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ABSTRACT: The authors reflect on the creation of the Doctoring program at the UCLA School of Medicine two decades ago. Although Doctoring-at UCLA and other institutions where it has been implemented-has successfully taught large numbers of students psychosocial content and communications skills that are often overlooked in traditional medical school curricula and has had an impact on the larger culture of medical education, the authors believe that its full promise remains unfulfilled. Of the many practical difficulties they encountered in creating and implementing this comprehensive program, the greatest barriers, by far, were cultural. The authors argue that the impact of programs like Doctoring-programs that attempt not only to change the content of what students learn but also to encourage students to think critically and to question fundamental aspects of the way medicine is taught, learned, and practiced-cannot grow unless and until the larger culture of medicine also changes. They offer recommendations for overcoming barriers to improve the next generation of Doctoring and similar programs; these include changing the philosophy behind the selection of medical students, providing far greater resources and support for course faculty, and altering incentives for medical school faculty. They conclude that until major cultural and structural barriers are overcome and the values that Doctoring and like programs attempt to engender become the primary values of the larger culture they seek to change, these programs will continue in fundamental ways to function outside the dominant culture of medicine.
Academic medicine: journal of the Association of American Medical Colleges 04/2013; 88(4):438-441. · 2.34 Impact Factor
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Michael S Wilkes
Journal of General Internal Medicine 06/2011; 26(8):824-5. · 2.83 Impact Factor
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ABSTRACT: Medical genetics lends itself to disseminated teaching methods because of mismatches between numbers of physicians having patients with genetic disorders and availability of genetic specialists.
During 3 years, we implemented an interactive, web-based curriculum on ethical, legal, and social implications in medical genetics for primary care residents in three specialties at three institutions. Residents took five (of 10) cases and three (of five) tutorials that varied by specialty. We assessed changes in self-efficacy (primary outcome), knowledge, application, and viewpoints.
Overall enrollment was 69% (279/403). One institution did not complete implementation and was dropped from pre-post comparisons. We developed a six-factor ethical, legal, and social implications self-efficacy scale (Cronbach α = 0.95). Baseline self-efficacy was moderate (71/115; range: 23-115) and increased 15% after participation. Pre-post knowledge scores were high and unchanged. Residents reported that this curriculum covered ethical, legal, and social implications/genetics better than their usual curricula. Most (68-91%) identified advantages, especially in providing flexibility and stimulating self-directed learning. After participation, residents reported creating learning goals (66%) and acting on those goals (62%).
Ethical, legal, and social implications genetics curricular participation led to modest self-efficacy gains. Residents reported that the curriculum covered unique content areas, had advantages over traditional curriculum, and that they applied ethical, legal, and social implications content clinically. We share lessons from developing and implementing this complex web-based curriculum across multiple institutions.
Genetics in medicine: official journal of the American College of Medical Genetics 06/2011; 13(6):553-62. · 3.92 Impact Factor
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ABSTRACT: Worldwide, health care providers use strikes and job actions to influence policy. For health care providers, especially physicians, strikes create an ethical tension between an obligation to care for current patients (e.g., to provide care and avoid abandonment) and an obligation to better care for future patients by seeking system improvements (e.g., improvements in safety, to access, and in the composition and strength of the health care workforce). This tension is further intensified when the potential benefit of a strike involves professional self-interest and the potential risk involves patient harm or death. By definition, trainees are still forming their professional identities and values, including their opinions on fair wages, health policy, employee benefits, professionalism, and strikes. In this article, the authors explore these ethical tensions, beginning with a discussion of reactions to a potential 2005 nursing strike at the University of California, Davis, Medical Center. The authors then propose a conceptual model describing factors that may influence health care providers' decisions to strike (including personal ethics, personal agency, and strike-related context). In particular, the authors explore the relationship between training level and attitudes toward taking a job action, such as going on strike. Because trainees' attitudes toward strikes continue to evolve during training, the authors maintain that open discussion around the ethics of health care professionals' strikes and other methods of conflict resolution should be included in medical education to enhance professionalism and systems-based practice training. The authors include sample case vignettes to help initiate these important discussions.
Academic medicine: journal of the Association of American Medical Colleges 03/2011; 86(5):580-5. · 2.34 Impact Factor
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ABSTRACT: We undertook this investigation to characterize conflict of interest (COI) policies of biomedical journals with respect to authors, peer-reviewers, and editors, and to ascertain what information about COI disclosures is publicly available.
We performed a cross-sectional survey of a convenience sample of 135 editors of peer-reviewed biomedical journals that publish original research. We chose an international selection of general and specialty medical journals that publish in English. Selection was based on journal impact factor, and the recommendations of experts in the field. We developed and pilot tested a 3-part web-based survey. The survey included questions about the presence of specific policies for authors, peer-reviewers, and editors, specific restrictions on authors, peer-reviewers, and editors based on COI, and the public availability of these disclosures. Editors were contacted a minimum of 3 times.
The response rate for the survey was 91 (67%) of 135, and 85 (93%) of 91 journals reported having an author COI policy. Ten (11%) journals reported that they restrict author submissions based on COI (e.g., drug company authors' papers on their products are not accepted). While 77% report collecting COI information on all author submissions, only 57% publish all author disclosures. A minority of journals report having a specific policy on peer-reviewer 46% (42/91) or editor COI 40% (36/91); among these, 25% and 31% of journals state that they require recusal of peer-reviewers and editors if they report a COI. Only 3% of respondents publish COI disclosures of peer-reviewers, and 12% publish editor COI disclosures, while 11% and 24%, respectively, reported that this information is available upon request.
Many more journals have a policy regarding COI for authors than they do for peer-reviewers or editors. Even author COI policies are variable, depending on the type of manuscript submitted. The COI information that is collected by journals is often not published; the extent to which such "secret disclosure" may impact the integrity of the journal or the published work is not known.
Journal of General Internal Medicine 01/2007; 21(12):1248-52. · 2.83 Impact Factor
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PLoS Medicine 07/2006; 3(6):e137. · 16.27 Impact Factor
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ABSTRACT: Medical students currently interface more and more with community-based physicians, many of whom have little training or experience as educators. They also start their ambulatory experiences from the beginning of their medical school training, not just at the clerkship year. This has prompted substantial literature on the need for improved faculty development for community preceptors, which is widely believed to be inadequate at present. The authors describe a novel program, designed to augment community preceptor teaching skills and practice behaviors, focusing on topics relating to humanism, communication, and psychosocial issues common in primary care. The program was conducted for four years beginning in 1999 and organized around acknowledged attributes of successful adult learning, and used case-based, small-group sessions, where individual community preceptors were each asked to "teach" a series of standardized students, in front of the group, regarding issues raised by a number of hypothetical patient cases. The standardized students had in turn been trained by the authors to interact with the participating faculty in a defined manner. The small-group sessions were led by community "opinion leaders" who had been chosen for this role by the participants, and who themselves first underwent training by the authors to familiarize them with core concepts felt to be essential to the program. At the conclusion of the entire process, surveys of the opinion leaders, the other community preceptor participants, and the standardized students suggested that the program did stimulate significant changes in attitude and behavior, although further research is needed to confirm this.
Academic Medicine 05/2006; 81(4):332-41. · 3.52 Impact Factor
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ABSTRACT: Although the benefits of prostate cancer screening are uncertain and guidelines recommend that physicians share the screening decision with their patients, most U.S. men over age 50 are routinely screened, often without counseling.
To develop an instrument for assessing physicians' knowledge related to the U.S. Preventive Services Task Force recommendations on prostate cancer screening.
Seventy internists, family physicians, and general practitioners in the Los Angeles area who deliver primary care to adult men.
We assessed knowledge related to prostate cancer screening (natural history, test characteristics, treatment effects, and guideline recommendations), beliefs about the net benefits of screening, and prostate cancer screening practices for men in different age groups, using an online survey. We constructed a knowledge scale having 15 multiple-choice items.
Participants' mean knowledge score was 7.4 (range 3 to 12) of 15 (Cronbach's alpha=0.71). Higher knowledge scores were associated with less belief in a mortality benefit from prostate-specific antigen (PSA) testing (r=-.49, P<.001). Participants could be categorized as low, age-selective, and high users of routine PSA screening. High users had lower knowledge scores than age-selective or low users, and they believed much more in mortality benefits from PSA screening.
Based on its internal consistency and its correlations with measures of physicians' net beliefs and self-reported practices, the knowledge scale developed in this study holds promise for measuring the effects of professional education on prostate cancer screening. The scale deserves further evaluation in broader populations.
Journal of General Internal Medicine 05/2006; 21(4):310-4. · 2.83 Impact Factor
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ABSTRACT: This article provides a framework for understanding the nature, role, functioning, design, and effects of organizational oversight systems. Using a case study with elements recognizable to an academic audience, the authors explore how a dean of a fictitious School of Medicine might use organizational control structures to develop effective solutions to global disarray within the academic medical center. Organizational control systems are intended to help influence the behavior of people as members of a formal organization. They are necessary to motivate people toward organizational goals, to coordinate diverse efforts, and to provide feedback about problems. The authors present a model of control to make this process more visible within organizations. They explore the overlap among academic medical centers and large businesses-for instance, each is a billion-dollar enterprise with complex internal and external demands and multiple audiences. The authors identify and describe how to use the key components of an organization's control system: environment, culture, structure, and core control system. Elements of the core control system are identified, described, and explored. These closely articulating elements include planning, operations, measurement, evaluation, and feedback systems. Use of control portfolios is explored to achieve goal-outcome congruence. Additionally, the authors describe how the components of the control system can be used synergistically by academic leadership to create organizational change, congruent with larger organizational goals. The enterprise of medicine is quickly learning from the enterprise of business. Achieving goal-action congruence will better position academic medicine to meet its multiple missions.
Academic Medicine 12/2005; 80(11):1054-63. · 3.52 Impact Factor
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ABSTRACT: Direct-to-consumer (DTC) advertising of prescription drugs in the United States is both ubiquitous and controversial. Critics charge that it leads to overprescribing, while proponents counter that it helps avert underuse of effective treatments, especially for conditions that are poorly recognized or stigmatized.
To ascertain the effects of patients' DTC-related requests on physicians' initial treatment decisions in patients with depressive symptoms.
Randomized trial using standardized patients (SPs). Six SP roles were created by crossing 2 conditions (major depression or adjustment disorder with depressed mood) with 3 request types (brand-specific, general, or none).
Offices of primary care physicians in Sacramento, Calif; San Francisco, Calif; and Rochester, NY, between May 2003 and May 2004.
One hundred fifty-two family physicians and general internists recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%.
The SPs were randomly assigned to make 298 unannounced visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. The SPs made a brand-specific drug request, a general drug request, or no request (control condition) in approximately one third of visits.
Data on prescribing, mental health referral, and primary care follow-up obtained from SP written reports, visit audiorecordings, chart review, and analysis of written prescriptions and drug samples. The effects of request type on prescribing were evaluated using contingency tables and confirmed in generalized linear mixed models that accounted for clustering and adjusted for site, physician, and visit characteristics.
Standardized patient role fidelity was excellent, and the suspicion rate that physicians had seen an SP was 13%. In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific, general, and no requests, respectively (P<.001). In adjustment disorder, antidepressant prescribing rates were 55%, 39%, and 10%, respectively (P<.001). The results were confirmed in multivariate models. Minimally acceptable initial care (any combination of an antidepressant, mental health referral, or follow-up within 2 weeks) was offered to 98% of SPs in the major depression role making a general request, 90% of those making a brand-specific request, and 56% of those making no request (P<.001).
Patients' requests have a profound effect on physician prescribing in major depression and adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse.
JAMA The Journal of the American Medical Association 05/2005; 293(16):1995-2002. · 30.03 Impact Factor
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ABSTRACT: To explore the use of graphical animation for helping clinicians to understand the evidence about expected risks and benefits associated with multi-step clinical management strategies.
We used Flash and XML to create a tool capable of displaying the sequence of health state changes that may result from a specific management strategy, as applied to a simulated population. We evaluated this tool in 6 focus groups involving a total of 44 community internists and family physicians. We successively revised the tool based on grounded theory analysis of the focus group transcripts.
The process of responding to design issues raised in focus groups resulted in a final tool that presents a group of person icons arranged in rows to give the illusion of people in a stadium or theater. Each action in the management strategy causes persons to change color and move among rows to reflect changes in health state. The tool can play audio narration to explain each step and links are provided to the supporting evidence. Most physicians found these visualizations to be attractive and clear. Some were interested in using the tool with patients. Others rejected the specific decision model used to demonstrate the tool and a few rejected the notion of applying quantitative risks to individual patients.
A visual approach to demonstrating the possible benefits and harms of a given management strategy holds interest for many clinicians. However, visualizations may fail to influence clinicians who do not believe the available evidence.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 02/2005;
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ABSTRACT: We characterized the quantity and quality of graphs in all pharmaceutical advertisements, in the 10 U.S. medical journals. Four hundred eighty-four unique advertisements (of 3,185 total advertisements) contained 836 glossy and 455 small-print pages. Forty-nine percent of glossy page area was nonscientific figures/images, 0.4% tables, and 1.6% scientific graphs (74 graphs in 64 advertisements). All 74 graphs were univariate displays, 4% were distributions, and 4% contained confidence intervals for summary measures. Extraneous decoration (66%) and redundancy (46%) were common. Fifty-eight percent of graphs presented an outcome relevant to the drug's indication. Numeric distortion, specifically prohibited by FDA regulations, occurred in 36% of graphs.
Journal of General Internal Medicine 05/2003; 18(4):294-7. · 2.83 Impact Factor
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ABSTRACT: We characterized the quantity and quality of graphs in all pharmaceutical advertisements, in the 10 U.S. medical journals. Four hundred eighty-four unique advertisements (of 3,185 total advertisements) contained 836 glossy and 455 small-print pages. Forty-nine percent of glossy page area was nonscientific figures/images, 0.4% tables, and 1.6% scientific graphs (74 graphs in 64 advertisements). All 74 graphs were univariate displays, 4% were distributions, and 4% contained confidence intervals for summary measures. Extraneous decoration (66%) and redundancy (46%) were common. Fifty-eight percent of graphs presented an outcome relevant to the drug's indication. Numeric distortion, specifically prohibited by FDA regulations, occurred in 36% of graphs.
Journal of General Internal Medicine 03/2003; 18(4):294 - 297. · 2.83 Impact Factor
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ABSTRACT: The practice of medicine has changed dramatically over the last 3 decades. Medical education has struggled to keep up with these changes, with only limited success. The 4th year of medical school offers a tremendous opportunity for curricular innovation, but little change has occurred in the past 30 years.
This article traces the history of the 4th year, from the Flexnerian era in which the classic preclinical-clinical model for medical education was developed, through the 1970s, when virtually every medical school adopted a largely elective 4th year, to the present. Although the classic 4th-year curriculum has a number of strengths such as flexibility and relative autonomy of scheduling for students, it also has significant weaknesses.
A major educational initiative for the 4th year-the "College Phase"-has been implemented at the David Geffen School of Medicine at UCLA. It is designed to remedy many of the weaknesses of the 4th-year curriculum while preserving the benefits.
Five colleges have been created: acute care, applied anatomy, medical science, primary care, and urban underserved. Students participate in a number of different college-specific activities that are hoped to produce a more engaging, rigorous, and enriching experience for students and faculty alike
Teaching and Learning in Medicine 02/2003; 15(3):186-93. · 0.75 Impact Factor
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ABSTRACT: Purpose: To assess how new National Board of Medical Examiners (NBME) performance examinations-computerbased case simulations (CBX) and standardized patient exams (SPX)-compare with each other and with traditional internal and external measures of medical students' performances. Secondary objectives examined attitudes of students toward new and traditional evaluation modalities.
Method: Fourth-year students (n = 155) at the University of California, Los Angeles, School of Medicine (including joint programs at Charles R. Drew University of Medicine and Science and University of California, Riverside) were assigned two days of performance examinations (eight SPXs, ten CBXs, and a self-administered attitudinal survey). The CBX was scored by the NBME and the SPX by a NBME/Macy consortium. Scores were linked to the survey and correlated with archival student data, including traditional performance indicators (licensing board scores, grade-point averages, etc.).
Results: Of the 155 students, 95% completed the testing. The CBX and the SPX had low to moderate statistically significant correlations with each other and with traditional measures of performance. Traditional measures were intercorrelated at higher levels than with the CBX or SPX. Students' perceptions of the various evaluation methods varied based on the assessment. These findings are consistent with the theoretical construct for development of performance examinations. For example, to assess clinical decision making, students rated the CBX best, while they rated multiple-choice examinations best to assess knowledge.
Conclusion: Examination results and student perception studies provide converging evidence that performance examinations measure different physician competency domains and support using multipronged assessment approaches.
Accurately measuring physicians' competencies is a crucial step toward improving medical education and, in turn, improving health care.1,2 The need to rigorously evaluate physicians' performances (by measuring, among other things, process, outcome, and effectiveness) pervades the economic, social, and scientific debates surrounding health care reform.3-5 The growing concern for accountability is demonstrated in current proposals in both the public and private sectors to develop and implement practice guidelines, outcomes assessment, evidence-based medicine, and measures such as consumer satisfaction surveys. Professional oversight bodies at the national, state, and local levels are challenging medical schools to undertake curricular reforms, including assessment procedures that will assure that graduates will be able to practice successfully and contribute to improved patient care in the newly restructured health care environment in the United States.4,6,7
Given the pronounced scrutiny of physicians' performances and educational reform, it is easy to understand why new evaluation methods are receiving increased attention in medical schools.8-10 There is concern that traditional measures of performance (multiple-choice examinations, medical licensing examinations, grades, and narrative rating forms) are constrained, subjective, or test recall and memorization, rather than application and decision making. Schools are increasingly turning to such simulated performance-evaluation methods as standardized-patient examinations (SPXs; in which students interact with patients who are portrayed by actors or specially trained patients) and computer-based case-simulation examinations (CBXs; in which students interactively manage medical scenarios presented on computers), which assess complex behavioral and cognitive dimensions. Both SPXs and CBXs allow students to experience realistic problems and demonstrate the ability to make clinical judgments without the risk of harm to actual patients.11-13 The student's decision-making process is captured for later analysis either in the computer's memory or on videotape. Each method of simulation has its own theoretical strengths and limitations. CBXs can avoid cueing students' responses by presenting cases that have multiple pathways and unfold over time, revealing pertinent information in stages. After the examination, educators can explore in detail the subcomponents of the student's decision-making process-such as sequencing, timing, and pathway-to reveal and classify management errors.14-21 SPXs evaluate students' questioning patterns, their communication and interpersonal skills, and their abilities to conduct a patient history and physical examination.
Confidence in cognitive-behavioral (performance) examination methods was evidenced by the 1995 decision of the governing bodies of the National Board of Medical Examiners (NBME) and the Federation of State Medical Board Examiners to implement a computer-based case-simulation examination (named Primum) as part of the United States Medical Licensing Examination (USMLE) Step 3 in the fall of 1999.12 Primum is the new Windows-based revision of the DOS version of the CBX. They also endorsed the eventual inclusion of an SPX in the licensure process.22 Other professions (such as airline pilots, nuclear reactor engineers, lawyers, and architects) have already incorporated such performance measures in their training, professional licensing, and assessment.23-25
However, enthusiasm for these newer examinations is not universal. Some education and measurement experts cite the need to further study the validity of performance examinations and are quick to remind us that simulations are, by definition, abstractions of reality and thus can miss significant aspects of the complex real-practice environment.26,27 A growing body of research suggests that a combination of evaluation methods is necessary to properly assess the complex skills that make up the practice of medicine.2,16,23,26,28
Research of evaluation methods has made educators and test developers more sensitive to the concept of consequential validity,29 which addresses the correspondence between the purpose of an examination, the administrative decision making based on the examination results, and the intended and unintended changes in the educational environment based on the examination results. Students' perceptions of examinations are related to the measurement of consequential validity. The perceptions of students help identify whether the test takers share the test makers' conception of an examination's purpose and help anticipate the consequences of performance examinations when used for high-stakes decisions. Little research has addressed medical students' perceptions of the myriad evaluation tools. Test-taker validation may be of added importance in performance examinations, for a number of reasons: (1) students may be less familiar with test formats and react in unexpected ways; (2) the tests require a longer sustained time with each test case and are potentially less frustrating if students perceive they are credible; (3) prompting toward correct answers is reduced because a correct answer is not written on the page; and (4) students are instructed to behave during the simulations as if they were conducting a real-life task. However, the formats may lend themselves to test-taking strategies or gaming plans that were not intended or perceived by the developers. While many studies have examined gender and ethnic differences in performances on multiple-choice examinations and other traditional evaluation methods, little comparative research has been conducted on the interactions of ethnicity and gender as variables modifying performance in the study of medical performance-based examinations.
To date, no one has systematically studied an entire medical school class to compare the SPXs and CBXs developed by the NBME with the more traditional evaluation measures. Such a comparison is important in that performance examinations are increasingly used as teaching and learning devices,30 and medical schools bear large costs, both financial-in terms of developing and administering the examinations22-and emotional-in terms of the burden and distress experienced by the students.
The object of our study was to evaluate the experiences of an entire senior medical school class as they took both traditional standardized examinations and the new performance examinations in order to answer the following questions: (1) How does performance of medical students vary across traditional measures of assessment and the new examinations (CBX and SPX)? (2) How does student performance on traditional methods of evaluation (USMLE) correlate with performances on the CBX and SPX? (3) How do the two new performance examinations of the NBME correlate with each other? (4) What are the attitudes and perceptions of students toward these new evaluation tools compared with traditional measures of performance? (5) Are there subgroup differences that appear on performance examinations that differ from those found with traditional examinations?
Academic Medicine 07/2000; 75(8):825-833. · 3.52 Impact Factor
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Journal of General Internal Medicine 12/1999; · 2.83 Impact Factor
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ABSTRACT: OBJECTIVE: To describe U.S. and Canadian medical journals, their editors, and policies that affect the dissemination of medical information.
DESIGN: Mailed survey.
PARTICIPANTS: Senior editors of all 269 leading medical journals published at least quarterly in the United States and Canada, of whom
221 (82%) responded.
MAIN MEASURES: The questionnaire asked about characteristics of journal editors and their journals and about journals’ policies toward peer
review, conflicts of interest, pre-publication discussions with the press, and pharmaceutical advertisements.
RESULTS: The editors were overwhelmingly men (96%), middle-aged (mean age 61 years), and trained as physicians (82%). Although 98%
claimed that their journals were “peer-reviewed,” the editors differed in how they defined a “peer” and in the number of peers
they deemed optimal for review. Sixty-three percent thought journals should check on reviewers’ potential conflicts of interest,
but only a minority supported masking authors’ names and affiliations (46%), checking reviewers’ financial conflicts of interest
(40%), or revealing reviewers’ names to authors (8%). The respondents advocated discussion of scientific findings with the
press (84%), but only in accord with the Ingelfinger rule, i.e.,after publication of the article (77%). Fifty-seven percent of the editors agreed that journals have a responsibility to ensure
the truthfulness of pharmaceutical advertisements, and 40% favored subjecting advertisements to the same rigorous peer review
as scientific articles.
CONCLUSIONS: The responding editors were relatively homogeneous demographically and professionally, and they tended to support the editorial
status quo. There was little sentiment in favor of tampering with the current peer-review system (however defined) or the
Ingelfinger rule, but a surprisingly large percentage of the respondents favored more stringent review of drug advertisements.
Journal of General Internal Medicine 04/1995; 10(8):443-450. · 2.83 Impact Factor
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ABSTRACT: This article describes two complementary technology systems used in academic medicine to 1) improve the quality of learning and teaching, and 2) describe the barriers and obstacles encountered in implementing these systems.
The literature was integrated with in-depth, case-based experience with technology related to student progression, faculty promotion and school administration.
Academic medicine concerns itself with data and outcomes. Psychiatrists need to attend to their learning and teaching paths as much as to developing the knowledge and skills to manage their patients.
Technology enables us to track, manage, and report these data with increasing ease, making transparency and accuracy more achievable.
Academic Psychiatry 30(6):456-64. · 0.81 Impact Factor
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ABSTRACT: The authors describe in detail the 3-year model of the Doctoring curriculum plus an elective fourth-year Doctoring course at University of California, Davis School of Medicine (UCDSOM) and University of California, Los Angeles (UCLA) School of Medicine and the critical role for psychiatry faculty leadership and participation.
The authors present a review of curricular materials and course operations for the different Doctoring courses for first-, second-, third-, and fourth-year curriculum. The authors describe the role of psychiatry faculty in both leadership and in group facilitation.
The Doctoring curriculum offers case-based, small-group learning that relies heavily on standardized patients to teach core content around doctor-patient communication, ethics, behavioral medicine, and counseling approaches. There are frequent psychosocial issues woven in to these encounters. Psychiatry faculty members and other mental health professionals are well-prepared by virtue of their training to lead small group discussions and facilitate the supportive elements of the small groups in medical education.
The Doctoring curriculum is both a biopsychosocial educational endeavor and a high-visibility leadership opportunity for the Department of Psychiatry. Other medical schools and departments of psychiatry may wish to pursue similar roles in their didactic programs.
Academic Psychiatry 32(3):249-54. · 0.81 Impact Factor
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ABSTRACT: At the University of California, Davis (UCD), the authors sought to develop an institutional network of reflective educational leaders. The authors wanted to enhance faculty understanding of medical education's complexity, and improve educators' effectiveness as regional/national leaders.
The UCD Teaching Scholars Program is a half-year course, comprised of 24 weekly half-day small group sessions, for faculty in the School of Medicine and Veterinary Medicine. The program's philosophical framework was centered on personal reflection to enhance change: 1) understanding educational theory to build metacognitive bridges, 2) diversity of perspectives to broaden horizons, 3) colleagues as peer teachers to improve interactive experiences, and 4) reciprocal process of testing theory and examining practice to reinforce learning. The authors describe the program development (environmental analysis, marketing, teaching techniques), specific challenges, and failed experiments. The authors provide examples of interactive exercises used to enhance curricular content. The authors enrolled 7-10 faculty per year, from a diverse pool of current and near-future educational leaders.
Four years of Teaching Scholars participants were surveyed about program experiences and short/longer term outcomes. Twenty-six (76%) respondents reported that they were very satisfied with the course (4.6/5), individual curricular blocks (4.2-4.6), and other faculty (4.7). They described participation barriers/facilitators. Participants reported positive impact on their effectiveness as educators (100%), course directors (84%), leaders (72%), and educational researchers (52%). They described specific acquired attitudes, knowledge, and skills. They described changes in their approach to education/career changed based on program participation. Combining faculty from different educational backgrounds significantly broadened perspectives, leading to greater/new collaboration.
Developing a cadre of master educators requires careful program planning, implementation, and program/participant evaluation. Based on participant feedback, our program was a success at stimulating change. This open assessment of programmatic strengths and weaknesses may provide a template for other medical institutions that seek to enhance their institutional educational mission.
Academic Psychiatry 31(6):452-64. · 0.81 Impact Factor
