K M Skeff

Uppsala University Hospital, Uppsala, Uppsala, Sweden

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Publications (35)132.79 Total impact

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    ABSTRACT: OBJECTIVE: To understand how teaching behaviors contribute to simulation-based learning, we used a 7-category educational framework to assess the teaching behaviors used in basic skills training. METHODS: Twenty-four first-year cardiothoracic surgery residents and 20 faculty participated in the Boot Camp vessel anastomosis sessions. A portable chest model with synthetic graft and target vessels and a tissue-based porcine model simulated coronary artery anastomosis. After each 2-hour session on days 1 and 2, residents assessed teaching behaviors of faculty using a 20-item questionnaire based on the 5-point Likert scale. After session on day 1, faculty completed a self-assessment questionnaire. At 3 months, faculty completed self-assessment questionnaires regarding teaching behaviors in simulation and clinical settings. Each questionnaire item represents 1 or more teaching categories: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," "evaluation," "feedback," and "self-directed learning." RESULTS: Generally, resident ratings indicated that faculty showed positive teaching behaviors. Faculty self-assessment ratings were all lower (P < .025) than those assigned to them by the residents except for 1 component representative of "feedback," which approached significance (P = .04); 2 items, representative of "promoting understanding and retention" and "evaluation", had mean scores of less than 3. At 3 months, compared with self-assessment at Boot Camp, faculty ratings suggested improved teaching behaviors in their simulation settings in the following: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," and "evaluation." The simulation environment was perceived as more positive for technical skills training in certain aspects compared with clinical setting: instructor reviewed function and operation of equipment with learner before session (representative of "promoting understanding and retention") and instructor allowed the learner ample time to practice (representative of "control of session" and "promoting understanding and retention") (P < .025). CONCLUSIONS: Simulation-based skills training is perceived by residents to be associated with positive teaching behaviors. Faculty self-ratings indicate that they do not always use many of these teaching behaviors and that their performance can be improved. The simulation setting may provide greater opportunity for positive teaching behaviors compared with the clinical environment.
    The Journal of thoracic and cardiovascular surgery 10/2012; · 3.41 Impact Factor
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    J Johansson, K M Skeff, G A Stratos
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    ABSTRACT: The Stanford Faculty Development Center at Stanford University has developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model. This study was designed to investigate the relative impact of role playing as an instructional technique within that course for facilitating change in teaching behaviours. From January 2009 to April 2010, six faculty development courses were delivered at Uppsala University Hospital to 48 physicians from different departments. The standard course presentation includes a range of instructional methods including short lectures, small group discussion, review of video re-enactments, role-play exercises and personal goal setting. For this study, participants were randomised to participate in (1) a 'standard' course with role play or (2) an 'alternative' course with no role play. The effects of the course on teaching performance were assessed with retrospective pre- and post-course self-ratings of 29 specific teaching behaviours. Self-assessment ratings indicated significantly greater positive changes in teaching behaviour among faculty who attended the standard course (with role play) as compared to those in the alternative course (p = 0.015). This study validates the commonly held view that role play is a useful instructional method for improving teaching.
    Medical Teacher 01/2012; 34(2):e123-8. · 1.82 Impact Factor
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    ABSTRACT: The Stanford Faculty Development Center (SFDC) at Stanford University developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model. We were curious to see if cultural factors might influence the applicability and impact of the course when delivered to non-American participants by a facilitator from that culture. A Swedish anaesthesiologist at Uppsala University Hospital, Sweden, was trained in October 2004 at Stanford University. From January 2005 to March 2007 he delivered five faculty development seminar series at Uppsala University Hospital to 40 physicians from different departments. Participants rated the usefulness of the seminar series and retrospective pre- and post-seminar ratings were used to assess effects on participants' teaching skills and behaviours. Participants rated the seminars as highly useful (M = 4.8, SD = 0.4). Participants' ratings of their teaching ability indicated significant increases across a variety of clinical and non-clinical teaching settings (p < 0.001), and positive changes in teaching behaviours were found for all seven educational categories assessed (p < 0.001). This faculty development model is highly transportable to medical teachers in Sweden, and capable of producing positive results, consistent with those found in the United States.
    Medical Teacher 08/2009; 31(8):e377-82. · 1.82 Impact Factor
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    ABSTRACT: Faculty and academic institutions face significant challenges in delivering effective ambulatory-care teaching to house staff and medical students. The effects of a faculty-development program on individual ambulatory-care faculty's knowledge, skills, and attitudes; and on participants' recommendations for improving the ambulatory-care environment were examined. The faculty development program trained faculty in either clinical teaching (CT), medical decision making (MDM), or preventive medicine (PM). Ten facilitators implemented a faculty-development program for 64 ambulatory-care faculty. On a 5-point scale (1 = definitely not, 5 = definitely yes), participants rated the usefulness of the seminars as 4.8 or greater. For the CT seminars, statistically significant pre- to post-intervention improvements were found for all seven categories of teaching skills covered (p< 0.001). For the MDM seminars, the participants' content knowledge increased from a pretest mean of 49% correct to a posttest mean of 70% correct (p = 0.01). Participants formulated 45 recommendations for improving the ambulatory-care setting; approximately one-half of these recommendations had been implemented by the institutions 6 months after completion of the program. Faculty-development programs improve the skills of individual faculty and may provide a method for generating recommendations to improve ambulatory-care education and patient care at the institutional level.
    07/2009; 19(4):285-292.
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    Kelley M Skeff
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    ABSTRACT: The process of teaching is ubiquitous in medicine, both in the practice of medicine and the promotion of medical science. Yet, until the last 50 years, the process of medical teaching had been neglected. To improve this process, the research group at the Stanford Faculty Development Center for Medical Teachers developed an educational framework to assist teachers to analyze and improve the teaching process. Utilizing empirical data drawn from videotapes of actual clinical teaching and educational literature, we developed a seven-category systematic scheme for the analysis of medical teaching, identifying key areas and behaviors that could enable teachers to enhance their effectiveness. The organizational system of this scheme is similar to that used in natural sciences, such as genetics. Whereas geneticists originally identified chromosomes and ultimately individual and related genes, this classification system identifies major categories and specific teaching behaviors that can enhance teaching effectiveness. Over the past two decades, this organizational framework has provided the basis for a variety of faculty development programs for improving teaching effectiveness. Results of those programs have revealed several positive findings, including the usefulness of the methods for a wide variety of medical teachers in a variety of settings. This research indicates that the development of a framework for analysis has been, as in the natural sciences, an important way to improve the science of the art of teaching.
    Transactions of the American Clinical and Climatological Association 02/2007; 118:123-32.
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    ABSTRACT: This article focuses on the evolution of faculty development in medicine. Of note, improving teaching in medical education is not a new concept. At a minimum, it was seriously discussed by pioneers like George Miller and Steve Abrahamson as early as the 1950s [Simpson & Bland (2002). Stephen Abrahamson, PhD, ScD, educationist: A stranger in a kind of paradise. Advances in Health Science Education Theory Practice, 7, 223–234]. By 2005, significant numbers of medical school faculty have participated in teaching improvement methods [Clark et al. (2004). Teaching the teachers: National survey of faculty development in departments of medicine of US teaching hospitals. Journal General Internal Medicine, 19, 205–14]. Yet, views of the importance and value of faculty development have evolved slowly. Fortunately, we are now in a more receptive era for program developers to assist faculty in their difficult roles.
    Teaching and Teacher Education - TEACH TEACH EDUC. 01/2007; 23(3):280-285.
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    Journal of General Internal Medicine 04/2004; 19(3):286-7. · 3.28 Impact Factor
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    Journal of General Internal Medicine 03/2004; 19(3):286 - 287. · 3.28 Impact Factor
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    Journal of General Internal Medicine 01/2003; 12(s2):56 - 63. · 3.28 Impact Factor
  • Academic Medicine 11/1999; 74(10 Suppl):S25-7. · 3.29 Impact Factor
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    ABSTRACT: Community-based clinical teachers provide an important cadre of faculty for medical education. This study was designed to examine the feasibility and value of an American College of Physicians-sponsored regional teaching improvement program for community-based teachers. We conducted five regional (Connecticut, New Hampshire/Vermont, New York, Ohio, and Virginia) 1- to 2-day teaching-improvement workshops for 282 faculty (49% community based, 51% university based). The workshops were conducted by regional facilitators trained by the Stanford Faculty Development Program using large group and small group instructional methods to teach participants a framework for analyzing teaching, to increase their repertoire of teaching behaviors, to define personal teaching goals, and to identify the educational needs of their teaching site. Participants used Likert ratings [1 (low) to 5 (high) scale] to assess workshop quality, facilitator effectiveness, and rewards for and barriers to teaching in their clinics. Using retrospective pre- and postintervention ratings, participants also assessed workshop impacts on teacher knowledge, attitudes, and skills. Finally, participants completed open-ended questions to identify recommended changes to improve their clinic as an educational site for students and residents. At all sites, participants evaluated the program as highly useful (4.6 +/- 0.6, mean +/- SD). Participants' ratings indicated that the program had a positive effect on their knowledge of teaching principles (4.0 +/- 0.9), an increase in their teaching ability (P <0.001), and an increase in their sense of integration with their affiliated institution (P <0.001). Regional training of university and community faculty can be an effective way of promoting the improvement of teaching and the collaboration between community-based teachers and academic centers. National physician organizations and regionally based facilitators can provide important resources for the delivery of such training.
    The American Journal of Medicine 01/1999; 106(1):76-80. · 5.30 Impact Factor
  • K M Skeff, S Mutha
    New England Journal of Medicine 01/1999; 339(27):2015-7. · 51.66 Impact Factor
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    ABSTRACT: Background: Among nonmedical educators, longitudinal faculty development programs most effectively increase teachers' abilities. Despite most medical settings providing little reinforcement for newinstructional skills, teaching improvement programs infrequently have explicit ongoing activities. We carried out a longitudinal program for medical educators designed to reinforce and firmly establish new teaching skills. Description: We conducted a longitudinal(18 months of biweekly 1-hr meetings) faculty development program. Its activities followed an initial structured seminar series, and the ongoing meetings involved reviewing video tapes of participants' teaching, enacting and debriefing role-plays, and a modified Balint group for medical educators. Evaluation: We assessed the program's process and outcomes using attendance, self-reported teaching behaviors, perceived program usefulness, educational administrative responsibilities, and qualitative analysis of audiotapes and session notes. Conclusions: Participants maintained high attendanceduring18months of meetings. Ratings of usefulness were high, comparable to other faculty development activities with established utility, and qualitative data support unique benefits of the ongoing meetings. The longitudinal component built on the initial seminar series; it seemed to enhance collegial support, to allow observation of instructional outcomes to reinforce newinstructional skills, and to foster greater involvement in the institution's teaching activities. Teaching improvement programs for physician educators have taken several forms, from workshops and expert consultations to month-long minisabbaticals. However, most are single or sequenced interventions, without an explicit long-term component. We present the structure of an 18-month program for clinician teachers and report observations supporting the program's utility. We hope that this descriptive study promotes greater attention to and subsequent prospective research of longitudinal faculty development.
    Teaching and Learning in Medicine 01/1999; 11(1):52-57. · 0.94 Impact Factor
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    ABSTRACT: To examine an instrument for evaluating clinical teaching using factor analysis and to refine the validated instrument to a practical length. Factor analysis on a split sample of 1,581 student evaluations rating 178 teachers. The instrument was based on the seven-category Stanford Faculty Development Program's (SFDP's) clinical teaching framework and contained 58 Likert-scaled items, with at least seven items per category plus five items measuring "teacher's knowledge." Standard methodology for survey item reduction was used to remove items with low or complex factor loadings and iteratively remove items with low item-scale correlation. Results were replicated on the second sample. The seven original categories emerged and items originally categorized under "knowledge" statistically combined with "promoting self-directed learning." Over 73% of the variance was explained. Item reduction resulted in 25 items with overall internal consistency over .97 and internal consistency of constructs ranging from .82 to .95. Factor analysis of student ratings validated the seven-category SFDP framework. An abbreviated instrument to measure the seven categories is described. Results suggest that students may not systematically distinguish between their teachers' knowledge and their teachers' ability to promote self-directed learning, an important finding for both administrators and faculty development programs.
    Academic Medicine 07/1998; 73(6):688-95. · 3.29 Impact Factor
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    ABSTRACT: Relatively little research has focused on faculty development methods that assist basic science teachers to improve their instructional skills. This study was designed to assess the effectiveness for basic science faculty of a faculty development seminar series that had been previously shown useful for clinical teachers. The Stanford Faculty Development Program's seminars on clinical teaching were adapted for basic science instruction. Eight pathology faculty participated in a series of nine small-group seminars designed to provide teachers with knowledge of a framework for analyzing teaching and identifying areas for improvement, and skill-based training in specific teaching behaviors. Each seminar included (1) brief lectures, (2) review of videotaped reenactments of teaching interactions, (3) role-play exercises with videotape review, and (4) formulation of personal and departmental teaching goals. Program evaluation included multiple measures: participant self-assessment, student ratings of the participants, and blinded ratings of pre- and post-seminar videotapes of participants' classroom teaching. All measures indicated a positive effect of the intervention. Faculty development programs have significant potential to enhance basic science instructors' teaching effectiveness.
    Academic Medicine 07/1998; 73(6):701-4. · 3.29 Impact Factor
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    ABSTRACT: To evaluate whether clinical-teaching skills could be improved by providing teachers with augmented student feedback. A randomized, controlled trial in 1994 included 42 attending physicians and 39 residents from the Department of Medicine at the Indiana University School of Medicine who taught 110 students on medicine ward rotations for one-month periods. Before teaching rotations, intervention group teachers received norm-referenced, graphic summaries of their teaching performances as rated by students. At mid-month, intervention group teachers received students' ratings augmented by individualized teaching-effectiveness guidelines based on the Stanford Faculty Development Program framework. Linear models were used to analyze the students' mean ratings of teaching behaviors at mid-month and end-of-month. Independent variables included performance ratings, intervention status, teacher status, teaching experience, and interactions with baseline ratings. Complex interactions with baseline performance were found for most teaching categories at mid-month and end-of-month. The intervention-group teachers who had high baseline performance scores had higher student ratings than did the control group teachers with similar baseline scores; the intervention group teachers who had low baseline performance scores were rated lower than were the control group teachers with comparable baseline scores. The residents who had medium or high baseline scores were rated higher than were the attending physicians with comparable baseline scores; the performance of the residents who had low baseline scores was similar to that of the attending physicians with comparable baseline scores. Baseline performance is important for targeting those teachers most likely to benefit from augmented student feedback. Potential deterioration in teaching performance warrants a reconsideration of distributing students' ratings to teachers with low baseline performance scores.
    Academic Medicine 04/1998; 73(3):324-32. · 3.29 Impact Factor
  • Academic Medicine 11/1997; 72(10 Suppl 1):S7-9. · 3.29 Impact Factor
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    Journal of General Internal Medicine 05/1997; 12 Suppl 2:S56-63. · 3.28 Impact Factor
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    ABSTRACT: Faculty development programs have focused on the improvement of clinical teaching for several decades, resulting in a wide variety of programs for clinical teachers. With the current constraints on medical education, faculty developers must reexamine prior work and decide on future directions. This article discusses 1) the rationale for providing faculty development for clinical teachers, 2) the competencies needed by clinical teachers, 3) the available programs to assist faculty to master those competencies, and 4) the evaluation methods that have been used to assess these programs. Given this background, we discuss possible future directions to advance the field.
    Family medicine 05/1997; 29(4):252-7. · 1.20 Impact Factor
  • K M Skeff, P Pompei, G A Stratos
    Journal of General Internal Medicine 08/1996; 11(7):435-6. · 3.28 Impact Factor

Publication Stats

751 Citations
132.79 Total Impact Points

Institutions

  • 2009–2012
    • Uppsala University Hospital
      Uppsala, Uppsala, Sweden
  • 1988–2009
    • Stanford University
      • • Department of Medicine
      • • Division of General Medical Disciplines
      Palo Alto, California, United States
  • 1988–2004
    • Stanford Medicine
      • Department of Medicine
      Stanford, California, United States
  • 1998–1999
    • Indiana University-Purdue University Indianapolis
      • Department of Medicine
      Indianapolis, IN, United States
  • 1997
    • Palo Alto University
      • Department of Medicine
      Palo Alto, CA, United States