Funding and Resourcing Quality Improvement Effort in Infectious Diseases.

Infectious diseases physicians are frequently called on to perform quality improvement and patient safety (QIPS) work. We describe a newly created faculty position at our institution that allows a faculty member with graduate training in quality and safety methodologies to address QIPS priorities at both the division and hospital levels.

Lack of standardization and faculty development in pediatric colonoscopy: A qualitative study.

A standard curriculum for pediatric colonoscopy training has neither been required nor universally implemented in North American fellowship programs. This qualitative study assessed the needs of colonoscopy training in pediatric gastroenterology to determine the standardized components of procedural teaching. Focus groups with pediatric gastroenterology attendings, fellows, procedural nurses, and interviews with advanced endoscopists, all practicing at a single institution, were conducted between March and June 2018. Data were analyzed using thematic analysis principles. Four themes emerged: (1) lack of standardization of colonoscopy performance, (2) lack of professional development of procedure teaching skills, (3) need for teaching behaviors that promote learner's performance, and (4) barriers to effective teaching and learning. A conceptual framework was created for developing a standardized "train-the-trainer" curriculum. Our needs assessment supports expansion of efforts to make this comprehensive training available to all pediatric gastroenterologists involved in procedure teaching.

Hybrid Train-The-Trainer course for the Fundamental Use of Surgical Energy certificates improves self-confidence in knowledge of surgical energy and develops teaching skills: a feasibility study.

BACKGROUND: Several well-trained expert instructors who completed the "Train-The-Trainer (TTT)" course are required to disseminate the safe use of surgical energy devices, which can be learned through the Fundamental Use of Surgical Energy (FUSE) program. This study aimed to explore whether the hybrid FUSE TTT course is feasible and effective, which can improve teaching skills of surgical energy. METHODS: The hybrid TTT course, which was designed to train FUSE-certified personnel as instructors, comprised three virtual sessions spread over 5 h in total and a 1-day in-person training, followed by a 100-min FUSE electrosurgery hands-on workshop in practice as an instructor. The participants reported on self-confidence regarding knowledge of various energy devices or adverse events before, immediately after, and 6 months after the course. Participants and experienced FUSE instructors assessed the trainees' presentation skills at the beginning of the in-person training and after the hands-on workshop. The primary outcomes were the feasibility and completion rate of the entire course. RESULTS: Seventeen participants completed the entire couse; most (94%) were satisfied with the course. Self-confidence in knowledge about various contents improved significantly: the fundamentals of electrosurgery (post, p < 0.001; 6 months, p = 0.01), mechanism and prevention of adverse events (post, p = 0.001; 6 months, p = 0.04), monopolar instruments (post, p = 0.002; 6 months, p = 0.01), bipolar instruments (post, p = 0.01; 6 months, p = 0.06), and integration with other medical devices (post, p = 0.006; 6 months, p = 0.02). The presentation skill index scores of self- and peer assessments improved after the in-person training (self-assessment [pre 44 vs. post 56, p < 0.001], peer assessment [pre 39 vs. post 68, p < 0.001]). CONCLUSIONS: The hybrid TTT course can provide FUSE-certified personnel with an improved self-confidence concerning knowledge of surgical energy and improve their presentation skills with midterm retention. This can help build trainees' self-confidence as instructors.

Factors influencing clinician-educators' assessment practice in varied Southern contexts: a health behaviour theory perspective.

In many contexts, responsibility for exit-level assessment design and implementation in undergraduate medical programmes lies with individuals who convene clinical clerkships. Their assessment practice has significant consequences for students' learning and the patients and communities that graduates will serve. Interventions to enhance assessment must involve these assessors, yet little is known about factors influencing their assessment practice. The purpose of this study was to explore factors that influence assessment practice of clerkship convenors in three varied low-and-middle income contexts in the global South. Taking assessment practice as a behaviour, Health Behaviour Theory (HBT) was deployed as a theoretical framework to explore, describe and explain assessor behaviour. Thirty-one clinician-educators responsible for designing and implementing high-stakes clerkship assessment were interviewed in South Africa and Mexico. Interacting personal and contextual factors influencing clinician-educator assessment intention and action were identified. These included attitude, influenced by impact and response appraisal, and perceived self-efficacy; along with interpersonal, physical and organisational, and distal contextual factors. Personal competencies and conducive environments supported intention to action transition. While previous research has typically explored factors in isolation, the HBT framing enabled a systematic and coherent account of assessor behaviour. These findings add a particular contextual perspective to understanding assessment practice, yet also resonate with and extend existing work that predominantly emanates from high-income contexts in the global North. These findings provide a foundation for the planning of assessment change initiatives, such as targeted, multi-factorial faculty development.

From constructive to critical and everywhere in between: education leaders' decision-making related to harsh feedback from learners about their teachers.

Feedback from learners is important to support faculty development, but negative feedback can harm teachers' motivation, engagement, and retention. Leaders of educational programs, therefore, need to balance enabling students' voices to be heard with maintaining teachers' enthusiasm and commitment to teaching. Given the paucity of research to explain or guide this struggle, we explored why and how education leaders grapple with negative learner feedback received about their teachers. Using an Interpretive Description methodology, 11 education leaders participated in semi-structured interviews. Discussion was stimulated by showing participants learner narratives they had previously asked to be deleted because they perceived the narrative to be overly critical. Transcripts were iteratively analyzed as codes were developed, refined, and combined into themes. Education leaders interpreted the scope, framing, and focus of the feedback to decide whether it was overly critical. Such determinations were combined with contextual considerations such as the teacher's personal circumstances, the learning environment and how the teacher might react to think through what potential damage the feedback might do to the teacher. Throughout the process, leaders struggled with whether protecting teachers risked not protecting learners and remained unsure about the ethics of censoring student voices. Our study offers direction regarding how to optimize feedback to teachers while minimizing risks inherent in sharing negative feedback with them. Implications include that there is value in: (1) extending feedback interpretation support to teachers, education leaders and learners; (2) situating upward feedback in a coaching dialogue; and, (3) applying the same principles recommended for the provision of feedback to learners, to teachers.

Twelve tips for creating a works in progress conference that builds capacity for educational scholarship and creates a scholarly community.

Educators have implemented various strategies to build capacity for education scholarship, and often, these strategies focus on a specific set of interested individuals. We perceived a need for a strategy to engage a health professions education community with peer support. The purpose of these 12 tips is to describe an approach in place for nearly two decades that concurrently advances education scholarship and fosters a community that welcomes novices to experts. The approach is based on principles that not only build capacity and community but also stress the importance of alignment with the institution's missions. The tips guide setting up, conducting, and sustaining such an approach.

'We're like Spider-Man; with great power comes great responsibility': Coaches' experiences supporting struggling medical students.

BACKGROUND: Medical students can experience a range of academic and non-academic struggles. Coaching is a valuable strategy to support learners, but coaches describe working with struggling learners as taxing. Transformative learning theory (TLT) provides insights into how educators grow from challenging experiences to build resilience. This study explores how coaches evolve as educators through supporting struggling students. METHODS: This qualitative study grounded in an interpretivist paradigm used interviews of longitudinal medical student coaches at two academic institutions. Interviews, using TLT as a sensitizing concept, explored coaches' experience coaching struggling learners. We performed thematic analysis. RESULTS: We interviewed 15 coaches. Coaches described supporting students through multi-faceted struggles which often surprised the coach. Three themes characterized coaches' experiences: personal responsibility, emotional response, and personal learning. Coaches shouldered high personal responsibility for learners' success. For some, this burden felt emotional, raised parental instincts and questions about maintaining boundaries with learners. Coaches evolved their coaching approach, challenged biases, and built skills. Coaches learned to better appreciate the learner point of view and employ resources to support students. DISCUSSION: Through navigating learner struggles, educators can gain self-efficacy, learn to understand learners' perspectives, and evolve their coaching approach to lessen their personal emotional burden through time.

Evolving from Didactic to Dialogic: How to Improve Faculty Development and Support Faculty Developers by Using Action Research.

Problem: Since competency-based medical education has gained widespread acceptance to guide curricular reforms, faculty development has been regarded as an indispensable element to make these programs successful. Faculty developers have striven to design and deliver myriad of programs or workshops to better prepare faculty members for fulfilling their teaching roles. However, how faculty developers can improve workshop delivery by researching their teaching practices remains underexplored. Intervention: Action research aims to understand real world practices and advocates for formulation of doable plans through cycles of investigations, and ultimately contributes to claims of knowledge and a progression toward the goal of practice improvement. This methodology aligns with the aim of this study to understand how I could improve a faculty development workshop by researching my teaching practices. Context: In 2016, we conducted four cycles of action research in the context of mini-Clinical Evaluation Exercise (mini-CEX) workshops within a faculty development program aiming for developing teaching and assessment competence in faculty members. We collected multiple sources of qualitative data for thematic analysis, including my reflective journal, field notes taken by a researcher-observer, and post-workshop written reflection and feedback in portfolio from fourteen workshop attendees aiming to develop faculty teaching and assessment competence. Impact: By doing action research, I scrutinized each step as an opportunity for change, enacted adaptive practice and reflection on my teaching practices, and formulated action plans to transform a workshop design through each cycle. In so doing, my workshop evolved from didactic to dialogic with continuous improvement on enhanced engagement, focused discussion and participant empowerment through a collaborative inquiry into feedback practice. Moreover, these processes of action research also supported my growth as a faculty developer. Lessons Learned: The systematic approach of action research serves as a vehicle to enable faculty developers to investigate individual teaching practices as a self-reflective inquiry, to examine, rectify, and transform processes of program delivery, and ultimately introduce themselves as agents for change and improvement.

Twelve tips for creating and sustaining a peer assessment program of clinical faculty.

While feedback is essential for learning in the health professions, clinical teachers rarely get feedback on their teaching, and the existing feedback is often non-specific and distant from teaching encounters. To enhance clinical teaching, we created a peer assessment program for clinical faculty. This program has been well-received and sustained for five years despite the challenges of faculty turnover and the pandemic. In this article, we identify twelve tips for creating and sustaining a peer assessment program for clinical faculty based on this experience. These tips focus on how to create a culture that supports peer assessment, on how best to implement a peer assessment program in practical terms, and on how to sustain a peer assessment program long-term. We hope these tips help educators receive better feedback about their clinical teaching and improve the future care delivered by our learners.

Twelve Tips to Deliver Large Scale Faculty Development in Health Professional Education: A system-based approach.

Clinical teachers do not acquire teaching skills through their traditional health professional education. Faculty development programmes are required to train these clinicians in essential educational theory and practical teaching skills. Such interventions are critical to successful clerkship experiences and preparedness for professional practice. However, sustained engagement in these programmes is challenging. Education and healthcare organisations have differing priorities often resulting in competing demands placed on clinical teachers. The twelve tips described in this article offer logical and simple approaches to designing large-scale faculty development programmes for clinical teachers. These tips emphasise the application of system theory to identify and address key regulatory, institutional, and individual barriers to implementation, risks to successful delivery and tools for upscaling faculty development programmes.

Characterization of Distinctive Teaching Practices in Longitudinal Integrated Clerkships: Perspectives From Students and Faculty.

Phenomenon: Longitudinal integrated clerkships (LICs) are novel curricula that place medical students in long-term learning and coaching relationships with faculty and require adaptation of teaching practices on the behalf of faculty to maximize learning outcomes. An understanding of how teaching in an LIC model differs from teaching trainees in more traditional models is critical to ensuring curricular innovation success through faculty development. Approach: A qualitative approach was used to describe the teaching practices of faculty and learning experiences of student participants in longitudinal integrated clerkships in different clinical and community settings. Forty-five faculty and 20 students participated in focus groups. Thematic analysis of focus group data was used to identify differences and similarities between groups, sites, and specialties. Findings: Two groupings of themes emerged in thematic analysis: (1) precepting strategies distinctive to the longitudinal integrated clerkship model and (2) precepting strategies enhanced when employed in the LIC model. Distinct to the LIC model, preceptors and students described the importance of understanding the curricular structure and supporting students in longitudinal care of patients. Enhanced in the LIC model are the strategies of relationship-based teaching, support of autonomy, feedback, and support of longitudinal growth in skills. Insights: Students and faculty across LIC sites were broadly aligned in their opinions of best practices for teaching in an LIC model. The longitudinal relationship between student and faculty in an LIC distinguishes this model from traditional block rotations and a distinctive approach to successful teaching is demonstrated. Preceptors use time afforded to build trusting relationships with students, which created opportunity for novel teaching approaches and enhanced otherwise effective teaching strategies. A focus on orientation to the curricular model and support of longitudinal relationships with patients may serve as an anchor for faculty development efforts in the development of an LIC.

How do we teach generative artificial intelligence to medical educators? Pilot of a faculty development workshop using ChatGPT.

PURPOSE: Artificial intelligence (AI) is already impacting the practice of medicine and it is therefore important for future healthcare professionals and medical educators to gain experience with the benefits, limitations, and applications of this technology. The purpose of this project was to develop, implement, and evaluate a faculty development workshop on generative AI using ChatGPT, to familiarise participants with AI. MATERIALS AND METHODS: A brief workshop introducing faculty to generative AI and its applications in medical education was developed for preclinical clinical skills preceptors at our institution. During the workshop, faculty were given prompts to enter into ChatGPT that were relevant to their teaching activities, including generating differential diagnoses and providing feedback on student notes. Participant feedback was collected using an anonymous survey. RESULTS: 27/36 participants completed the survey. Prior to the workshop, 15% of participants indicated having used ChatGPT, and approximately half were familiar with AI applications in medical education. Interest in using the tool increased from 43% to 65% following the workshop, yet participants expressed concerns regarding accuracy and privacy with use of ChatGPT. CONCLUSION: This brief workshop serves as a model for faculty development in AI applications in medical education. The workshop increased interest in using ChatGPT for educational purposes, and was well received.

PharmaCORE: Optimizing medical pharmacology education with an innovative instructional dashboard.

WHAT WAS THE EDUCATIONAL CHALLENGE?: Diminishing emphasis on pharmacology education in medical schools has resulted in a concerning lack of prescribing knowledge among physician graduates. These concerns mirror our graduates' expressed dissatisfaction with the structure and quality of pharmacology educational experiences over the past 5 years. WHAT WAS THE SOLUTION?: PharmaCORE, a web-based instructional dashboard, was developed as an interactive faculty development tool to enhance integration and instruction of pharmacology content in pre-clinical curriculum at a US medical school. HOW WAS THE SOLUTION IMPLEMENTED?: PharmaCORE was introduced in Spring 2022 for instructors teaching pharmacology in the pre-clinical curriculum. Instructors used the dashboard to assess coverage of specific drug topics throughout the curriculum and to apply tailored, learner-centered teaching strategies to optimize learner engagement and comprehension. WHAT LESSONS WERE LEARNED THAT ARE RELEVANT TO A WIDER GLOBAL AUDIENCE?: The initial assessment indicated that the dashboard was user-friendly and positively influenced instructor awareness of pharmacology content and learner-centered teaching. This faculty development approach underscores the importance of skill-based mapping and maintaining learner-centered teaching standards to address other integrated subjects and broader curricular challenges. WHAT ARE THE NEXT STEPS?: This study lays the foundation for the broader applicability of instructional dashboards in tracking and addressing curricular challenges across pharmacology and other science subjects. Future steps include more personalized feedback for instructors, creating a student-accessible version, and ongoing monitoring of maintenance measures like milestone exams.

Twelve tips for designing and implementing an academic coaching program.

Coaching has become increasingly popular as a mechanism to support learning across the health professions education (HPE) continuum. While there is a growing body of literature in this area, there is minimal guidance related to the design and implementation of academic coaching in health professional courses. This paper seeks to contribute to this literature by presenting guidance for academic developers who are considering introducing academic coaching into a health professional course. The 12 tips are based on the authors' collective experiences of designing and implementing academic coaching in university medical courses in Australia and the UK. Although focused on medical education, this paper is intended to have applicability across the health professions, and potentially across university and postgraduate training contexts. Together, the tips offer a strategic and operational framework to guide the design and implementation of academic coaching initiatives in health professions education.

Reimagining faculty development: A paradigm shift from content to transformative learning processes.

BACKGROUND: Faculty development programs in health professional education traditionally emphasise theories, principles, and effective teaching practices. However, the efficacy of these strategies in instigating meaningful changes in instructional practices has come under scrutiny. METHODS: This qualitative research aims to enhance our understanding and support of educators' ongoing learning and growth. Employing a transformative learning lens, the study explored the experiences, professional development practices, and responsibilities of clinical educators who participated in a faculty development course. Utilising Mezirow's transformative learning theory as a framework, this research investigated the transformative journey of educators, analysing reflective pieces from 144 participants. RESULTS: The study findings revealed shifts in pedagogical approaches, ranging from the recognition of a haphazard teaching style to the intentional integration of evidence-based methods and pedagogical philosophies. The thematic analysis identified key stages in the transformative process, illuminating educators' commitment to structured teaching, self-directed learning, and continuous improvement. CONCLUSION: This research has contributed valuable insights into how faculty development programs can stimulate reflective practices and transformative learning in health professional education. The article argues for the centrality of transformative learning processes in faculty development, presenting an intriguing perspective on sustainable and impactful professional growth. Trends across learning experiences are presented, accompanied by practical recommendations. The implications of the research for clinical educators, administrators, and developers of formal faculty professional development programs are also discussed.

Situations that prompt teachers in problem-based curricula to reflect on their beliefs, identity and mission.

Teachers have different perceptions of how to enhance student learning. Whereas some take a teacher-centred perspective, others lean more towards a student-centred approach. Many studies in higher education have invoked Korthagen's onion model (2014) to explain how teachers' perspectives can impact their teaching practices. Spanning six interrelated layers, this model contains both outer (environment, behaviour, competencies) and inner (beliefs, identity, and mission) aspects. Focusing essentially on teachers' outer aspects, previous studies have paid scant attention to how particular situations affect teachers' inner aspects and, consequently, how teachers perceive student-centred learning. In this descriptive qualitative study, we explored situations that encouraged or discouraged teachers to embrace student-centred beliefs, identities and missions. We held three focus-group discussions with 18 teachers from two Indonesian medical schools, performing a thematic analysis of the data thus obtained. We found that certain situations made teachers reflect on their inner aspects, which either favourably or adversely affected their acceptance of a student-centred learning approach. Teachers' outer aspects (i.e. their prior problem-based teaching and learning experiences, learning situations from their own training as well as clinical duties) strongly interacted with their inner aspects, thereby shaping their teaching perspectives. Understanding how specific situations can influence teachers' inner aspects might help institutions to design faculty development programmes that address teachers' specific educational needs.

Twelve tips for including disability education in undergraduate medical education.

Disability is a large and growing minority population worldwide. People with disabilities continue to experience health and healthcare disparities. Despite multiple calls to action to provide disability education within undergraduate medical education as a strategy to mitigate ongoing inequities, robust disability education is not routinely provided across medical schools. This article provides twelve tips that any medical school faculty can utilize to integrate meaningful disability education within existing core medical education.

Interprofessional learning in practice-based settings: AMEE Guide No. 169.

The provision of optimum health care services requires collaboration of health care professionals in integrated interprofessional (IP) teams. This guide addresses the practical aspects of establishing and delivering pre-licensure IP programs to prepare graduates of health professional programs to work in teams and wider collaboration, and consequently enhance the quality of health care. The main updated IP frameworks are presented to highlight commonalities that represent the essential competencies and outcomes of programs implementing interprofessional education (IPE). We discuss how these may be adapted to the local context, and present examples of models of implementation to guide the initial steps of establishing similar programs. Examples of pre-licensure IP practice-based learning, such as community-based, simulation-based, student-run and led clinics, and interprofessional training wards, and post-licensure interprofessional learning (IPL), are described. We consider assessment of IPL along the continuum of learning IP. This guide also emphasises the need to tailor faculty development programs for local contexts and consider factors affecting sustainability such as funding and accreditation. We finish with the governance of IP programs and how global IP networks may support interprofessional practice-based learning from development to delivery.

Career development of doctorally prepared nurses.

AIM: To integrate research literature regarding careers, career development and factors influencing the career development of doctorally prepared nurses. DESIGN: An integrative review. DATA SOURCES: Medline, CINAHL and Embase were searched in June 2022 without time restrictions. METHODS: Peer-reviewed empirical publications written in English with different types of study designs were included. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals using Joanna Briggs checklists. Data were extracted and analysed using a convergent integrated approach with thematic analysis. Themes were established within three categories based on the research questions: career, career development and factors influencing career development. RESULTS: Twenty-two studies were included. Nine themes were identified. One theme regarding careers describes that doctorally prepared nurses need to prioritize work within different positions. The two themes focusing on career development described the need to determine career goals after the doctorate and further develop competencies. Six themes described factors influencing career development: 'Intrinsic motivation to improve health care and nursing education', 'Available support sources', 'Professional development programmes', 'Work-life balance', 'Organizational infrastructures for career advancement' and 'Competition and hostile treatment among colleagues'. CONCLUSION: Limited knowledge of the careers and career development of doctorally prepared nurses was found. Doctorally prepared nurses need to balance work with various part-time positions. Careers and career development could be supported by the development of structures for career advancement as well as supportive working environments. IMPACT: Doctorally prepared nurses with strong careers are important to health care and nursing as they generate and implement new knowledge into clinical practice and thereby support the improvement of (nursing) care and patient outcomes. This study provides considerations towards strengthening the careers of doctorally prepared nurses. REPORTING METHOD: PRISMA. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Defining a set of teaching EPAs tailored to an undergraduate medical curriculum using a modified Delphi approach.

BACKGROUND: The concept of entrustable professional activities (EPAs) has recently been extended to operationalize professional tasks in teacher training and faculty development in health professions education. The aim of this study is to report on the process and results of defining a set of teaching EPAs (t-EPAs) tailored to the local characteristics of a particular undergraduate medical program. METHODS: The undergraduate medical program at the Charité - Universitätsmedizin Berlin is competency-based, integrates thematic modules and spans 6 years. A writing team identified teaching EPAs based on the program's study regulations and drafted content descriptions with titles, specifications and knowledge, skills and attitudes. Content validation involved a modified Delphi procedure with a systematic, iterative interaction between a panel of content experts consisting of purposively selected educators and physicians from our faculty (n = 11) and the writing team. The threshold for a consensus was an agreement of 80% of the participants. RESULTS: After two Delphi rounds, a consensus was reached regarding the teaching activities to be included and their content descriptions. The response rate was 100% in both Delphi rounds. The Delphi results include the content descriptions of a total of 13 teaching EPAs, organized into the two overarching EPA domains of classroom-based (n = 10) and workplace-based (n = 3) activities. Tailoring the classroom EPAs to small group teaching and the workplace EPAs to supervising medical students led to several distinct EPAs. Another feature was the development of 2 teaching EPAs for interdisciplinary teaching. CONCLUSIONS: In systematic, Delphi-based process, we defined a set of 13 distinct teaching EPAs tailored to a specific undergraduate medical program that cover the core teaching tasks for faculty in this program. Our report on the principles of the process and the results may guide other medical schools and educators in defining and tailoring teaching EPAs according to their contexts.