the resources available to guide medical educator promotion and career development.

According to a 2017 IAMSE Member Survey (published in Medical Science Educator in 2018), faculty awareness of publications and guidelines meant to assist in promotion was modest and institutional adoption of such published guidelines for promotion was poor. In addition, the survey revealed that a majority of faculty are not aware of their own institution’s guidelines for promotion and tenure. These findings were identified as challenges to faculty promotion and tenure, in addition to several other major challenges identified in 2007, which faculty seeking promotion are still faced with today. These include lack of protected time for scholarship, lack of recognition for alternate forms of scholarship, differing perceptions of the relative value of educational contributions compared to others, lack of mentorship, lack of assistance in writing publications, and lack of understanding of how to publish or present educational work.

Dr. Dickinson concluded her portion of the webinar by summarizing the documentation that the IAMSE Educator Toolkit can provide to help faculty seeking promotion and tenure overcome the many challenges to advancement. he Toolkit helps educators develop portfolios beyond the curriculum vitae and the educational/teaching philosophy statement by framing (and documenting) their contributions in the five domains of educator activities: 1) Teaching, 2) Learner Assessment, 3) Advising and Mentoring, 4) Curriculum Development, and 5) Educational Leadership and Administration. Although not the focus of this webinar, Dr. Dickinson also mentioned that CAMSE has developed a companion toolkit, the Evaluator Toolkit, to provide guidance to those evaluating applications for promotion and tenure.

Dr. Maria Sheakley continued the webinar with a brief history of educational scholarship and the development of the Q2E model that gave rise to the IAMSE Educator Toolkit. In 1990, Boyer’s “Scholarship Reconsidered,” identified education as a true modality for promotion was advocated, efforts to promote the role of education as a true modality for promotion and scholarship became more widespread. In 2006, the AAMC GEA Consensus Conference on Educational Scholarship identified the five domains of educator activity (mentioned previously), which can be used to promote scholarship and excellence. Furthermore, to aid in illustrating the quality of these educational activities and relating them to scholarship, the Q2E (Quantity, Quality, and Engagement) model was designed to assess excellence and engagement for producing documentation for promotion. According to the Q2E model, “Excellence” can be assessed through both the quantity and the quality of the educational activities, and “Engagement” can be assessed through evidence of a Scholarly approach to activities (e.g., the work is informed by knowledge in the field) and through scholarship (e.g., contribution to the field’s knowledge through local, regional, national, and/or international dissemination).

CAMSE then used the Q2E model to frame development of the IAMSE Educator Toolkit. The Toolkit was designed to assess Quantity and Quality of educational activities by quantitifying information about the activity (e.g., number of leaners taught, how often, how much time devoted to the activity, etc.). Viewing Quantity/Quality together with Engagement on a continuum, these values are documented through evidence of an informed approach to the educational activity, activity outcomes, reflective critique of that activity, and finally through dissemination of the work (scholarship).

Dr. Sheakley then discussed the role of the IAMSE Educator Toolkit in developing an educator portfolio for promotion. In contrast to the CV, which lists all activities, the purpose of the educator portfolio is to document and showcase achievements that are representative of the educator’s work, highlighting the depth, breadth, impact and accomplishments of the work for presentation to a promotion and tenure committee. To aid educators in highlighting their achievements and developing their portfolios, the CAMSE created worksheets to apply to each of the five domains of educator activities (Teaching, Learner Assessment, Curriculum Development, Mentoring and Advising, and Educational Leadership and Administration).

Dr. Sheakley finished the webinar by encouraging educators to study their institution’s Promotion and Tenure guidelines and determine if a template already exists. The IAMSE Educator Toolkit can be used as a template to create a portfolio narrative if none is available, or it can be used to identify important elements of the CV to highlight. After choosing activities to highlight and determining where they fall along the Q2E-continuum, educators can fill out the toolkit worksheets to create portfolios and narratives that encompass the quality, quantity, excellence, engagement, and scholarship of educator achievements.

The IAMSE Educator Toolkit and its companion, the IAMSE Evaluator Toolkit, will be available as free resources from the IAMSE website.

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

IAMSE Webinar Series, Fall 2019

Speaker: Darin Latimore, MD
Title: Recruiting, Retaining and Developing a Diverse Faculty
Series: Re-imagining Faculty Development in Health Professions Education

The Fall 2019 IAMSE Web Seminar Series entitled “Re-imagining Faculty Development in Health Professions Education,” is focused on providing participants with practical tips for developing their own skills as well as insight into how to become engaged with and possibly improve the faculty development culture within their institutions. The second installment of this series, entitled, “Recruiting and developing a diverse faculty,” was delivered by Dr. Darin Latimore, the Deputy Dean for and inaugural Chief Officer of Diversity and Inclusion at the Yale School of Medicine. Dr. Latimore holds leading roles in developing a comprehensive plan for furthering diversity, equity, and inclusion at the Yale School of Medicine, including a robust recruitment and retention program for faculty and students from historically underrepresented medical communities. During his talk, Dr. Latimore outlined the need for growing the underrepresented minority (URM) component of the physician workforce, explored best practices for robust recruitment of URM faculty in medicine, and summarized effective strategies medical schools have used to retain URM faculty.

Dr. Latimore first emphasized the need for recruiting and retaining URM faculty, which he defined to include Black/African American, Hispanic/Latinx, and Native American/Pacific Islander faculty. When comparing demographic data between United States medical school faculty1 and the general United States population2, there is a much lower percentage of URMs in faculty (especially in the ranks of associate and full professor1) compared to the general population. In particular, the percentages of faculty from URMs Dr. Latimore identified have not increased by even 1% over the last 15 years across all medical schools.

To underscore the value of diversity in medicine, Dr. Latimore discussed several studies across multiple fields (including business and academia) to show that teams rich in diversity produce higher quality of outcomes3,4,5,6,7. In addition, the patient-physician race concordance is highly relevant for medical care, as patients are more likely to visit physicians with a similar race/ethnicity as themselves8 and tend to perceive physician-patient communication as being poorer when there is a racial/ethnic discordance9. Dr. Latimore stated that URM physicians are also more likely to see underinsured or uninsured patients of all ethnicities, emphasizing the role URM physicians play in addressing healthcare inequity in the United States.

To recruit URM faculty, Dr. Latimore suggested developing learners in the campus “pipeline” by intentionally developing an inclusive culture and allowing URM learners (medical students, residents, and fellows) opportunities to envision themselves (and/or remain) as faculty10. He also discussed examples of such efforts being implemented at Yale School of Medicine, including URM mentorship programs, curriculum revisions to focus on health equity, and mitigation of microaggressions, harassment, and discrimination more proactively when reported. Yale also provides several opportunities for URM learners to network and interact with URM faculty, including a lecture series given by MD, PhD, and resident Yale alumni. Anecdotally, Dr. Latimore discussed that post-exit interviews report that these interventions have led to greater engagement with Yale and the community.

Dr. Latimore next discussed strategies to recruit URM faculty through proactive prospecting. Prior to posting job opportunities, utilize existing faculty networks, NIH-funded grant databases, and conference activities to identify potential candidates10. Unconscious bias training, increasing diversity of search committees and charging search committees to identify candidates of diverse backgrounds can help identify qualified URM faculty candidates11. Contacting diversity subcommittees of organizations can also help when deciding where and how to advertise job postings or locate potential URM candidates. Finally, ensuring the candidate search process and the interview experience are equitable across all demographics is essential to successful recruitment11.

Dr. Latimore also discussed Yale University’s holistic approach to faculty recruitment packages. Rather than offering recruitment packages through individual departments, Yale utilizes a centrally located fund that allows for strategic application and flexibility to adjust funding priorities based on need. The Yale University 50 million Faculty Excellence and Diversity Initiative has facilitated 65 recruitments campus-wide over 3 years, and funds up to 50% of faculty salary (or non-salary requirements) for up to 3 years12.

One of the major challenges to recruiting diverse faculty is the lack of “critical mass” of URM faculty at medical schools to attract other potential candidates13. The cohort recruitment method encourages the recruitment of multiple URM faculty simultaneously to rapidly establish a diverse environment. This method of recruitment has been effective for institutions with very few URM faculty.

Shifting towards the retention of URM faculty, Dr. Latimore discussed two major factors as being important: fostering an inclusive culture at the institutional level and having formal programs geared towards URM professional development and networking at the individual level. Using the University of California San Diego School of Medicine as a case study, Dr. Latimore described a Junior faculty development program (National Center for Leadership in Academic Medicine: NCLAM) with an 87% (13/15) retention rate of participating URM faculty hired in 200514,15. For comparison, USCD has a 58% retention rate of all faculty recruited in 2005, including URM and women faculty subgroups15. This comprehensive program (with funding assistance from a center of excellence grant) provides structured mentorship and sponsorships to junior faculty and is especially proactive in including URM and women junior faculty. The program offers counseling, completion of a professional development project, and several sessions with mentors. Mentors agree to partner with their mentees on projects, critique scholarly work, promote mentees at networking events, advocate for leadership roles for mentees at conference sessions, and encourage invitations to submit manuscripts.

An example of a faculty retention program implemented at Yale is the Minority Organization for Retention and Expansion (M.O.R.E.), a self-run faculty organization supported by Dr. Latimore’s office and the Dean16. The organization offers network/community-building events and open lunches based on topics including appointments and promotion groups, increasing URM presence in leadership, internal and external grant opportunities, and resources to handle bias and discriminatory behavior. In addition to hosting an annual professional development retreat, each department is encouraged to have a junior URM faculty mentorship program run by senior URM faculty. Other initiatives at Yale to promote URM faculty development and retention include a pilot junior faculty coaching program, with a (1-5 year) professional development plan as an outcome, participation in AAMC minority professional development programs for junior and mid-career faculty, and coordinated sessions with media experts to help minority faculty increase career exposure and influence at the national level17.

Dr. Latimore also discussed the importance of developing diverse leaders who will not only mentor URM faculty to encourage individual development but also actively seek and advocate career advancement opportunities for their faculty as a sponsor18. For institutions looking to establish these sponsorship initiatives, it is important to consider the compatibility between mentors and mentees to promote faculty satisfaction with mentorship.

Dr. Latimore concluded by emphasizing the importance of working on institutional climates to promote successful inclusion and retention of URM faculty. Understanding and monitoring the institutional culture is challenging, but focus groups, one-on-one meetings, and exit interviews can help identify areas that need improvement. Since even the most excellent URM faculty may not be able to thrive in a culture of bias hostility or exclusion, inclusive environments are needed, and the environment must be developed as much as the individual faculty.

References (as provided by Dr. Latimore):
1. “Medical School Faculty by Sex and Race/Ethnicity” (2019). Association of American Medical Colleges
2. “United States Census” (2018.) United States Census
3. Hong L., Page SE., 2004
4. Rohner V., Dougan B., 2012
5. Dendon N., Chang MJ., 2019
6. Freeman, R., Huang W., “ Collaborating with People Like Me: Ethnic Coauthor ship within the United States.” J. Labor Economics, Vol. 33 (3) 2015.
7. Campbell L.G., et. al., “Gender-Heterogenous Walking Groups Provide Higher Quality Science.” PLUS-ONE, Vol. 8 (10) 2013.
8. Simon, A.E., et al., “Physician-Patient Race Concordance from the Physician Perspective,” J Natl Med Assoc. 105; 150-156; 2013.
9. Shen, M.J., et al., J. Racial & Ethnic Health Disparities March 2017.
10. Peek M.E., et al., “URM Candidate Are Encouraged to Apply: A national Study to Identify Effective Strategies to Enhance Racial and Ethnic Faculty Diversity in Academic Departments of Medicine”. Acad. Med. ; 88 (3) 405-412, March 2013.
11. Christopher D. Lee. Search Committees: A Comprehensive Guide to Successful Faculty, Staff, and Administrative Searches. 2nd edition. Sterling, VA: Stylus Publishing, 2014.
12. Faculty.yale.edu/faculty-excellence–and-diversity
13. Kaplan, S.E., et al., “Challenges in Recruiting Retaining and Promoting Racially and Ethnically Diverse Faculty,” J Natl Med Assoc, Vol. 110 (1) 58-65, 2018.
14. Assoc, Vol 111 (1) 44-53, 2019.
Daley S., et al., “ Improving the Retention of Underrepresented Minority Faculty in Academic Medicine,” J Natl Med Assoc, Vol 98 (9) 1435-1440, 2006.
15. Wingned D., et al. “ Faculty, Equity, Diversity Culture and Climate Change in Academic Medicine. A Longitudinal Study,” J Natl Med
16. https://medicine.yale.edu/more
17. https://medicine.yale.edu/diversity
18. Raphael J.L., “ The Role of Sponsorship in Achieving Workforce Diversity in Academic Pediatrics.” Pediatrics; 144 (2) 1-4, 2019.