The evolution of faculty development in Canada since the 1980s: coming of age or time for a change?

AIM: To determine the current status of university based faculty development at Canadian Medical Schools. BACKGROUND: The roles and responsibilities of faculty members at Canadian medical schools are changing significantly as a consequence of influences such as the competency dictates outlined in the CanMEDS roles. One result of the changes is an increased need for faculty development to assist faculty members in carrying out their new and expanded roles. METHODS: The changing climate in medical schools, and the enhanced performance expectations of academic faculty, led us to conduct a survey of current faculty development practices in Canadian medical schools to determine what is being done to address the new and expanded expectations of faculty members. We used an on-line survey instrument based on surveys of faculty development conducted in 1987 and 1997. RESULTS: We received responses from faculty development directors at all 17 Canadian medical schools. Among the principal findings are a continued emphasis on faculty members' teaching roles, increased funding of faculty development activities at most schools, and a broadened emphasis on faculty roles other than teaching. Among these are research and scholarship, and management and administrative roles. The survey revealed a mismatch between what faculty development directors consider to be effective development practices and which practices are actually used in their schools. Another notable finding is the absence of credible faculty development impact studies. CONCLUSION: The 2007 survey of faculty development practices in Canadian medical schools indicates that teaching is still the number one priority for faculty members and the main focus of faculty development programs. There are notable efforts to help faculty members deal with their newly identified roles including those outlined in the CanMEDS framework. In looking forward, Canadian faculty development directors should continue their efforts to devise credible program evaluation methods. Furthermore, they should expand their thinking beyond Canada's borders. It is time to aggressively explore and understand the approaches and experiences which have proven successful internationally in the United States and Europe.

A pilot study designed to acquaint medical educators with basic pedagogic principles.

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

The acquisition of tacit knowledge in medical education: learning by doing.

AIM: This study was designed to assess medical school teachers' tacit knowledge of basic pedagogic principles and to explore the specific character of the knowledge base. METHODS: We developed a 50-item, multiple-choice question test based on important pedagogic principles, and classified all questions as requiring either declarative or procedural knowledge. A total of 72 medical teachers representing 5 different groups of clinicians and educators agreed to sit the test. RESULTS: Teachers in all 5 groups performed well on the test of tacit pedagogic knowledge but those with advanced education degrees, or local recognition as experts, performed best. All test takers performed best on questions requiring procedural knowledge. CONCLUSION: Medical teachers possess tacit knowledge of basic pedagogic principles. Superior test performance on questions requiring procedural knowledge is consistent with their working in a clinical environment characterised by repeated procedural activities.

Clinical teachers' tacit knowledge of basic pedagogic principles.

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness.

Seven principles for teaching procedural and technical skills.

The authors developed a cognitive-theory-based checklist of seven important principles for teaching technical skills. They then used the checklist in a workshop for doctors who teach procedural and technical skills. Participants in the workshop found the principle-based approach to be more effective than the traditional "see one, do one, teach one" approach.

The evaluation of a workshop to promote interactive lecturing.

BACKGROUND: The lecture is the most widely used method of teaching in medical education. Although effective lecturing has been described in the literature, many question whether problem-solving skills or attitudes can be transmitted using the traditional lecture. Introducing interactive techniques can promote learner participation and, as a result, can lead to a higher level of learning. This article assesses the effectiveness of interactive learning. DESCRIPTION: A 4-hr workshop has been offered for 4 consecutive years to faculty members in the Faculty of Medicine at McGill University to allow participants to explore interactive techniques and incorporate them into their lectures. For this study, an evaluation was conducted of the workshop given in Spring 1996. The experimental group consisted of the first 60 faculty members to register for the workshop, and the comparison group comprised the 40 individuals on the waiting list. Three instruments were used in the evaluation. An immediate postworkshop questionnaire was completed by the participants. Six months after the session, a 6-month postworkshop questionnaire was completed by the experimental and comparison groups that explored the use of interactive lecturing techniques since the workshop. In addition, 23 individuals from the experimental group and 14 from the comparison group were videotaped 6 months after the session and were scored on a videotape observational grid by an independent rater. EVALUATION: Overall, the workshop was deemed very useful by the majority of the participants. On the 6-month postworkshop questionnaire, the only difference found in the demographic data between the 2 groups was in the number of years of teaching experience. The experimental group had given more interactive lectures over the past 6 months and had used more audience responses, certain types of questions, audience surveys, live interviews, verbal and written cases, and study guides. From the videotape observational data, the experimental group scored higher in questioning and engaging the audience, and in using nonverbal gestures. As well, this group received higher ratings for their interactivity and for the students' responsiveness. CONCLUSIONS: Interactive lectures can increase student participation and involvement in the large class lecture. This 4-hr workshop, designed to promote the use of interactive lecturing techniques, can be considered successful based on self-reports from participants as well as from observational data.

Using focus groups to design a valid questionnaire.

The authors planned to study the roles and concerns of senior faculty members at their institutions. To elaborate the aims of their study and to help them design a valid questionnaire, they conducted focus groups with senior faculty. The authors describe how the information gleaned from the focus groups helped them develop their questionnaire.

Co-tutors in the basis of medicine.

In 1994 the McGill University preclinical medical curriculum was changed from predominantly didactic, discipline-based instruction to a problem-based approach, in which the emphasis lies in student discussion of clinical cases with physician mentors. Although the new curriculum has rapidly gained favour with students, it has also generated some problems. Foremost among the problems is the diminishing pool of physician-scientist tutors to facilitate the ever-increasing number of small-group discussions. From the concepts embodied in educational theories of situated learning and learning communities, this paper has proposed that physicians in clinical practice and PhD scientists engaged in biomedical research, be trained to co-facilitate small-group discussions. Their complementary knowledge and similar training, should provide a forum through which medical students will develop clinical reasoning skills, based on sound scientific knowledge, early in their training.

Can computerized risk profiles help patients improve their coronary risk? The results of the Coronary Health Assessment Study (CHAS).

BACKGROUND: The Coronary Health Assessment Study (CHAS) was developed to determine the feasibility of using patient-specific, multifactorial computerized coronary risk profiles as a clinical decision aid to support primary prevention of CHD. METHODS: Study participants included 253 community based physicians, randomized into profile and control groups, and 958 of their patients. The profile group physicians received coronary risk profiles for their patients within 10 working days after the baseline patient assessment providing early feedback. The control group received their profiles only if the patient was clinically reevaluated during a 3-month follow-up visit. Patients' coronary risk factors were evaluated at baseline and at follow-up. RESULTS: The profile group had a significantly higher (P < 0.05) ratio of high-risk/low-risk patients who returned for a follow-up visit compared to the control group (1.23 vs 0.77). The patients in the profile group also had significantly (P < 0.05) greater mean reductions in total cholesterol (-0.5 vs -0.1 mmol/L), LDL cholesterol (-0.4 vs 0.0 mmol/L), the total cholesterol/ HDL ratio (-0.6 vs -0.2), and the predicted 8-year coronary risk (-1.8 vs -0.3%). CONCLUSIONS: Computer-generated coronary risk profiles can be effective in assisting physicians to identify high-risk patients. Their use is also associated with significantly greater improvements in the serum lipid profiles and the overall coronary risk of these patients.

Stress and depressed mood in medical students, law students, and graduate students at McGill University.

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

Faculty development in Canadian medical schools: a 10-year update.

OBJECTIVE: To compare the current status of faculty development practices in Canadian medical schools with the status of such practices in 1986. DESIGN: Mail survey. SETTING: All 16 Canadian medical schools. PARTICIPANTS: Faculty development coordinators at the medical schools. OUTCOME MEASURES: Existence of faculty development committees, funding for faculty development activities, types of activities and recognition of faculty participation in such activities. RESULTS: Completed responses were received from all schools. They indicated a significant, positive evolution in faculty development since the previous survey, conducted in 1986. Most schools have established a faculty development committee and provide funds for such activities as workshops, sabbatical leaves and conference attendance. Although traditional development practices are prevalent, there is now widespread emphasis on computer technology, information retrieval, management skills and research. Experienced faculty and other experts are more widely used for consultation on teaching. Very little has been done to evaluate the impact of faculty development. CONCLUSION: Faculty development in Canadian medical schools has undergone a major, positive transition during the last 10 years.

Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study.

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

Helping physicians in distress. Developing a physician assessment and referral service.

In 1987, a Physician Assessment and Referral Service was created in the Department of Family Medicine of a large urban hospital to help physicians and their families. This article describes the rationale, development, accomplishments, and limitations of the service in light of 5 years' experience. Although this program was developed for family physicians in particular, it has value for all medical specialties.

Physician, heal thyself. Developing a hospital-based physician well-being committee.

This article describes the development of a physician well-being committee at the Sir Mortimer B. Davis-Jewish General Hospital. It discusses the issue of physician stress, outlines the committee's mandate, and describes the various activities and services that were implemented.

Orientation for new teachers. Workshop on clinical teaching skills.

Since 1987, McGill University's Department of Family Medicine has invited new faculty to an orientation workshop. Workshop topics cover learning agreements and principles of adult learning, effective teaching methods, and feedback and evaluation. Workshop methods aim to promote active participation and experiential learning.