Evaluating the Career Impact of Faculty Development Using Matched Controls.

BACKGROUND AND OBJECTIVES: Faculty development (FD) is required for medical educators, yet few studies address its long-term career impact on graduates. This project presents the impact of FD on career development, as perceived by physician faculty graduates of a longitudinal primary care FD educator program, compared to nonenrollees. METHODS: Between 2011 and 2016, 33 physician faculty from three departments participated in monthly half-day in-class FD for 20 months, emphasizing educator skills and career development. After physician-graduates were stratified by year, 10 were randomly selected and matched with 10 nonparticipants (controls) by specialty, gender, academic rank, and time in academic medicine. Narrative responses from semistructured interviews were recorded in a common template. Qualitative analysis methods identified themes, with agreement obtained by researchers. RESULTS: Median time in academic medicine for FD graduates (50% male) was 5.5 years; controls 7.5 years (40% male). Common themes across all respondents included that they: value their roles as clinical teachers; define success as training high-quality, competent physicians; align their professional aims with organizational priorities; manage commitments; develop and sustain colleague networks; and seek continued growth. Within themes, FD graduates differed from controls, detailing greater perceived success and growth as educators, placing higher value on scholarly products and academic promotion, and having more expansive local and national colleague networks. CONCLUSIONS: FD graduates, compared to matched controls, report expanded clinician-educator scope and roles, and a greater value on scholarly activity. This evaluation provides the groundwork for further investigations.

Teaching Competencies for Community Preceptors.

BACKGROUND AND OBJECTIVES: Although community physicians provide one-fourth of the outpatient training received in medical school, usually there is no formal training of the preceptor. Currently there is no agreed-upon list of teaching competencies for community physician-preceptors. Using a modified Delphi process, the authors aimed to identify core teaching competencies for community preceptors for use in training and evaluation. METHODS: A medical educator and three faculty members with expertise in faculty development created a list of teaching competencies organized in five domains. These competencies were finalized through a multiround modified Delphi technique with key stakeholder groups including (1) nonphysician medical educators, (2) academic physicians involved in faculty development, (3) community physicians who regularly precept medical students, (4) family medicine residents, (5) third-year medical students in a 9-month-long longitudinal clerkship. Proposed competencies were retained if 70% of the participants ranked it as "very or extremely important." RESULTS: In the first round, 24 competencies were evaluated by 40 physician preceptors participating in a rural faculty development conference. These were refined, and four additional competencies were added by the cohort. Subsequent rounds utilized a survey approach with broader audiences resulting in a final list of 21 competencies in five domains. CONCLUSIONS: Five competency domains with 21 teaching competencies can now be used to guide community preceptors' training and evaluation.

Reaching and Supporting At-Risk Community Based Seniors: Results of a Multi-church Partnership.

The purpose of this study was to determine the impact of a nurse-led, church-based educational support group for "at-risk," older African Americans on hospitalization and emergency department use. Study nurses enrolled 81 "at-risk" older adult members of ten churches. Participants completed a trifold pamphlet identifying personal health information and support, and they attended eight monthly educational/support group sessions in their church during the 10-month intervention. Study nurses completed a risk assessment interview with each senior both pre- and post-participation. The study nurse completed post-program assessments with 64 seniors, a 79% retention rate. At the program's conclusion researchers conducted a focus group with the study RNs and used an anonymous written survey to gather participant appraisals of program elements. Neither hospitalization nor emergency department/urgent care usage was significantly different from pre- to post-program. Session attendance was moderate to high and over half of the seniors brought a family member or friend to one or more sessions. The majority of seniors initiated positive health changes (e.g., smoking cessation, weight loss, or diet changes). Participants expressed high satisfaction and expressed satisfaction to perceive that they were supporting other seniors in their community. We conclude that this intervention was successful in engaging and motivating seniors to initiate health behavior change and contributed to a health-supportive church-based community. To demonstrate a statistically significant difference in hospital and ED usage, however, a stronger intervention or a larger sample size is needed.

Continuity in Community Medicine Training: Is It Time to Rethink the Block Rotation?

BACKGROUND AND OBJECTIVES: Family medicine residency training emphasizes the importance of community medicine. Recent scholarship has helped to identify important elements of community partnerships, including bidirectionality and continuity. Given the importance of continuity in family medicine and community partnerships, this study explores the relationship between continuity in community medicine curricula, partnership quality, and residents' community medicine competency. METHODS: Survey questions were included in the 2015-2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Family Medicine Program Director survey that probed community medicine curricular structures, partnership quality, and outgoing resident competency in community medicine. Multivariate logistic regression was used to test the impact of continuity on the outcomes of partnership quality and residents' community medicine competency. RESULTS: Respondents represented 227 of 461 family medicine programs (49%). Block rotation, used in 150 (66%) programs, was the approach most commonly used to deliver community medicine curriculum. Eighty-five (45%) programs self-reported high quality partnerships and about one-third described outgoing residents as highly proficient in community medicine competencies. Program-level continuity in community partnerships was significantly correlated to high quality partnerships (odds ratio [OR] 3.51, 95% confidence interval [CI] 1.79-6.89, P<0.001) and educational outcomes (OR 2.85, 95% CI 1.38-5.89, P=0.005), while resident-level continuity was not. CONCLUSIONS: Our findings support the importance of continuity to the quality of family medicine residency community partnerships as well as resident education in community medicine. Further research is needed to understand the importance of continuity at the program level versus individual resident level.

Influences of a Church-Based Intervention on Falls Risk Among Seniors.

BACKGROUND AND OBJECTIVES: Prior studies illustrate that community-based programs effectively decrease falls risk in older adults and that faith-based programs improve health behaviors. The literature is unclear whether faith-based initiatives reduce seniors' fall risks. To tackle this gap, a long-term partnership led by 10 urban churches, a nearby nursing school, and a medical school developed a study with 3 objectives: determine baseline health concerns associated with falls (eg, depression, polypharmacy), implement a nurse-led, faith-based health education initiative for community-dwelling African American seniors at-risk of hospitalization, and assess pre- to post -program fall frequency. METHODS: The 100 Healthy, At-Risk Families study team implemented 8 monthly educational health sessions promoting self-care and social support. Community nurses led the 60- to 90-minute sessions at each of 10 churches. To collect study data, nurses interviewed enrolled seniors pre- and post-intervention. Descriptive and comparison statistics were analyzed in Excel and Statistical Package for Social Sciences. RESULTS: Senior data at baseline found high rates of polypharmacy and physical imbalance, and no significant depression or gaps in social support. There was not a statistically significant change pre- to post-program in fall frequency "in prior year." CONCLUSIONS: Study findings reveal insights about African American senior health and fall risks. Church settings may provide a protective, psychosocial buffer for seniors, while polypharmacy and mobility/balance concerns indicate need for continued attention to fall risks. No increase in pre- to post-program falls was encouraging.

Students' Critical Incidents Point the Way to Safer Patient Care Transitions.

INTRODUCTION: Patient care transitions are prevalent in health care, and faulty transition-related communications are associated with 80% of serious medical errors. While medical student curricula on care transitions are increasing, there are limited evaluation reports and little guidance on primary care transition training. METHODS: The Medical College of Wisconsin initiated an annual 2-hour patient care transition intersession for third-year medical students. The intersession used a critical incident report, where students wrote about a recent, de-identified patient transition they witnessed that evoked in them "a strong emotional reaction." Next, intersession training included a novel, structured communication handoff mnemonic. At the intersession conclusion, students wrote what they would do differently if their critical incident transition occured in the future. Evaluations (2010-2014) consisted of students' post-session reactions and learning. Authors completed a detailed, qualitative analysis of students' critical incident reports from the 2010 intersession. RESULTS: Students reacted positively to all intersession elements, especially clinician-led, small-group discussions. Student reports revealed that over 90% of their critical incident evoked negative emotional reactions (eg, frustrated, disappointed, helpless). Post-intersession, 86% of students reported intentions to adopt new strategies to improve future care transitions, and 38% referenced components of the learned mnemonic. CONCLUSION: Medical students reacted positively to this intersession, especially small-group discussions. Students revealed mostly negative emotions from their critical incident on patient handoffs, but they gained effective strategies for future handoff communications. Authors recommend continued use of the handoff mnemonic, with greater attention to training environments that emphasize patient and learner safety.

Towards Building a Bridge between Community Engagement in Research (CEnR) and Comparative Effectiveness Research (CER).

A major national priority is establishing an effective infrastructure for translation of scientific discoveries into the community. Knowledge and practice continue to accelerate in health research yet healthcare recommendation adoption remains slow for practitioners, patients, and communities. Two areas of research placed in the later stages of the translational research spectrum, Community Engagement in Research and Comparative Effectiveness Research, are ideal for approaching this challenge collaboratively. The Clinical and Translational Science Institute of Southeastern Wisconsin convened academics and community-based organizations familiar with these fields of research in a 1-day workshop to establish an initial dialogue on similarities and differences with a goal of exploring ways to operationalize a collective effort. Participants represented four academic institutions and twelve other healthcare and community-based service organizations. Primary fields of study included community engaged research, comparative effectiveness research, psychology, clinical research, administration, nursing, public health, education, and other professionals. This initial report outlines the results of this diverse discussion and provides insights into the priorities, diverging issues, and areas for future examination and practice. Key discoveries reveal clear crosscutting issues, value in philosophical and provocative discussions among investigators, a need for practice and lessons learned, and bidirectional exchange with community representation.

A randomized trial of peer-delivered self-management support for hypertension.

BACKGROUND: Peer-led interventions to improve chronic disease self-management can improve health outcomes but are not widely used. Therefore, we tested a peer-led hypertension self-management intervention delivered at regular meetings of community veterans' organizations. METHODS: We randomized 58 organizational units ("posts") of veterans' organizations in southeast Wisconsin to peer-led vs. professionally delivered self-management education. Volunteer peer leaders at peer-led posts delivered monthly presentations regarding hypertension self-management during regular post meetings. Volunteer post representatives at seminar posts encouraged post members to attend 3 didactic seminars delivered by health professionals at a time separate from the post meeting. Volunteers in both groups encouraged members to self-monitor using blood pressure cuffs, weight scales, and pedometers. Our primary outcome was change in systolic blood pressure (SBP) at 12 months. RESULTS: We measured SBP in 404 participants at baseline and in 379 participants at 12 months. SBP decreased significantly (4.4mm Hg; P < 0.0001) overall; the decrease was similar in peer-led and seminar posts (3.5mm Hg vs. 5.4mm Hg; P = 0.24). Among participants with uncontrolled BP at baseline, SBP decreased by 10.1mm Hg from baseline to 12 months but was again similar in the 2 groups. This pattern was also seen at 6 months and with diastolic blood pressure. CONCLUSIONS: Our peer-led educational intervention was not more effective than didactic seminars for SBP control. Although peer-led educational programs have had important impacts in a number of studies, we did not find our intervention superior to a similar intervention delivered by healthcare professionals. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00571038.

Clinical clerkship students' perceptions of (un)safe transitions for every patient.

PURPOSE: As calls for training and accreditation standards around improved patient care transitions have recently increased, more publications describing medical student education programs on care transitions have appeared. However, descriptions of students' experience with care transitions and the sender/receiver communication that supports or inhibits them are limited. To fill this gap, the authors developed this project to understand students' experiences with and perceptions of care transitions. METHOD: At the start of a patient safety intersession at the Medical College of Wisconsin (2010), 193 third-year medical students anonymously wrote descriptions of critical incidents related to care transitions they had witnessed that evoked a strong emotional reaction. Descriptions included the emotion evoked, clinical context, and types of information exchanged. The authors analyzed the incident descriptions using a constant comparative qualitative methodology. RESULTS: Analysis revealed that 111 of the 121 medical students (92%) who disclosed emotional responses had strong negative reactions to unsuccessful transitions, experiencing frustration, irritation, fear, and anger. All of these negative emotions were associated with lack of or poor communication between the sender and receiver: ambiguous roles and responsibilities, insufficient detailing of the patient's medical course, inadequate identification of the people involved in the transition, incomplete delineation of what the patient needed, and unclear reasons for the transition. CONCLUSIONS: Third-year medical students' descriptions of care-transition incidents reveal high rates of strong negative emotions and of communication gaps that may adversely affect patient care. Results support curricular innovations that align students' needs and experiences with safe patient care transitions.

Training lay volunteers to promote health in central-city African American churches.

In a nation plagued by skyrocketing healthcare costs, is there an affordable way to address health needs of older African Americans in medically underserved areas? The Milwaukee, Wisconsin's Elder Community Health Upholder (ECHU) project indicates yes, we can. The key: A partnership that guides committed volunteers focused on establishing and sustaining health initiatives in faith-based settings.

Evaluation of a peer-led hypertension intervention for veterans: impact on peer leaders.

Volunteer peer leaders (PLs) benefit from their involvement in health interventions but we know little about how they compare with other non-PL volunteers or with the intervention recipients themselves. We randomized 58 veterans' service organizations' posts (e.g. VFW) to peer- versus professionally led self-management support interventions. Our primary research questions were whether hypertensive PLs changed over the course of the project, whether they changed more than hypertensive volunteers who were not randomized to such a role [i.e. post representatives (PRs)] and whether they changed more than the intervention recipients with respect to health knowledge, health beliefs and health outcomes from baseline to 12 months. After the intervention, PLs provided open-ended feedback and participated in focus groups designed to explore intervention impact. Hypertensive PLs improved their systolic blood pressure and hypertension knowledge and increased their fruit/vegetable intake and pedometer use. We found no differences between PLs and PRs. PLs improved knowledge and increased fruit/vegetable intake more than intervention recipients did; they provided specific examples of personal health behavior change and knowledge acquisition. Individuals who volunteer to be peer health leaders are likely to receive important benefits even if they do not actually take on such a role.

Location and organizational features: what type of veteran communities participate in health programs?

BACKGROUND: Research shows that community-based membership organizations are effective partners in health promotion activities; however, most community organizations do not participate in such partnerships. There is little research regarding the geographical and organizational characteristics associated with participation. OBJECTIVE: We examined the factors associated with community-based veterans service organization (VSO) units' decision to participate in a health promotion project. METHODS: We collected location and organizational characteristics regarding 218 VSO units asked to participate in POWER, a partnership to improve hypertension self-management skills between the Medical College of Wisconsin, the Milwaukee Veterans Affairs Medical Center (VAMC) and Wisconsin branches of the American Legion, Veterans of Foreign Wars (VFW), Vietnam Veterans of America, and National Association of Black Veterans. We tested the association of these characteristics with participation using chi-square and Fisher's exact tests for categorical variables, and analysis of variance and the Kruskal-Wallis test for continuous variables. We used multivariable logistic regression to identify factors independently associated with participation. RESULTS: In bivariable analyses, likelihood of participation was positively associated with increasing membership (p < .001), meeting attendance (p < .001), publication of an organizational newsletter (p < .001), presence of a women's auxiliary (p = .02), and location within 44 miles of the VAMC (p = .047). On multivariable analysis, only meeting attendance and census tract-level educational attainment predicted participation. CONCLUSIONS: Greater membership sizes, meeting attendance, and more group resources might be important factors for researchers to consider when initiating community-based health and wellness programs.

Evaluating community-based public health leadership training.

CONTEXT: Addressing the nation's increasingly complex public health challenges will require more effective multisector collaboration and stronger public health leadership. In 2005, the Healthy Wisconsin Leadership Institute launched an annual, year-long intensive "community teams" program. The goal of this program is to develop collaborative leadership and public health skills among Wisconsin-based multisectoral teams mobilizing their communities to improve public health. OBJECTIVE: To measure the scope of participation and program impacts on individual learning and practice, including application of new knowledge and collective achievements of teams on coalition and short-term community outcomes. DESIGN: End-of-year participant program evaluations and follow-up telephone interviews with participants 20 months after program completion. SETTING: Community-based public health leadership training program. PARTICIPANTS: Sixty-eight participants in the Community Teams Program during the years 2006 to 2007 and 2007 to 2008. MAIN OUTCOME MEASURES: Professional diversity of program participants; individual learning and practice, including application of new knowledge; and collective achievements of teams, including coalition and short-term community outcomes. RESULTS: Participants in the Community Teams Program represent a diversity of sectors, including nonprofit, governmental, academic, business, and local public health. Participation increased knowledge across all public health and leadership competency areas covered in the program. Participating teams reported outcomes, including increased engagement of community leadership, expansion of preventive services, increased media coverage, strengthened community coalitions, and increased grant funding. CONCLUSIONS: Evaluation of this community-based approach to public health leadership training has shown it to be a promising model for building collaborative and public health leadership skills and initiating sustained community change for health improvement.

Ethical challenges in a randomized controlled trial of peer education among veterans service organizations.

Efforts to increase community members' involvement in research may create novel ethical challenges. We describe an ongoing randomized trial of a peer-delivered intervention to encourage hypertension self-management. Community members serving as peer leaders participate in subject recruitment, the informed consent process, and intervention. We describe our experience with several ethical issues that may arise when conducting research in similar settings: (1) coercion of community members, by the community, to participate either as leaders or as study subjects; (2) threats to the privacy of health information; and (3) conflict between peer leaders' roles as community members and study team members.

Preliminary description of the feasibility of using peer leaders to encourage hypertension self-management.

BACKGROUND: Despite consensus that effective treatment of hypertension reduces morbidity and mortality, control rates remain relatively low. This report describes key features of a peer support program designed to motivate individuals to improve self-management of hypertension. METHODS: We recruited Veterans of Foreign Wars posts in southeastern Wisconsin and trained members of these posts to be peer health leaders over a period of 18 months. The curriculum covered information important to blood pressure control, as well as peer educator skills. During this time, the peer leaders presented educational materials and encouraged self-monitoring of blood pressure at post meetings. Surveys and focus groups were conducted to evaluate the adoption of the program at the posts. RESULTS: After a series of informational mailings and visits to veteran posts, 15 posts and 27 peer leaders volunteered to participate. Fourteen posts (93%) continued active participation throughout the study period, as did 24 peer leaders. Peer leaders reported that they gained health knowledge, skills, and confidence to perform as informational resources at their posts, resulting in greater levels of health support among post members. CONCLUSION: The partnership of health care professional, medical school, and veteran service organization successfully organized and maintained a community-based, peer-led program to promote healthy behaviors among Wisconsin's armed services veterans. Community physicians should be familiar with programs of this type as chronic disease self-management grows in appeal in our communities and increasing numbers of veterans return from armed service duty.

Improving the value of CME: impact of an evidence-based CME credit designation on faculty and learners.

BACKGROUND AND OBJECTIVES: The American Academy of Family Physicians (AAFP) designates enhanced continuing Medical education (CME) credit (evidence based [EB] CME) to activities that meet specific criteria incorporating EB medicine principles. However, little is known about the effect of this innovation on EB-CME faculty or their learners. METHODS: Subjects were faculty presenters and participants at the 2006 AAFP Annual Scientific Assembly. We compared presenters and participants of sessions with EB-CME approval to those without, assessing faculty preparation and participants' perceptions of CME quality and value. RESULTS: EB-CME faculty preparation was more likely to use evidence-based medicine (EBM) resources and less likely to rely upon books, journals, or personal experiences. There were statistically significant differences in session participants' perceptions with regard to scientific evidence presented, perception of commercial bias, and application of information to practice, with EB CME sessions more favorable in all dimensions. Main faculty barriers to EB- CME application were time constraints and limited understanding of the application and approval process. CONCLUSIONS: The AAFP's EB-CME designation is associated with greater faculty use of EBM sources, while EB-CME participants perceive EB-CME as higher in quality and value.

The influence of double-credit evidence-based continuing medical education on presenters and learners.

BACKGROUND: Medical specialties are adopting methods to improve continuing medical education (CME). A "double credit" option, sponsored by the American Academy of Family Physicians, is now available for presentations submitted and approved as evidence based (EB). PURPOSE: To compare usual and double-credit CME presentations to determine differences in preparation resources and time, and to compare conference attendees' satisfaction. Those not submitting double-credit applications were asked about perceived barriers. METHODS: Three pretested, written surveys were administered at a 2.5 day CME conference held annually in Southeastern Wisconsin. Subjects were 38 presenters and 172 attendees, mostly primary care physicians. RESULTS: Twelve presentations were approved for double-credit; these presenters used a greater percentage of on-line EB resources to prepare their talks (64% versus 23%), and preparation required an additional 4.75 hours on average. Over 90% of attendees perceived greater conference quality due to the EB emphasis. Top barriers to double-credit EB applications were time limits and perceptions that topics were inappropriate. CONCLUSIONS: Double-credit presenters use a greater percentage of EB resources, while their counterparts used more professional experience to prepare CME presentations. Attendees reported improved quality and value with increased EB CME. Time is a perceived and real factor in preparing double-credit applications.

Fifteen years of aligning faculty development with primary care clinician-educator roles and academic advancement at the Medical College of Wisconsin.

Starting in 1991, the Medical College of Wisconsin's (MCW) primary care-focused faculty development programs have continuously evolved in order to sustain tight alignment among faculty members' needs, institutional priorities, and academic reward structures. Informed by literature on the essential competencies associated with academic success and using educational methods demonstrated to achieve targeted objectives, MCW's initial 1.5-day per month comprehensive faculty development programs prepared faculty as clinician-researchers, leaders, and educators. As institutional priorities and faculty roles shifted, a half-day per month advanced education program was added, and the comprehensive faculty development program transitioned to its current half-day per month program. Using a modular approach, this program focuses exclusively on clinician-educator competencies in curriculum, teaching, leadership, evaluation, and learner assessment. Instructional methods combine interactive, face-to-face sessions modeling a range of instructional strategies with between-session assignments now supported through an e-learning platform. All participants complete a required project, which addresses a divisional or departmental need, meets standards associated with scholarship, and is submitted to a peer-reviewed forum. To date, over 115 faculty members have enrolled in MCW's faculty development programs. Program evaluation over the 15-year span has served to guide program revision and to provide clear evidence of program impact. A longitudinal evaluation of comprehensive program graduates from 1993 to 1999 showed that 88% of graduates' educational projects were implemented and sustained more than one year after program completion. Since 2001, each participant, on average, attributes more than two peer-reviewed presentations and one peer-reviewed publication to program participation. Based on 15 years of evaluation data, five tenets associated with program success are outlined.