A faculty development program to train tutors to be discussion leaders rather than facilitators

A systematic review of faculty development programs based on the Harden teacher's role framework model

BACKGROUND

Despite the changing roles of faculty in the health professions over the past two decades, none of the reviews has been paid enough attention to the impact of the faculty development programs on these roles. The objective of this review is to synthesize the existing evidence that addresses the questions: "What are the types and outcomes of faculty development programs based on the Harden teachers' role framework and which of the areas described by Harden and Crosby are the authors referring to?"

METHODS

This review was conducted according to the guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In 2020, a literature search was conducted in MEDLINE/PubMed, Scopus, ERIC, ScienceDirect, Google Scholar, Magiran and SID databases. The review included 119 studies (between 1990 and 2020) that met the review criteria. Data were extracted using a modified coding sheet. We used the modified Kirkpatrick model to assess the educational outcomes of faculty development programs.

RESULTS

The majority of faculty development programs were workshops (33.61%) with various durations. Most programs focused on the domain of information provider and coach (76.47%), followed by the facilitator of learning and mentor (53.78%) and assessor and diagnostician (37.81%). Only five faculty development programs focused on the domain of role model. The majority (83.19%) of outcomes reported were at level 2B, level 1 (73.95%) and level 2A (71.42%). Gains in knowledge and skills related to teaching methods and student assessment were frequently noted. Behavior changes included enhanced teaching performance, development of new educational curricula and programs, improved feedback and evaluation processes, new leadership positions, increased academic output and career development. The impact on the organizational practice continued to be underexplored.

CONCLUSION

Based on the review findings, broadening the scope of faculty development programs beyond the traditional roles of the faculty members by utilizing a competency-based framework for developing a comprehensive faculty development program is recommended. Attention to individualized form of faculty development programs and incorporating more informal approaches into the design and delivery of faculty development programs is also needed.

Does your group matter? How group function impacts educational outcomes in problem-based learning: a scoping review

BACKGROUND

Problem-based learning (PBL) is a common instructional method in undergraduate health professions training. Group interactions with and within PBL curricula may influence learning outcomes, yet few studies have synthesized the existing evidence. This scoping review summarized the literature examining the influence of group function on individual student PBL outcomes. Following Kirkpatrick's framework, experiential, academic, and behavioral outcomes were considered. The impacts of three aspects of group function were explored: (1) Group Composition (identities and diversity), (2) Group Processes (conduct and climate, motivation and confidence, and facilitation), and (3) PBL Processes (tutorial activities).

METHODS

A literature search was conducted using Medline, CINAHL, and APA PsychInfo from 1980-2021, with the help of a librarian. English-language empirical studies and reviews that related group function to learning outcome, as defined, in undergraduate health professions PBL curricula were included. Relevant references from included articles were also added if eligibility criteria were met. The methods, results, discussions, and limitations of the sample were summarized narratively.

RESULTS

The final sample (n = 48) varied greatly in context, design, and results. Most studies examined junior medical students (n = 32), used questionnaires for data collection (n = 29), and reported immediate cross-sectional outcomes (n = 34). Group Processes was the most frequently examined aspect of group function (n = 29), followed by Group Composition (n = 26) and PBL Processes (n = 12). The relationships between group function and outcomes were not consistent across studies. PBL experiences were generally highly rated, but favorable student experiences were not reliable indicators of better academic or behavioral outcomes. Conversely, problematic group behaviors were not predictors of poorer grades. Common confounders of outcome measurements included exam pressure and self-study.

CONCLUSIONS

The main findings of the review suggested that (1) group function is more predictive of experiential than academic or behavioral PBL outcomes, and (2) different Kirkpatrick levels of outcomes are not highly correlated to each other. More research is needed to understand the complexity of group function in PBL tutorials under variable study contexts and better inform curricular training and design. Standardized tools for measuring PBL group function may be required for more conclusive findings.

Lessons learned from the initial 4 years of the SBM Mid-Career Leadership Institute

In 2015, the Society of Behavioral Medicine (SBM) created the Mid-Career Leadership Institute. The initial model that motivated the creation of the institute came from my participation in the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) program, specifically designed to enhance the leadership skills of senior female faculty in the health sciences. My participation in ELAM was transformative. It led me to run for president of SBM in 2014, to consider how behavioral scientists could similarly benefit from mid-career leadership training, and ultimately to work with the SBM Executive Director, the SBM Leadership Institute Steering Committee, and leadership training professionals to launch the Leadership Institute in 2016. The overarching goal of the SBM Leadership Institute is to train mid-career behavioral scientists engaged in academic and health care settings to develop essential skills needed to navigate the unique challenges of mid-career. Central to this goal is a focus on integrating diversity, equity, and inclusion into their emerging leadership roles through participation in training exercises, lectures, and dynamic group discussions. To optimize the Leadership Institute experience, opportunities were developed, including mentoring from SBM seasoned members, peer mentoring through the creation of "learning communities," career coaching, and additional networking opportunities. The purpose of this brief commentary is to summarize lessons learned by highlighting program evaluation, describing key changes over the initial 4 years, and sharing future plans for leadership training.

Nurse-Doctor Co-Teaching: A Pilot Study of the Design, Development, and Implementation of Structured Interprofessional Co-Teaching Sessions

INTRODUCTION

High levels of interprofessional collaboration are beneficial for patients and healthcare providers. Co-teaching may be one method for creating a collaborative environment. This pilot study designed, developed, and implemented Nurse-Doctor Co-Teaching on an inpatient medicine service.

METHODS

Ten Nurse-Doctor Co-Teaching pairs designed 30-minute, structured co-teaching sessions with learning objectives, evidence-based content, interactive teaching strategies and a Take-Away of key content with the help of a coaching team. Each session was presented by a nurse and senior doctor to nurse and resident learners. Our assessment blueprint included: 1. Anonymous surveys assessing the overall rating of each session and 2. Pre- and post-anonymous surveys assessing measures of interprofessional collaboration and communication between nurses and residents before and after the series of ten co-teaching sessions.

RESULTS

Data from ten post-session surveys included 121 of 156 participants (77.6%). Attendance at each session ranged from 13-19 participants with 8-17 participants completing a survey per session for an average of 12.1 surveys analyzed. All Nurse-Doctor Co-Teaching sessions scored in the excellent range between 1.00 and 1.43 on a Likert scale (1 is excellent and 5 is poor). In response to the question "What did you like best?", interactive teaching strategies was the most frequent spontaneous answer. A significant correlation between the number of interactive teaching strategies and enjoyability of the session (p-value=0.01) was observed. Measures of interprofessional collaboration and communication did not change significantly in the pre-intervention compared to post-intervention period.

CONCLUSION

We created a unique model of interprofessional co-teaching on an inpatient service. The overall excellent ratings of our interactive sessions indicate that Nurse-Doctor Co-Teaching is a valued form of learning. Our structured format is adaptable to various medical settings and could be expanded to include additional allied health professionals. We plan further studies to assess if Nurse-Doctor Co-Teaching improves measures of interprofessional collaboration.

Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings' Asking Questions

BACKGROUND

Morning bedside rounds remain an essential part of Internal Medicine residency education, but rounds vary widely in terms of educational value and learner engagement.

OBJECTIVE

To evaluate the efficacy of an intervention to increase the number and variety of questions asked by attendings at the bedside and assess its impact.

DESIGN

We conducted a randomized, controlled trial to evaluate the efficacy of our intervention.

PARTICIPANTS

Hospitalist attendings on the general medicine service were invited to participate. Twelve hospitalists were randomized to the experimental group and ten hospitalists to the control group.

INTERVENTION

A one-hour interactive session which teaches and models the method of asking questions using a non-medical case, followed by practice using role plays with medical cases.

MAIN MEASURES

Our primary outcome was the number of questions asked by attendings during rounds. We used audio-video recordings of rounds evaluated by blinded reviewers to quantify the number of questions asked, and we also recorded the type of question and the person asked. We assessed whether learners found rounds worthwhile using anonymous surveys of residents, patients, and nurses.

KEY RESULTS

Blinded analysis of the audio-video recordings demonstrated significantly more questions asked by attendings in the experimental group compared to the control group (mean number of questions 23.5 versus 10.8, p< 0.001) with significantly more questions asked of the residents (p<0.003). Residents rated morning bedside rounds with the experimental attendings as significantly more worthwhile compared to rounds with the control group attendings (p=0.009).

CONCLUSION

Our study findings highlight the benefits of a one-hour intervention to teach faculty a method of asking questions during bedside rounds. This educational strategy had the positive outcome of including significantly more resident voices at the bedside. Residents who rounded with attendings in the experimental group were more likely to "strongly agree" that bedside rounds were "worthwhile".

Does the tutors' academic background influence the learning objectives in problem-based learning?

Background: Problem-based learning (PBL) is an essential element of the curriculum of the Medical University of Vienna (MUV) and is performed in an eight steps model with: clarifying, defining, analysing, shifting & sorting, identifying learning objectives, going to learn and coming back to talk and feedback. With an annual intake of up to 740 students the MUV has to recruit PBL tutors from various academic backgrounds including undergraduate near-peer students. Therefore, we were interested to see whether a tutor's academic background had an influence on the resulting PBL sessions as reflected by the percentage of learning objectives (LOs) which were actually achieved in relation to the intended LOs. Methods: For each PBL session "intended learning objectives" (ILOs) were defined. ILOs were communicated to all tutors by means of PBL session guides in order to provide homogenous learning opportunities to all students. However, it was not mandatory to reach all ILOs. The PBL coordination regarded a range of two thirds to three quarters of ILOs as a desirable goal. For analysis we retrieved data concerning ILOs, characteristics of tutors and PBL groups from the institution's PBL quality assurance system. Results: From 2012-2014, 216 PBL groups were facilitated by 106 tutors with different academic backgrounds. On average, 70.8% (95% CI: 69.2-72.5%) of the ILOs were achieved; MUV clinicians reached 74.3% (70.8-77.8%), MUV non-clinicians 74.2% (71.7-76.6%), external faculty (clinicians and non-clinicians) 68.6% (64.4-72.8%), and near-peer students 64.7% (61.8-67.7%). Statistically significant differences were found between near-peer students and MUV clinicians (p<.001) as well as MUV non-clinicians (p<.001). Conclusions: ILOs were reached within a satisfactory range. However, groups taught by near-peer students reached significantly fewer ILOs than groups taught by MUV faculty tutors. This finding raises the question whether tutor training for near-peer students should be intensified. Also, further research is needed to explore the group dynamics of student-led PBL groups.

Asking a Variety of Questions on Walk Rounds: a Pilot Study

BACKGROUND

Morning walk rounds have lost some of their engagement while remaining a useful and valued practice.

AIM

We created a pilot study to evaluate the impact on rounds of learning to asking a variety of different questions.

SETTING

One-hour intervention sessions were voluntarily offered to members of the Department of Medicine and taught by an expert in the question, listen, and respond method.

PARTICIPANTS

Participants included attendings and residents in Internal Medicine on medical teams.

PROGRAM DESCRIPTION

Questionnaires were collected on six pre-intervention and six post-intervention days. Nine months later, an anonymous online survey was sent to participants asking about their use of a wider variety of questions.

PROGRAM EVALUATION

Two hundred eight physicians (residents 175 (45.5%), attending physicians 25 (27.7%)) filled out pre-intervention surveys. One hundred eighty-one physicians (residents 155 (40.3%), attending physicians 18 (20%)) filled out post-intervention surveys. When survey responses from the attendings and residents on the medical teams were combined, post-intervention rounds were perceived as more worthwhile (1.99 pre-intervention and 1.55 post-intervention, [95% confidence interval 1.831-2.143]) (p < 0.001) and more engaging (1.68 pre-intervention and 1.30 post-intervention, [95% confidence interval 1.407-1.688]) (p < 0.001).Non-medical teams' survey responses did not change. Patient census data indicated no significant difference in the hospital's census on the pre- and post-intervention dates. Spontaneous suggestions for improving rounds came largely from the residents and included teaching points, clinical pearls, patient focus, more interactive, increased dedicated time for teaching, inclusive/multidisciplinary, questions, and evidence-based teaching. Of the participants who answered the online survey 9 months later, 75% (6/8) reported that they "actually asked a wider variety of types of questions."

DISCUSSION

This pilot study indicates that the 1-h intervention of learning to ask a variety of different questions is associated with rounds that are rated as more worthwhile and engaging by the medical teams.

A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40

BACKGROUND

This review, which focused on faculty development initiatives designed to improve teaching effectiveness, synthesized findings related to intervention types, study characteristics, individual and organizational outcomes, key features, and community building.

METHODS

This review included 111 studies (between 2002 and 2012) that met the review criteria.

FINDINGS

Overall satisfaction with faculty development programs was high. Participants reported increased confidence, enthusiasm, and awareness of effective educational practices. Gains in knowledge and skills, and self-reported changes in teaching behaviors, were frequently noted. Observed behavior changes included enhanced teaching practices, new educational initiatives, new leadership positions, and increased academic output. Organizational changes were infrequently explored. Key features included evidence-informed educational design, relevant content, experiential learning, feedback and reflection, educational projects, intentional community building, longitudinal program design, and institutional support.

CONCLUSION

This review holds implications for practice and research. Moving forward, we should build on current success, broaden the focus beyond individual teaching effectiveness, develop programs that extend over time, promote workplace learning, foster community development, and secure institutional support. We should also embed studies in a theoretical framework, conduct more qualitative and mixed methods studies, assess behavioral and organizational change, evaluate transfer to practice, analyse key features, and explore the role of faculty development within the larger organizational context.

From Industry to Generativity: The First 12 Years of the Association for Academic Psychiatry Master Educator Program

OBJECTIVE

This study presents a mixed-methods evaluation of the first 12 years of the Association for Academic Psychiatry (AAP) Master Educator (ME) program, developed in 2003 to help academic psychiatrists hone their skills as educators. Participants attend two 3-h workshops at the annual meeting, organized in 3-year cycles, for a total of 18 h. Core topics include assessment, curriculum design, and program evaluation.

METHODS

Overall session rating scores from 2003 to 2014 were analyzed using descriptive statistics. A 20-question survey was sent to 58 program graduates in October 2014, exploring participant perspectives on the impact of the ME program on their careers and on the educational programs they were affiliated with. Survey responses were analyzed quantitatively (for multiple choice questions) and qualitatively (for open-ended questions).

RESULTS

The mean overall session scores ranged between 4.1 and 4.9 (on a Likert-type scale of 1-5) for each 3-year cycle. Twenty-nine graduates completed the survey (50 % response rate). Survey responses indicated a positive perception of the impact of the ME program on participants' careers. Most respondents noted improvement in their teaching methods and curriculum development skills and being able to link educational theory with their individual practices. There was a significant increase in perceived confidence, leadership, and further contributions to their educational milieu. Fifteen (52 %) participants also reported generative behaviors that directly impacted others, such as developing new programs, enhancing existing programs at their institutions, or contributing to national educational efforts.

CONCLUSION

The AAP ME program has demonstrated significant benefit over its 12 years of existence. This program represents one strategy to sustain and grow an international community of like-minded educators working to develop their own and future generations' skills in providing high-quality education in psychiatry.

Straight from the Horse's Mouth: Using Vignettes to Support Student Learning in Veterinary Ethics

In the last few decades, the importance of imparting ethical competences to veterinary students has been increasingly acknowledged. Despite its relevance, there are few published descriptions of teaching approaches to veterinary ethics and their effect on student learning. At University College Dublin, veterinary ethics is part of a core module on animal behavior and welfare in the pre-clinical teaching program. The present study describes the implementation of a student-centered, skills-based approach to veterinary ethics teaching using vignettes (i.e., case scenarios). Vignettes were inspired by several resources, including a focus group, and designed to represent significant ethical challenges faced by veterinary professionals in Ireland in addition to cases of potential professional misconduct. In small groups, students had to identify the stakeholders and their conflicting interests and to suggest possible solutions and alternative outcomes to the case scenario. Results from qualitative material from the teaching sessions and from a quantitative post-teaching survey show that student understanding of stakeholders increased as a result of the tutorial, which helped them to clarify possible solutions to the scenario and to propose alternative outcomes to either mitigate or avoid future occurrence of the ethical challenges. These findings suggest that incorporating meaningful vignettes into the teaching of veterinary ethics can support student ethical awareness and skills, while promoting a pluralistic approach to considering ethical issues, making the best of available time and human resources.

The perceived effects of faculty presence vs. absence on small-group learning and group dynamics: a quasi-experimental study

BACKGROUND

Medical education increasingly relies on small-group learning. Small group learning provides more active learning, better retention, higher satisfaction, and facilitates development of problem-solving and team-working abilities. However, less is known about student experience and preference for different small groups teaching models. We evaluated group educational dynamics and group learning process in medical school clerkship small group case-based settings, with a faculty member present versus absent.

METHODS

Students completed surveys after cases when the faculty was present ("in") or absent ("out") for the bulk of the discussion. 228 paired surveys (114 pairs) were available for paired analysis, assessing group dynamics, group learning process, student preference, and participation through self-report and self-rating of group behaviors tied to learning and discussion quality.

RESULTS

Ratings of group dynamics and group learning process were significantly higher with the faculty absent vs. present (p range <0.001 to 0.015). Students also reported higher levels of participation when the faculty member was absent (p = 0.03). Students were more likely to express a preference for having the faculty member present after "in" case vs. "out" case discussions. (p < 0.001). There was no difference in reported success of the case discussion after "in" vs. "out" cases (p = 0.67).

CONCLUSIONS

Student groups without faculty present reported better group dynamics, group learning processes, and participation with faculty absent. Students reported that they feel somewhat dependent on faculty, especially when the faculty is present, though there was no significant difference in students reporting that they obtained the most they could from the discussion of the case after both "in" and "out" cases.

Advancing faculty development in medical education: a systematic review

PURPOSE

To (1) provide a detailed account of the nature and scope of faculty development (FD) programs in medical education, (2) assess the quality of FD studies, and (3) identify in what areas and through what means future research can purposefully build on existing knowledge.

METHOD

The authors searched MEDLINE, CINAHL, and ERIC for articles reporting evaluations of FD initiatives published between 1989 and 2010. They applied standard systematic review procedures for sifting abstracts, scrutinizing full texts, and abstracting data, including program characteristics, evaluation methods, and outcomes. They used a modified Kirkpatrick model to guide their data abstraction.

RESULTS

The authors included 22 articles reporting on 21 studies in their review. The most common program characteristics included a series/longitudinal format, intended for individuals, and offered to physicians only. Although the most common aim was to improve teaching effectiveness, several programs had multiple aims, including scholarship and leadership. Program evaluation focused on quantitative approaches. A number of studies employed longitudinal designs and included some follow-up component. Surveys were the most popular data collection method, participants the most common data source, and self-reported behavior changes the most commonly reported outcome.

CONCLUSIONS

Although the authors' findings showed some recent expansion in the scope of the FD literature, they also highlighted areas that require further focus and growth. Future research should employ more rigorous evaluation methods, explore the role of interprofessional teams and communities of practice in the workplace, and address how different organizational and contextual factors shape the success of FD programs.

Problem-based learning: Where are we now? Guide supplement 36.1 - viewpoint

The AMEE Guide No 36 by Taylor and Miflin (2008) provides an excellent resource about the current status of problem-based learning (PBL). The authors discussed the roots of PBL and generated hypotheses about possible causes for the confusion about PBL. They also discussed a number of challenges facing PBL. The guide is worth reading by novice PBL tutors and experienced medical and health educators. In this article, I would like to reflect on some of the challenges facing PBL and provide an insight into practical issues related to these challenges.

Using medical students to enhance curricular integration of cross-cultural content

We hypothesized that an interested medical student group would be helpful in reviewing tutorial cases and giving relevant feedback on the curricular integration of cross-cultural content using case triggers in a preclinical gastrointestinal pathophysiology course. Self-selected student leaders (n = 9) reviewed pre-existing problem-based learning tutorial cases (n = 3) with cross-cultural triggers, and provided narrative feedback to course faculty. The cases were modified and used for the entire class in the following 2 years. Participating course students' comments and teaching faculty feedback were also noted. Outcomes were a change in case content, student global evaluations of the course, and self-reported faculty comfort with teaching the cases. All three tutorial cases were reviewed by a separate group of 2-3 students. Major and minor revisions were made to each case based on the student feedback. These cases were used in 2007 and 2008 and were the major change to the course during that time. Overall course evaluation scores improved significantly from 2006 to 2008 (p = 0.000). Tutors (n = 22 in 2007; n = 23 in 2008) expressed relief during tutor meetings that students had reviewed the cases. A general framework for eliciting student feedback on problem-based cases was developed. Student feedback, consisting of self-selected students' case reviews and solicited course and tutor comments, added value to a curricular reform to improve the integration of cross-cultural content into a problem-based learning curriculum. Our study underscores the fundamental link between teachers and students as partners in curricular development.

Interactive film scenes for tutor training in problem-based learning (PBL): dealing with difficult situations

BACKGROUND

In problem-based learning (PBL), tutors play an essential role in facilitating and efficiently structuring tutorials to enable students to construct individual cognitive networks, and have a significant impact on students' performance in subsequent assessments. The necessity of elaborate training to fulfil this complex role is undeniable. In the plethora of data on PBL however, little attention has been paid to tutor training which promotes competence in the moderation of specific difficult situations commonly encountered in PBL tutorials.

METHODS

Major interactive obstacles arising in PBL tutorials were identified from prior publications. Potential solutions were defined by an expert group. Video clips were produced addressing the tutor's role and providing exemplary solutions. These clips were embedded in a PBL tutor-training course at our medical faculty combining PBL self-experience with a non-medical case. Trainees provided pre- and post-intervention self-efficacy ratings regarding their PBL-related knowledge, skills, and attitudes, as well as their acceptance and the feasibility of integrating the video clips into PBL tutor-training (all items: 100 = completely agree, 0 = don't agree at all).

RESULTS

An interactive online tool for PBL tutor training was developed comprising 18 video clips highlighting difficult situations in PBL tutorials to encourage trainees to develop and formulate their own intervention strategies. In subsequent sequences, potential interventions are presented for the specific scenario, with a concluding discussion which addresses unresolved issues. The tool was well accepted and considered worth the time spent on it (81.62 +/- 16.91; 62.94 +/- 16.76). Tutors considered the videos to prepare them well to respond to specific challenges in future tutorials (75.98 +/- 19.46). The entire training, which comprised PBL self-experience and video clips as integral elements, improved tutor's self-efficacy with respect to dealing with problematic situations (pre: 36.47 +/- 26.25, post: 66.99 +/- 21.01; p < .0001) and significantly increased appreciation of PBL as a method (pre: 61.33 +/- 24.84, post: 76.20 +/- 20.12; p < .0001).

CONCLUSIONS

The interactive tool with instructional video clips is designed to broaden the view of future PBL tutors in terms of recognizing specific obstacles to functional group dynamics and developing individual intervention strategies. We show that this tool is well accepted and can be successfully integrated into PBL tutor-training. Free access is provided to the entire tool at http://www.medizinische-fakultaet-hd.uni-heidelberg.de/fileadmin/PBLTutorTraining/player.swf.

When a problem-based learning tutor decides to intervene

PURPOSE

To appropriately contribute to group discussion, tutors should be experts in their field and possess facilitative skills. However, knowing when to interject is always a difficult question. This study investigated the specific scenarios or cues during group tutorial sessions that prompted or motivated tutors to interject and participate in the group discussion.

METHOD

From 2005 through 2008, the authors, using the interpersonal process recall method, videotaped 40 tutorial discussions led by eight experienced tutors from the departments of medicine, nursing, and clinical psychology. The tutors were later shown the tapes and asked to explore their intentions and analyze the contexts for the 636 episodes in which they had intervened in the discussions.

RESULTS

Qualitative analyses revealed three themes for the tutors' interventions: (1) Tutorial group process included 10 categories related to discussion sequence, students' roles, and group dynamics, (2) quality of discussion included nine categories related to clarity and accuracy of the information brought forward by the students, and relevance and critical appraisal of the information in relation to the major objectives, and (3) quality and quantity of the materials discussed included eight categories related to amount, datedness, accuracy, representativeness, and source (whether primary or secondary).

CONCLUSIONS

These findings provide valuable insights into the contextual situations that lead problem-based learning tutors to intervene and provide material to build a framework for training new tutors.

A faculty and resident development program to improve learning and teaching skills

OBJECTIVE

To assess the value of a faculty and resident medical education development program.

STUDY DESIGN

Modules on Accreditation Council for Graduate Medical Education (ACGME) competencies and evaluation, teaching methods, and Residency Review Committee guidelines were created, beta tested, and installed on a website. Pretests and posttests were developed. Faculty and residents were required to complete the course. At initiation and 6 months after training, residents completed a feedback perception survey. Statistical analysis was performed using Student t test. P < .05 was considered significant.

RESULTS

Forty-nine voluntary faculty members and residents completed the course. The posttest scores on all the ACGME competencies were significantly higher than the pretest scores (P < .05). The results of the residents' survey indicated that the educational development program significantly improved their perceptions of corrective and immediate feedback by faculty.

CONCLUSION

A formal Internet-based program significantly increases short-term cognitive knowledge about the ACGME competencies among participants and improves trainees' perceptions of the quality of faculty feedback up to 6 months after training.

Integration of racial, cultural, ethnic, and socioeconomic factors into a gastrointestinal pathophysiology course

BACKGROUND & AIMS

Our study describes a faculty development program to encourage the integration of racial, cultural, ethnic, and socioeconomic factors such as obesity, inability to pay for essential medications, the use of alternative medicine, dietary preferences, and alcoholism in a gastrointestinal pathophysiology course.

METHODS

We designed a 1-hour faculty development session with longitudinal reinforcement of concepts. The session focused on showing the relevance of racial, ethnic, cultural, and socioeconomic factors to gastrointestinal diseases, and encouraged tutors to take an active and pivotal role in discussion of these factors. The study outcome was student responses to course evaluation questions concerning the teaching of cultural and ethnic issues in the course as a whole and by individual tutorials in 2004 (pre-faculty development) and in 2006 to 2008 (post-faculty development).

RESULTS

Between 2004 and 2008, the proportion of students reporting that "Issues of culture and ethnicity as they affect topics in this course were addressed" increased significantly (P = .000). From 2006 to 2008, compared with 2004, there was a significant increase in the number of tutors who "frequently" taught culturally competent care according to 60% or greater of their tutorial students (P = .003). The tutor's age, gender, prior tutor experience, rank, and specialty did not significantly impact results.

CONCLUSIONS

An innovative faculty development session that encourages tutors to discuss racial, cultural, ethnic, and socioeconomic issues relevant to both care of the whole patient and to the pathophysiology of illness is both effective and applicable to other preclinical and clinical courses.

Problem-based learning: where are we now?

The definition of problem-based learning (PBL) as an educational concept is as elusive in 2008 as it has been since the concept was first expressed over forty years ago. A definitive guide to the practice of PBL is equally elusive. Like all worthwhile educational ideas, PBL has proved attractive to those teachers who seek improvements for their courses. Its appeal has transcended the traditional boundaries in formal education so that there are examples of PBL from primary to tertiary education, and across many disciplines within these. Dissemination, however, has wrought confusion in understanding and practice, and consequent difficulties for researchers in evaluating its efficacy, and lack of clear advice for those who would like to adopt PBL. Rather than attempting to be definitive, this Guide explores the various interpretations and practices that claim the label PBL, and critiques these against the original concept and practice. The primary aim is to provide insight into the causes of the confusion about PBL in 2008. The second aim is to point a feasible way forward so that, where appropriate, the potential of PBL as a whole-of-curriculum concept may be realised; and, where it is not possible to implement the whole concept, worthwhile educational principles that have been associated more or less with PBL may be recognised as such and given value in their own right.

Problem-based learning in veterinary education

Problem-based learning (PBL) replicates life experiences to stimulate learning, the integration of knowledge, and lifelong learning skills, all of which are requirements for veterinary medical education. As the curricular content of veterinary schools expands to immense proportions following advances in medical knowledge and biotechnology, it becomes impracticable to ensure that all students at the beginning of their careers have such a wide knowledge base. Students who are faced with vast amounts of information to learn by rote, much of which may seem irrelevant to their prospective career, may become disillusioned with their chosen course, hence the temptation to convert to a PBL curriculum. The PBL strategy of teaching is becoming increasingly popular in veterinary faculties worldwide, encompassing both curriculum content and a process of learning. In PBL, clinical cases are carefully selected to provoke deep student learning by the acquisition of both basic scientific and clinical knowledge critical to the case; cultivate problem-solving abilities; and encourage the development of team-building, self-directed learning, communication, and self- and peer-assessment skills. Problem-solving skills, understanding of the basic sciences, and clinical performance are all improved by the PBL process. The aim of this paper is to review a decade of literature pertaining to the inclusion of PBL in veterinary and medical curricula.