Background and Objectives: In 1995, a new pilot 12-week clerkship was begun that included third-year medical students dividing their time equally among general internists, general pediatricians, and family physicians while residing in the community. Many of the community faculty involved had little previous teaching experience and were too busy to travel to a central site for traditional faculty development sessions. The program described here was designed for 1-15 attendees in 60- to 90-minute sessions at a local site, including a meal.

Methods: A 20-page faculty guide for community-based education was adapted from the larger Preceptor Education Project workshop leader's workbook (1). A short summary of each of the key sections on orientation/introduction, observation, teaching, feedback, evaluation, and handling problems was included, along with scenarios for role-playing. This guide formed the basis for workshops organized by local area health education centers (AHECs) across the 60-county East Texas AHEC region. The sessions began with an introduction of participants and sharing of previous teaching experiences and expectations for the workshop. This informal needs assessment enabled the group to determine which sections of the manual would be emphasized in the rest of the session. Most sessions included two brief role-plays focused on feedback and/or observation skills, depending on perceived group needs.

Results: Eight sessions with a total of 50 community physicians were held; the three specialties were about evenly represented at the workshops. Feedback included that the informal nature of the sessions and their locations were especially appreciated, and 100% of participants indicated that the objectives had been met.

Conclusions: These short, transportable teaching skills workshops were convenient, individualized, and addressed the needs of the community faculty who were unable to attend more traditional workshops.

Reference
1. STFM Preceptor Education Project Committee. Preceptor Education Project workshop leader's manual and workbook. Kansas City, MO: STFM, 1992.

Recent Innovations and Research in Faculty Development
(Fam Med 1997;29(4):280-1.)

Background and Objectives: Medical schools have recently increased their use of small groups for learning. This change brings with it a need for faculty development, since most faculty have received little or no training as facilitators. The SOAP Facilitating Model was developed to meet this need.

Methods: The model uses a familiar acronym to help facilitators remember what they should do to maximize learning during small-group sessions. The acronym consists of S-Set the Stage for Learning; O-Onward to Achieve Objectives; A-Assess Learning; P-Put It All Together. Checklists of desirable facilitating behaviors are associated with each letter. The checklists were used to assess faculty during videotaped small-group sessions. The faculty were given individualized feedback about their strengths and weaknesses for each part of the model. The individual meetings were followed by a workshop that explained the model further, summarized findings from the videotaped observations, and provided training in areas of group weaknesses. After the workshop, faculty completed a questionnaire about the model's effectiveness.

Results: The mean for all questionnaire items was more than 4.5 on a 5-point scale. The faculty reported that the model was easy to remember and apply and would help them become better facilitators. Data from the initial videotaping revealed that all faculty were weak (means between 1-2 on a 5-point scale) in many behaviors related to the "S," "A," and "P" sections of the model. The faculty were videotaped 6 months later and assessed again using the SOAP checklist. Data analysis is in progress to measure improvement in behaviors related to the model.

Conclusions: Preliminary data indicates that the SOAP Model appears to be an effective and easy-to-use tool for assessing and improving facilitating skills.

Recent Innovations and Research in Faculty Development
(Fam Med 1997;29(4):281.)

Background and Objectives: Used in combination, role-playing and simulations (ie, training activities designed to reflect reality) can be powerful techniques for teaching attitudes and concepts.

Methods: In 1995, the University of North Carolina faculty development curriculum included a community-based medical education (CBE) segment. Fellows participated in a simulated planning meeting and developed a community rotation for hospital-based residents. The simulation 1) enabled fellows to appreciate the diversity of issues and real-world concerns that arise when planning CBE, 2) demonstrated individual "stakeholder's" effect on program planning and outcome, and 3) illustrated the importance of assessing the community's capacity to support medical education. Fellows divided into two groups; each group was assigned one of eight stakeholder roles (eg, residency director, chief resident, community health center medical director, executive director (not a clinician), and advisory board member).

Results: During the 45-minute session, stakeholders brought out role-specific issues in which they were vested. They also explored capacity issues associated with budgets, staffing, facilities, and space. Afterward, each group conducted a 15-minute review of stakeholder roles to examine the impact of various stakeholders' perspectives on the planning process. During debriefing, participants were allocated time to free themselves from their stakeholder roles. The larger group reconvened for 5-minute reports from small-group leaders who posted program planning outcomes and issues. Patterns and similarities among groups were noted.

Conclusions: Fellows experienced costs, benefits, and effects of program planning decisions without incurring actual risks. Their written evaluations indicated the simulation was "fun," "very instructive," and "very useful" when planning CBE and helped them think about many of the important issues to consider and the importance of consensus-building and problem-solving skills.

Recent Innovations and Research in Faculty Development
(Fam Med 1997;29(4):281.)

Background and Objectives: Inspired by the work of Donald Schon,1 our faculty development center (FDC) developed a "design studio" approach to training teachers of family medicine in the core program areas of teaching, curriculum development, research, administration, and community-based programs.

Methods: While the design studio is a metaphor for practice rather than a physical setting where fellows labor and create, the concept is rooted in the idea of "apprenticeship," in which learning comes from the examples, guidance, and support of physicians, behavioral scientists, and other teachers. In addition to traditional classroom seminars, faculty members present their own research or curricular projects to the seven (1996-1997) fellows and then address the fellows' projects individually in subsequent group meetings to give constructive feedback and encouragement. Thus, teaching is side-to-side rather than face-to-face.

Results: One recent example used a faculty research project on diabetes as a model for instruction. At the beginning of the fellowship year, FDC faculty members and other collaborators developed a proposal (funded by the American Academy of Family Physicians Foundation) to study physician and patient perspectives on diabetes through narrative interviews and clinical observations. The proposal was presented to fellows for discussion and feedback during week one of the program, and utilized by them as a model for developing and presenting their own research designs and grant proposals in subsequent sessions.

Conclusions: By encouraging individual self-reflection and by providing multiple "mirrors," each individual's work is developed and improved through understanding it from the various perspectives of the other group members. The group is cycled through collaborative work in each of these core areas, and each fellow receives the groupÍs attention on his/her project.

Reference
1. Schon DA. Educating the reflective practitioner. San Francisco: Jossey-Bass, 1987

(Fam Med 1997;29(4):282.)

Background and Objectives: Enhancing teaching without compromising patient care is a dilemma for community-based physician faculty. Efforts to improve teaching, which often require off-site workshops, are typically episodic, lack follow-up, and can interfere with patient care. Initial discussions with community-based faculty supported a fellowship with an on-site component as a solution to this dilemma. In response, the Michigan Osteopathic Model (MOM) was developed.

Methods: MOM, partially funded by the Public Health Service, is a part-time, year-long faculty development fellowship with three components: workshops, learning projects, and on-site visits by faculty development specialists. The fellowship curriculum, based on Bland(1) and Battles(2), incorporates curriculum design, instructional methods, clinical teaching, computer competency, and teaching about the underserved. The program is unique in that specialists make monthly visits to observe physicians' formal and clinical teaching. They document the application of teaching/learning principles and skills and provide immediate feedback. Visits also include individualized instruction, videotape reviews, and computer training.

Results: To date, 64 attendings and residents have participated in the fellowship. Progress is documented through field notes and videotapes. For the 1994-1995 fellowship, 85% of the graduates demonstrated competency in instructional methods and 75% in curriculum design. In addition, 91% of the graduates from 1994-1996 (n=34) agreed that the training specialists were an important part of the program, and 94% agreed that specialists helped them apply program components. Observations and products created by participants also reveal that change occurred in their educational vocabulary, evaluation skills, and computer competencies.

Conclusions: On-site delivery allows community-based physicians to participate in faculty development. Training specialists' visits provide one-on-one teaching, individualized feedback, and documentation of behavior change. The presence of specialists, combined with workshops, results in behavior change in physician faculty.

References
1. Bland C, Stritter F, Schmitz C, Aluise J, Henry R. A model curriculum to prepare family medicine physicians to assume the role of new faculty members in either university or community-based educational programs. Minneapolis: University of Minnesota, 1986.
2. Battles J, Kirk L, Dowell D. The residency teacher series flexible training kit. Dallas: University of Texas Southwestern Medical Center, 1989.

(Fam Med 1997;29(4):282.)

Background and Objectives: The growing emphasis on community-based training for medical students challenges faculty development programs to meet the needs of community physicians who want to teach students. Yet, the Fellowship Directory for Family Physicians(1) identifies only four part-time faculty development fellowship programs. Recognizing the need, the University of Arizona implemented a Community-responsive Faculty Development (CRFD) Fellowship in which educational mentors and community physicians collaboratively assess community faculty needs and provide learning experiences to help these physicians acquire and apply critical educational and information management competencies.

Methods: This year-long program incorporates Internet technology to develop physicians' clinical teaching and research skills and introduces them to the application of information technology in these areas. Fellowship faculty use written needs assessments and site visits to participants' clinical settings to plan relevant content for the monthly all-day seminars. Participants are taught to use personal computers (provided by the program) to perform teaching-related tasks (eg, manage student schedules or develop a patient database for teaching) during each session. Hands-on Internet training modules also teach fellows to obtain educational material and access research databases on medical topics. E-mail discussions between seminars reinforce seminar material and model collaboration to address common on-site precepting and research issues. Seminar assignments help participants apply session content with learners in their clinical settings and receive feedback from on-site mentors who work closely with fellowship faculty.

Results and Conclusions: Physicians commit 10% of their time to attend the program sessions and fulfill related obligations. Physicians report that the CRFD Fellowship helps them efficiently obtain practical academic skills, as well as competencies to select and manage information more effectively to enhance their service, education, and research missions as community faculty.

Reference
1. American Academy of Family Physicians and the Society of Teachers of Family Medicine. Fellowship directory for family physicians. Kansas City, Mo: American Academy of Family Physicians, 1996.

(Fam Med 1997;29(4):283.)

Background and Objectives: A review of the literature provides no descriptions of advanced faculty development programs (FDP) explicitly designed to continue developing the competencies needed for success as academic physicians. A 2-year longitudinal FDP was designed for family physicians at the assistant or associate professor rank who are graduates of a faculty development/fellowship program.

Methods: Fifteen faculty participate in one of three tracks: research (n=3), administration (n=6), and education (n=6). The primary goal for this track-based advanced FDP is to increase the scholarly products of faculty (eg, peer-reviewed journal publication, acceptance of instructional materials by STFM) through ongoing small-group instruction and project-based consultation in a focused area of study. Each track meets monthly for 4 hours with content and format determined by track instructor and participants. For example, the education track currently has a dual focus of assessment of learner performance and qualitative research. Instruction in assessment requires participants to collectively develop a test blueprint, write and critique multiple-choice questions for an ambulatory medicine clerkship, and analyze the multiple choice question item/test statistics following exam administration. The qualitative research curriculum is also application oriented; track participants work as a project team to design and implement a study focusing on the careers of family physicians as educators using survey and interview methodologies.

Results and Conclusions: Participant evaluation of and attendance at track sessions are high. Participants report that hands-on experience with real-life educational tasks and limited out-of-class preparation enhances application of track instruction to their own projects. To date, all education track participants have submitted an abstract to Academic Medicine, 83% have submitted a paper to a peer-reviewed journal, and one has submitted an educational booklet to STFM, supporting the efficacy of an advanced FDP to enhance participants' scholarly productivity.

(Fam Med 1997;29(4):283.)

Background and Objectives: Michigan has a strong family medicine faculty development tradition. Michigan State University (MSU) has conducted an academic faculty development fellowship since 1978, and more than 200 family physicians have graduated from that fellowship.

Methods: In 1993, we conducted a needs assessment of residency directors and chairs of Michigan allopathic family practice residencies and departments. The results supported a faculty development approach complementary to the MSU fellowship, designed as a series of monthly 1-day sessions. With the assistance of Division of Medicine funding, we developed and implemented the University of Michigan Family Medicine Faculty Development Institute (FDI).

The FDI is designed specifically for current and future faculty interested in improving their basic classroom and clinical teaching, evaluation, and administrative skills. Faculty use a variety of large- and small-group educational strategies during the sessions conducted in Ann Arbor. In addition to session activities, FDI participants develop a plan for an educational project to be conducted in their home institution and make a 15-minute project presentation.

Eighteen individuals participated in 1994-1995 and 1995-1996. Participants have included faculty, fellows, and third-year residents. We conducted a series of FDI evaluation activities. Each session was evaluated, including an evaluation of the presenters and session content. At the conclusion of each FDI, we conducted an extensive debriefing, including the collection of written and verbal feedback.

In March 1996, we conducted follow-up evaluations with the 1994-1995 FDI participants. Follow-up data were also collected from the supervisors of these participants. An external review was conducted in May 1996. Consultants reviewed the evaluation data, met with the FDI faculty, observed the project presentations and prepared a final report.

Results and Conclusions: These internal and external evaluations indicated high participant and supervisor satisfaction and that the sessions were geared at the appropriate level for the participants and addressed relevant topics and skills.

(Fam Med 1997;29(4):284.)

Background and Objectives: A well-planned faculty evaluation program can promote departmental mission and vision while enhancing individual and unit scholarship. We describe an evaluation process that incorporates a faculty development needs assessment.

Methods: Annually, faculty enumerate career goals in relationship to the department's mission and vision, responsibilities and time commitments, self-assessment of performance, career development efforts and their value, desired changes in responsibilities, and career development objectives and their predicted impact. The department's executive committee reviews evaluations, adds its assessment, and negotiates changes. Finally, the chair and each faculty member meet to review evaluation outcomes and confirm reciprocal commitments for the upcoming year. This process assures group ownership for the success of its individual members, providing advice on career development and minimizing unfocused competition for departmental resources, while considering each faculty member's unique talents and needs. Individualized faculty development is based on faculty's reflection and self-assessment during the evaluation process and is couched in the context of departmental objectives. Each faculty's plan may involve development of a portfolio, mentoring, release time for formal course work, research support, skill development seminars, and self study. Faculty development seminars are provided in areas of broad faculty need or interest.

Results and Conclusions: To evaluate the utility of recent faculty development efforts and to promote planning of future activities, faculty were asked to assess their development needs using a list of 58 skills adapted from Bland et al.(1) In 1993, faculty rated their level of need at the inception of the department's faculty development program. They did so again in 1996. Eighteen items (31%) showed significant reduction in perceived need over 3 years; the rest remained stable. The areas of improvement corresponded with individual and/or group faculty development efforts, specifically in the areas of research, writing, using computers, designing and evaluating educational programs, and decision making.

Reference
1. Bland CJ, Schmitz CC, Stritter FT, Henry RC, Aluise JJ. Successful faculty in academic medicine: essential skills and how to acquire them. New York: Springer Publishing Company, 1990.

(Fam Med 1997;29(4):284.)

Background and Objectives: Success in academic medicine requires faculty to positively influence the process and outcomes of committees, teams, and other task-related groups. These group interaction skills are specifically targeted as one component of a comprehensive faculty development program for family medicine faculty at the Medical College of Wisconsin. This component was developed in collaboration with Alverno College, internationally recognized for its ability-based, outcome-oriented curriculum that incorporates performance-based assessments.

Methods: Two didactic sessions introduce faculty to a standard system for categorizing behaviors observed in a task-oriented group (eg, information and opinion seeking/giving, evaluating, challenging, summarizing, advocating, mediating, blocking) and subsequently translating these behaviors into specific leadership and management dimensions (eg, influence others, foster teamwork, manage disagreements, analyze issues, think strategically). Skills are developed during two group simulations and individual feedback sessions conducted by trained assessors from Alverno College. The group simulations are conducted during half-day sessions 2 months apart.

One simulation requires faculty to prepare recommendations for the vice chair of the department regarding the implications of creating an additional family practice residency program within the department. The other simulation requires faculty to serve on an ad hoc committee charged with proposing methods for documenting leadership and management accomplishments for their annual performance review and ultimately for promotion and tenure. The simulations are videotaped, and assessors provide immediate feedback to faculty regarding their performance on the leadership and management competencies. The assessors help faculty design self-development plans during both feedback sessions.

Results and Conclusions: Faculty report significant increases in their leadership and management competencies following the program. Initially, the program relied on outside consultants to serve as assessors. Recently, the Alverno College consultants/assessors trained a cadre of internal faculty and staff who now serve as assessors for future training sessions, resulting in significant cost savings.

(Fam Med 1997;29(4):285.)

Background and Methods: The Faculty Development Fellowship Program conducted by the Department of Family Practice and Community Health, University of Minnesota Medical School, began training its first cohort of fellows in 1986. This 2-year, full-time fellowship presently has 24 graduates. Didactic requirements in the fellowship include graduate course work based in the department, teaching practica with predoctoral students and residents, and methods courses offered in the School of Public Health. A degree program of the individual's choice is an option to which every fellow has subscribed; a majority selected the MPH in epidemiology (n=14).

Results: A survey of graduates found that 17 presently occupy full- or part-time academic positions. Of the 14 fellowship graduates who pursued the MPH in epidemiology, eight have received major federal or other national-level research grants, are either tenured or occupy positions where they will be reviewed for tenure, or both.

Of the 10 fellowship graduates who selected other degree programs, two occupy positions where they will be reviewed for tenure; none have received major grant funding to date. The degree program selected by fellows is not a predictor for scholarly involvement in education as measured by the development of new curricula. All graduates at either academic medical centers or community-based programs have been productive in this regard. Crucial competencies for carrying out this scholarly activity were gained in the department-based course work required for all fellows.

Conclusions: Future productivity in research is facilitated by an epidemiology degree. Further, both research and education appear to be well served when requisite competencies are addressed through a combination of didactic course work and mentored experiences that approximate in scope those academic responsibilities that graduates are expected to assume.

(Fam Med 1997;29(4):285.)

Background and Objectives: Our department's on-site, comprehensive faculty development program (FDP) instituted an annual research forum in 1991. The forum was designed to provide FDP participants with practical experience writing and reviewing abstracts, promote and recognize collaborative authorship, and foster interaction among faculty from on- and off-campus teaching sites. Ultimately, the forum's goal is to stimulate submission of papers for peer-reviewed publication or national presentation.

Methods: Convening the forum involves four stages. In December, a call for abstracts is distributed to all department faculty, residents, and professional staff. In March, the FDP participants review all abstracts, provide feedback to authors, and outline the forum schedule. During April, accepted authors revise and finalize abstracts for inclusion in the forum booklet. The forum is held in early June and features platform and poster presentations.

By early July, all authors receive a summary of evaluations provided by forum attendees. To determine if the forum was successful at stimulating submission of papers for peer-reviewed publication or national presentation, we surveyed presentation authors. All first authors (n=52) of papers presented since 1991 were surveyed, which included 30 (58%) who were faculty development program participants.

Results: Forty-nine respondents (94%) reported the following: 16 accepted publications (33%), 11 accepted regional or national presentations (22%), and two had publications under review (4%). Eleven authors (22%) were planning to submit their papers, while only nine (17%) reported no further plans.

Conclusions: The forum has successfully met its goal of stimulating submissions for peer-reviewed publication and national presentation. It also provides FDP participants with practical experience writing and reviewing abstracts and encourages collaboration (papers average three authors each). Evaluations reveal that the forum is perceived as a collegial, "safe" atmosphere for receiving project support and encouragement, a factor that may help explain moderately high rates of project dissemination.

(Fam Med 1997;29(4):286.)

Background and Objectives: The medical school at the University of Minnesota (UMN) implemented a 2-day workshop in response to recently established requirements from the National Institutes of Health (NIH) for instruction in the responsible conduct of research for all research trainees and the increasing expectation for the principal investigator in this area. The workshop was required for all medical school faculty and available to NIH trainees in UMNÍs seven Health Sciences Schools.

Methods: The workshop covered nine topics: science and society, laboratory practices (including the uses and care of animal subjects and health and safety issues), principal investigator responsibilities, informed consent, institutional review board, university code of conduct, conflict of interest, authorship and publication, and role of mentors and mentees. Lectures and case discussions were used to address these topics, as well as a brief play on mentor/mentee relationship. The workshop was offered three times and had a total of 806 participants.

Results: The workshop was effective in increasing participant abilities as evidenced by statistically significant improvement on pre/post-multiple choice tests (final pre-workshop average score was 12 out of 21, versus 15 post workshop) and retrospective pre/post ratings of competencies addressed (average rating was 2.58 to 3.53 on a scale where 5=extremely able).

Conclusions: The workshop approach was effective, but the amount of increase on both perceived abilities and on the multiple choice test was less than hoped. Alternative approaches are being considered for next year, such as the workshop followed by department-based seminars for trainees and new faculty and Web-based individualized instruction for veteran faculty as needed, ie, on new issues, regulations, university systems, etc.

(Fam Med 1997;29(4):286.)

Background and Objectives: Based on prior research and current public policy needs, this article identifies five areas that should receive priority in future research on faculty development: 1) To conduct research, greater clarity is needed about the components, competencies, and strategies of faculty development. 2) A stronger link needs to be created between assessment and outcomes of faculty development programs. 3) As faculty roles and career paths change, greater understanding of the nature of professional development is needed. Strategies for promoting teaching, research, and leadership skills require further study. 4) Organizational culture and structure require greater description and illumination as contributors to organizational vitality. 5) Information and instructional technology offer new opportunities for faculty development, but research is needed to determine appropriate uses. Since research takes place in a broader context of societal needs and resources, we conclude with public policy recommendations. We strongly recommend that government, foundations, and universities work together to support fundamental research on faculty development.

(Fam Med 1997;29(4):287-9.)

Background and Objectives: Several recurring conclusions about the changed conditions and future needs of faculty emerged from the articles in this dedicated issue. Faculty work is becoming more differentiated; time is increasingly constrained; and faculty are working in more diverse settings. Faculty reward structures and career ladders are changing, and acquiring additional competencies in new areas is essential. Although less then anticipated, there is some research to guide the development of programs to prepare faculty for these changes.

Based on these conclusions, it is expected that in the future, faculty and program chairs will seek a tight match between what a faculty development effort addresses and the responsibilities of faculty participants and/or the goals of the department or program. The following trends are expected: 1) Regional/national comprehensive programs will often be the best choice for new faculty since many departments and residencies will not have sufficient resources to support their own faculty development programs. 2) Research-oriented faculty will be expected to devote 2 years or more to formal training. 3) Experienced faculty and department/program leaders, many of whom are graduates of our faculty development programs, will need advanced training in targeted areas, through on-site, contextualized education or through individualized programs&emdash;perhaps electronic. 4) Organizational development will be needed to help departments and programs make changes in missions and processes and to maintain a sense of community.

At the same time that new models must be created to meet these future faculty development needs, support for such programs has decreased. Both local and national sources must be recommitted to support faculty development programs and research so we may advance our understanding of cost-effective approaches to faculty development. Funding agencies need to change their guidelines to match the current needs for development and limit funding to programs designed on evidence.

(Fam Med 1997;29(4):290-3.)