Harvard Medical Center
Boston, MA
Program Description
A needs assessment has demonstrated that our fellows are interested in improving their teaching skills and pursuing careers in medical education. We have designed a dedicated fellow-as-teacher rotation to provide trainees with an introduction to key aspects of medical education while participating in hands-on teaching opportunities. This experience combines observed teaching, OSTEs, and attending-level feedback in order to improve fellows’ teaching skills and encourage fellows to explore careers as medical educators.
Type of Program
Combined Fellowship
Number of Fellows in Program
30
Abstract Authors
Jakob I. McSparron MD, Jeremy B. Richards MD, MA, David H. Roberts MD, Richard M. Schwartzstein MD, and Peter Clardy MD
Carl J. Shapiro Institute for Education & Research at the Beth Israel Deaconess Medical Center and the Harvard Pulmonary Fellowship Program, Massachusetts General Hospital
Submitter(s) of Abstract
Jakob McSparron
RATIONALE
Teaching is a core component of academic medical practice, from engaging medical students or residents in clinical settings to educating patients about their health issues and treatments. The role of physicians as teachers is emphasized in the Accreditation Council for Graduate Medical Education’s Practice-based Learning and Improvement core competency. Although fellows traditionally receive explicit clinical and research training, instruction on teaching skills is frequently absent from fellowship curricula. Given this context and the strong interest among our fellows in improving their teaching skills, we implemented a novel educational innovation in our Pulmonary and Critical Care Medicine (PCCM) fellowship training program: faculty observation of fellows’ morning ICU teaching sessions followed by directed feedback, complimented by a dedicated medical education rotation.
METHODS
We performed a needs assessment by anonymously surveying all PCCM fellows in the four-year Harvard Fellowship Program regarding their attitudes about developing their teaching skills and their career interest in medical education. To address fellows’ interest in developing teaching skills as demonstrated in the needs assessment, we implemented dedicated faculty observation of fellows’ small group teaching occurring four times a month by two separate attendings with advanced training as medical educators. A standardized assessment tool is used by faculty observing fellows teaching, and dedicated feedback is provided immediately after the observation. Feedback focuses on the key skills of didactic teaching, small group discussion leadership, and reflective practice on teaching strategies and techniques. In some cases, the attending assists the fellow in planning a new educational approach to a particular topic. The culmination of teaching observations, a new “fellowas- teacher” rotation combines diverse teaching experiences (small group, lecture, simulation, procedural teaching, patient education) with formal didactics led by experts in medical education. During this protected time, fellows are introduced to aspects of education theory, teaching strategies, education research, and learner assessment. A unique component of this rotation is the incorporation of an objective structured teaching exercise (OSTE), in which fellows are observed teaching a standardized student in the simulation center and receive directed feedback during a subsequent debriefing. The OSTE provides the trainee with immediate feedback, and allows for objective evaluation of teaching skills in a standardized environment.
RESULTS
Fellows in our program demonstrate extremely high self-reported interest in developing their teaching skills: 56% of fellows rank teaching skills as “very important”, 30% as “important”, and 15% as “moderately important”. With regard to pursuing a career as a medical educator, 22% of fellows are “very interested” and 33% are “interested”. In response to questions about faculty observations of their teaching, 70% of Fellows reported being observed on ICU rotations, and 28% noted that their teaching was observed on Pulmonary Consult rotations. Fellows feel that dedicated observation of and feedback about their teaching is beneficial; 90% of fellows indicate that they feel more comfortable as teachers from the beginning to end of the academic year.
CONCLUSIONS
Our needs assessment demonstrates that PCCM fellows are interested in improving their teaching skills and a sizeable percentage are interested in pursuing careers in medical education. Dedicated observation of fellows’ teaching in small group sessions is both noted and appreciated by fellows, and they feel that focused assessment of their teaching contributes to them becoming better teachers. Our fellow-as-teacher rotation combines an intense introduction to key aspects of medical education with hands-on teaching opportunities. Increasing the frequency of teaching opportunities, observed teaching, OSTEs, and attending-level feedback will improve fellows’ teaching skills and encourage fellows to explore careers as medical educators.
