The Health Professions Education Pathway: Preparing Students, Residents, and Fellows to Become Future Educators.

PROBLEM: Training the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner. INTERVENTION: The University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation. CONTEXT: Through course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice. OUTCOME: From 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment). LESSONS LEARNED: Learners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator communities of practice. Also important for learner success was alignment of their projects with the goals of the local educator community of practice. Our community of practice approach to educator career development has shown promising early outcomes by nurturing learners' passion for teaching; expanding their interest in educational leadership, innovation, and scholarship; and focusing on their identity formation as future educators.

Teaching residents screening, brief intervention, and referral to treatment (SBIRT) skills for alcohol use: Using chart-stimulated recall to assess curricular impact.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) improves identification and intervention for patients at risk for developing an alcohol use disorder (AUD). Residency curriculum is designed to teach SBIRT skills, but resources are needed to promote skill implementation. The electronic health record (EHR) can facilitate implementation through integration of decision-support tools. The authors developed electronic tools to facilitate documentation of alcohol assessment and brief intervention and to reinforce skills from an SBIRT curriculum. This prospective cohort study assessed primary care internal medicine residents' use of SBIRT skills and EHR tools in practice using chart-stimulated recall (CSR). METHODS: Postgraduate year 2 and 3 residents received a 5-hour SBIRT curriculum with skills practice and instruction on SBIRT electronic tools. Participants were then given a list of their patients seen in a 1-year period who were drinking at/above the recommended limit. Trainees selected 3 patients to review with a faculty member in a CSR. Faculty used a 24-item chart checklist to assess application of SBIRT skills and electronic tool use and met with residents to complete a CSR interview. CSR interview notes were analyzed qualitatively to understand application of SBIRT skills and EHR tool use. RESULTS: Eighteen of 20 residents participated in the CSR, and 5 faculty reviewed 46 patient charts. Residents documented alcohol use (84.2% of charts) and assessment of quantity/frequency of use (71.0%) but were less likely to document assessment for an AUD (34%), an appropriate plan (50.0%), or follow-up (55%). Few residents used EHR tools. Residents reported barriers in addressing alcohol use, including lack of knowledge, patient barriers, and time constraints. CONCLUSIONS: More intensive training in SBIRT with opportunities for practice and feedback may be necessary for residents to consistently apply SBIRT skills in practice. EHR tools need to be better integrated into the clinic workflow in order to be useful.

Team-based learning exercise efficiently teaches brief intervention skills to medicine residents.

BACKGROUND: Evaluations of substance use screening and brief intervention (SBI) curricula typically focus on learner attitudes and knowledge, although effects on clinical skills are of greater interest and utility. Moreover, these curricula often require large amounts of training time and teaching resources. This study examined whether a 3-hour SBI curriculum for internal medicine residents utilizing a team-based learning (TBL) format is effective for SBI skills as measured by a standardized patient (SP) assessment. METHODS: A waitlist-controlled design was employed. RESULTS: Twenty-four postgraduate year 2 (PGY-2) and PGY-3 residents participated in a SP assessment prior to the TBL session (waitlist control group) and 32 participated in a SP assessment after the TBL session (intervention group). The intervention residents demonstrated better brief intervention skills than waitlist control residents, but there were no differences between the groups in screening and assessment skills. Residents receiving the TBL curriculum prior to the SP assessment reported increased confidence in all SBI skills. CONCLUSION: Findings indicate that a brief educational intervention can improve brief intervention skills. However, more intensive education may be needed to improve substance use screening and assessment.

Continuity in a longitudinal out-patient attachment for Year 3 medical students.

CONTEXT: Concerns about the quality of medical student learning experiences during traditional clerkships have prompted calls to restructure clinical education around continuity. Many US medical schools have added longitudinal out-patient attachments to enhance student continuity with patients and supervising doctors. However, continuity with patients can be difficult to achieve and little is known about the independent effect of continuity with a supervising doctor and setting. This study describes students' perceptions of the types of continuity experienced in longitudinal attachments and the learning associated with continuity. METHODS: This is a qualitative study using a grounded theory approach. Interviews were conducted with 12 Year 3 medical students about their continuity experiences with patients, supervisors and settings during their attachment. The resulting data were subjected to thematic analysis. RESULTS: Continuity with supervising doctors provided students with career mentorship and personal support. Student autonomy varied and was most dependent on the supervisor and setting. Students with patient continuity were more likely to report learning about chronic illness and communication skills. Students described the longitudinal attachment as helping them to develop their clinical skills and gain self-confidence within their role as future doctors, and as influencing their career choice. CONCLUSIONS: There is much variation in student experiences of patient continuity during a longitudinal attachment. Continuity with patients, supervisors and settings affects student learning in different ways. Additional dimensions of the experience, such as the nature of the patient-doctor relationship, the pace of work and the patient population, impact learning outcomes and should be considered when continuity experiences are being designed.

Implementation of interprofessional education (IPE) in 16 U.S. medical schools: Common practices, barriers and facilitators.

BACKGROUND: Enhanced patient outcomes and accreditation criteria have led schools to integrate interprofessional education (IPE). While several studies describe IPE curricula at individual institutions, few examine practices across multiple institutions. PURPOSE: To examine the IPE integration at different institutions and determine gaps where there is potential for improvement. METHOD: In this mixed methods study, we obtained survey results from 16 U.S. medical schools, 14 of which reported IPE activities. RESULTS: The most common collaboration was between medical and nursing schools (93%). The prevalent format was shared curriculum, often including integrated modules (57%). Small group activities represented the majority (64%) of event settings, and simulation-based learning, games and role-play (71%) were the most utilized learning methods. Thirteen schools (81.3%) reported teaching IPE competencies, but significant variation existed. Gaps and barriers in the study include limitations of using a convenience sample, limited qualitative analysis, and survey by self-report. CONCLUSIONS: Most IPE activities focused on the physician role. Implementation challenges included scheduling, logistics and financial support. A need for effective faculty development as well as measures to examine the link between IPE learning outcomes and patient outcomes were identified.

Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

Teaching Residents to Teach: The Impact of a Multi-Disciplinary Longitudinal Curriculum to Improve Teaching Skills.

BACKGROUND: Residents have primary responsibility for teaching medical students, yet many receive no formal teaching instruction. This study evaluated the impact of a longitudinal multidisciplinary teaching curriculum on resident participants' self-perceived teaching skills. METHODS: Residents received instruction on teaching and leadership skills during a four-month longitudinal teaching course. Participants completed a validated pre-post self-assessment inventory for teaching and a teaching self-efficacy survey. RESULTS: Participants' self-rated teaching skills significantly increased in all categories of the self-assessment inventory for teaching. Self-efficacy survey results revealed statistically significant increased participant confidence in all teaching skills. Residents were very satisfied with course content. CONCLUSION: Residents are eager to improve their teaching skills and benefit from a multidisciplinary learning group. A successful teaching curriculum increases resident interest in teaching and impacts self-efficacy and self-assessed teaching skills.

A literature review of "resident-as-teacher" curricula: do teaching courses make a difference?

OBJECTIVES: To examine the evaluation methods of resident teaching courses and to estimate the effectiveness of these teaching courses. DESIGN: We searched the literature from 1975 to May 2003 using the PubMed MESH terms internship and residency and teaching; 1,436 articles were identified and 77 contained information regarding teaching courses. Fourteen articles contained information regarding outcomes of resident teaching courses and were selected for intensive review. MAIN RESULTS: Five uncontrolled pre-post studies used resident self-reported teaching skills/behaviors as outcome measures; all reported some improvement in self-reported skills. Three uncontrolled pre-post studies examined live or videotaped resident teaching encounters and all revealed improvement in some teaching skills. One uncontrolled trial and three nonrandomized controlled trials used learner evaluations of resident teaching behaviors as outcomes and all revealed an improvement in ratings of residents after course participation. Four randomized controlled trials of resident teaching curricula are included in this review. One study did not show any quantitative benefit of a resident teaching course on performance on an objective structured teaching evaluation. Two studies assessing resident teaching evaluations before and after course participation showed conflicting results. One study noted improvements in resident teaching skills assessed through videotape analysis. CONCLUSIONS: Resident teaching courses improve resident self-assessed teaching behaviors and teaching confidence. Teaching courses are linked to improved student evaluations. Further studies must be completed to elucidate the best format, length, timing, and content of resident teaching courses and to determine whether they have an effect on learner performance.