1. A Community-Academic Partnership to Facilitate Meeting the FM RRC Faculty Development Requirements Joseph J. Brocato, Ph.D. & Mark Yeazel, MD, MPH

2. Objectives By the end of the session, conference attendees will be able to: Describe a systematic approach toward developing a faculty development curriculum State some of the constraints toward developing local faculty development curricula Share some solutions to these constraints Describe the content of an electronic tool useful for conducting a local needs assessment of faculty List examples of practical methods toward meeting faculty development requirements for local faculty development programs

3. The Importance of Faculty Development for Family Medicine The constant need to train new faculty in family medicine, sometimes directly out of residency Midcareer faculty may have had uneven access to title VII faculty development training Senior faculty often express an interest in returning to teaching and academic toward career capstones Accreditation: ACGME RRC Requirements….

4. The ACGME Requirement for Faculty Development “There must be a structured program of faculty development that involves regularly scheduled faculty development activities. Since family medicine faculty should demonstrate the same skills, knowledge and attitudes that are expected of the residents, faculty skill development and update are an important part of faculty development. The program is expected to address clinical, educational, administrative, leadership, research and behavioral components of faculty performance.” FM RRC Requirement II.B.9

5. The ACGME Requirements for Faculty Development (continued) “It should involve at least annual departmental, residency and individual faculty needs assessments, and may include structured group and individual activities. Although clinical update is important, faculty development should provide experience to improve teaching in all settings. This should be measurable and documented in evaluations by residents”.

6. Constraints and solutions? brainstorm constraints, then possible solutions to constraints

7. Constraints

8. Your solutions

9. The Department of Family Medicine & Community Health at The University of Minnesota Founded in 1971 with over 1,500 residency alumni Department: Located on TC campus, 73 fulltime faculty and 994 non salaried community faculty Eight Residencies: five TC urban & suburban sites, plus three rural and small town sites. Duluth, St. Cloud, Mankato 175+ Residents Two fellowships: Sports Medicine and Hospice and Palliative Medicine

10. Constraints Toward Local Faculty Development $$ for program operations Lack of educational expertise: in development and in teaching Competing faculty demands, primarily clinical/Encroachment on administrative time for faculty Lack of administrative time to implement Other Piece-meal faculty development locally, regionally, nationally Others?

11. Kern Curriculum Development Model Problem identification done for us! Targeted Needs Assessment first phase Goals and Objectives for the Fellowship Followed

12. Faculty Development Needs Assessment Survey created using Survey Monkey Conducted online 69 respondents of 84 faculty = 82% response rate

13. Needs Assessment Survey Items in four domains –Education –Research and Written communication –Administration –Professional Academic Skills Items ranked on 3 point scale –1 Little need/interest for faculty development –2 Moderate need/interest –3 High interest/need

14. Needs Assessment: Education 18 items Curriculum Development Skills Conducting a Needs Assessment Writing goals and objectives Basic educational theory Evaluating teaching effectiveness Evaluating learner performance Developing instructional materials Using the Web for course development Clinical teaching (e.g. precepting or bedside)

15. Needs Assessment: Research and Written Communications: 9 Items EBM and critical appraisal of literature Electronic resources for academic Family physicians Searching the literature Writing peer-review journal articles Writing grant proposals Qualitative research methods Quantitative research methods Grant opportunities for academic family physicians IRB and Human Subjects at the U of Minnesota

16. Needs Assessment: Administrative 5 items Leadership skills for academic family physicians Overview of the UMN medical School, and Academic Health Center Promotion and tenure ACGME and FM RRC: Program requirements, PIFS, Internal Reviews Residency management systems: E-Value and New Innovations

17. Needs Assessment: Professional Academic Skills- 7 items How to advise medical students and residents How to be a mentor Developing professional networks in FM Setting and operationalizing a mission for FM residencies Family medicine profession: future faculty and other initiatives Establish a healthy work life balance Curriculum vitae and portfolio development

18. Needs Assessment: Education Small group teaching Formal lecture and presentation skills Performing demonstrations Simulated learning and OSCE’s Giving learners positive and negative feedback Dealing with problem medical students/residents Motivating medical students/residents to learn Teaching and evaluating ACGME mandates –(General Competencies) Portfolio based learning

19. Needs Assessment Number of years you have taught? What types of learners do you teach? … percentage of time I spend teaching in the follow settings (lecture, small group, precepting, etc.)? Preferred delivery methods, times? Participated in other faculty development activities?

20. RankSubject AreaLittle NeedModerate need High needRating Average 1Leadership skills for academic family physicians (A) 19.1% (13)33.8% (23)39.7% (27)2.22 2Evaluating teaching effectiveness (E) 17.4% (12)50.7% (35)31.9% (22)2.14 3Evaluating learner performance (E)23.2% (16)40.6% (28)36.2% (25)2.13 4How to be a mentor (P)19.1% (13)51.5% (35)29.4% (20)2.1 5Establishing a health work/life balance (P) 35.3% (24)22.1% (15)42.6% (29)2.07 6Curriculum development skills (E)27.5% (19)42.0% (29)30.4% (21)2.03 7. (T)Dealing with the problem medical students/residents (E) 29.0% (20)40.6% (28)29.0% (20)2 7. (T)Grant Opportunities for academic family physicians (R) 35.3% (24)25.0% (17)35.3% (24)2 9Writing Grant Proposals (R)33.8% (23)35.3% (24)29.4% (20)1.96 10Electronic resources for academic family physicians (R) 27.9% (19)45.6% (31)22.1% (15)1.94

21. RankSubject AreaLittle NeedModerate need High need Average 11Motivating medical students/residents to learn (E) 31.9% (22)42.0% (29)24.6% (17)1.93 12Evidence-based medicine and critical appraisal of the literature (R) 36.8% (25)33.8% (23)27.9% (19)1.91 13Writing peer-reviewed journal articles (R) 35.3% (24)38.2% (26)25.0% (17)1.9 14How to advise medical students and residents (P) 33.8% (23)38.2% (26)23.5% (16)1.89 15. (T)The family medicine profession: future faculty and other initiatives (P) 35.3% (24)38.2% (26)23.5% (16)1.88 15. (T)Promotion and tenure within the Department of Family Medicine & Medical School (A) 30.90%50.0% (34)19.1% (13)1.88 15. (T)Portfolio based learning (E)31.9% (22)43.5% (30)20.3% (14)1.88 18Curriculum Vitae and portfolio development (P) 35.3% (24)42.6% (29)22.1% (15)1.87 19Giving learners positive and negative feedback (E) 33.3% (23)47.8% (33)18.8% (13)1.86 20. (T)Clinical teaching (e.g. precepting or bedside) (E) 33.3% (23)44.9% (31)18.8% (13)1.85 20. (T)Qualitative Research Methods36.8% (25)39.7% (27)22.1% (15)1.85

22. The curriculum: getting buy-in Supportive department chair and residency program directors Supplementing local, regional, national faculty development Agreement to repeat based upon interest Close relationship among area residency programs outside the system

23. The curriculum: getting buy-in (continued) Total Year one Budget (20 fellows): $14,686 –Faculty time ($9,246) –Textbooks ($1,500) –Handouts/Copying ($1,000) –Snacks ($1,200) –Parking ($1440) –Graduation Certificates ($200) –Misc. Supplies ($100)

24. The curriculum: getting buy-in (continued) The power of collaboration: cost- sharing for outside of the system faculty ($14,685/20=$734.25 per trainee) –$14,685/20=$734.25 –Less than $100 per instruction hour—compares favorably with CME and university tuition

25. The curriculum: Determining the Target Audience Target audience: new/junior faculty; 21/68 of faculty had 0-5 years or less of teaching experience. This cohort is the largest 5 year block and has increased since needs assessment conducted Prior fellowship and training for mid- career and senior faculty existed Open to all faculty MD, Ph.D. and D.O faculty—all have needs for development Open to UME and GME faculty

26. The curriculum: The Inaugural Class 20 faculty fellows: 14 in system, 6 out of system. One is UME-based, two were fellowship-based, 17 were residency-based One is DO, one was PhD., and 18 were MDs. Gender-balanced: 55%F and 45%M Diversity represented: URM 10%

27. The curriculum: Fellowship’s Goals The faculty development fellowship program’s goals are to teach faculty development fellows how to: Construct needs assessments, goals and objectives, educational and evaluation strategies, and evaluation plans (i.e., systematic instructional development) toward the implementation of local curricular content. Integrate the principles of educational theory toward shaping personal educational theories and educational best practices implementation. Develop teaching skills mastery (lectures, small groups, etc.) with structured coaching and peer feedback. Incorporate instructional technology where appropriate to address instructional delivery limitations and challenges.

28. The curriculum: Fellow’s Curricula Projects Acquisition of Pain Management Skills Pediatric Curriculum* Coding & Billing & QI* Guiding Patient Center Behavior Change: Motivational Interviewing* Transformative Journal Club/EBM Hospital Medicine Track* Outpatient Procedures Musculoskeletal Manual Med. For DO's Team-Based Care Model Colposcopy Course - Outpatient Gynecology Sleep Management in Residency Integrating Cores for Core Basic Science –*collaborative curriculum

29. The curriculum: Instructional Content Six monthly 3 hour workshops (18 hours total), Tuesdays 2-5pm Two monthly educational topics presented each month Structured small group curriculum development time Reflects on teaching: Parker Palmer’s Courage to Teach

30. The curriculum: Instructional Content (Continued) Six Monthly Workshops Taught by Joseph Brocato, Ph.D. and Mark Yeazel, MD, MPH –January 2010: Problem Identification and General Needs Assessment; Targeted Needs Assessment –February 2010: Basic Educational Theory; Writing Goals and Objectives –March 2010: Content and Methods; Instructional Technology –April 2010: Learner Evaluation; Formal Presentation Skills –May 2010: Program Evaluation; Small Group Teaching –June 2010: Fellowship Curriculum Project Presentations

31. The curriculum: Instructional Methods Workshops with formal presentation, small group curriculum development, small group discussion of teaching (Parker Palmer) Remote connection for faculty in Duluth and Mankato (1.5-3 hours drive) Moodle website for background readings, curriculum examples, essential course documents, formal presentation archives

32. Evaluation Pre/Post Academic Skills Self-Assessment (40 items in curriculum development, learning theory, evaluation, technology, teaching strategies, formal presentation skills, small group discussion, clinical teaching encounters). Scores range from 1.31 to 3.56 on 5 point scale* Highest scored items: (1) Doing an effective lecture; (2) Developing rapport; (3) Demonstrating effective use of feedback. Lowest scored items : (1) Define/List the steps in a systems approach to instruction; (2) Describe University resources for web-based instruction/characteristics of computer-based instruction; (3) Discuss pros and cons of various evaluation strategies. –*5=extremely able, 4=Highly Able, 3=Able, 2=Slightly Able, 1=Not at all able

33. Evaluation Pre/Post Teaching Formative Evaluation –Formal Presentation Skills within Medical School, Residency, Fellowship –Formal Presentation Skills outside the normal teaching setting –Preceptor encounters in clinic Post workshop session 1- minute evaluations

34. Pilot Year Evaluation Data: Lessons Learned Session evaluations show workshop formats are optimizing, but like to vary order of elements. Kern (Curriculum development) is a “new language.” Some are frustrated that topics are presented as overviews Scheduling two observation for 20 faculty impossible given geographic distance, schedules, teaching faculty time available

35. Pilot Year Evaluation Data: Lessons Learned Faculty appreciate joint projects and fellowship flexibility (curriculum implementation not expected during 6 month fellowship) Writing curriculum in workshops in sporadic Fellows enjoy discussing their teaching and sharing ideas and resources in addition to curriculum development

36. What other models of faculty development work for you?

37. Conclusions/Next Steps for Our Program Complete fellowship year Program evaluation of pilot program with course revision Curriculum development for leadership/career development fellowship Mobilizing fellowship alumni