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Academic Medicine:
doi: 10.1097/01.ACM.0000242585.59705.da
Medical Education Fellowships

Fifteen Years of Aligning Faculty Development With Primary Care Clinician–Educator Roles and Academic Advancement at the Medical College of Wisconsin

Simpson, Deborah PhD; Marcdante, Karen MD; Morzinski, Jeffrey PhD, MSW; Meurer, Linda MD, MPH; McLaughlin, Chris; Lamb, Geoffrey MD; Janik, Tammy; Currey, Laura MS

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Author Information

Dr. Simpson is associate dean, Educational Support and Evaluation, professor, Family and Community Medicine, and director, Office of Educational Services, Medical College of Wisconsin, Milwaukee, Wisconsin.

Dr. Marcdante is professor and vice chair, Education, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.

Dr. Morzinski is associate professor, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Dr. Meurer is associate professor, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Ms. McLaughlin is editor/writer, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Dr. Lamb is associate professor of medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Ms. Janik is program coordinator II, Office of Educational Services, Medical College of Wisconsin, Milwaukee, Wisconsin.

Ms. Currey is program coordinator II, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Simpson, Office of Educational Services, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226; telephone: (414) 456-4332; fax: (414) 456-6506; e-mail: (dsimpson@mcw.edu).

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Abstract

Starting in 1991, the Medical College of Wisconsin’s (MCW) primary care-focused faculty development programs have continuously evolved in order to sustain tight alignment among faculty members’ needs, institutional priorities, and academic reward structures. Informed by literature on the essential competencies associated with academic success and using educational methods demonstrated to achieve targeted objectives, MCW’s initial 1.5-day per month comprehensive faculty development programs prepared faculty as clinician–researchers, leaders, and educators. As institutional priorities and faculty roles shifted, a half-day per month advanced education program was added, and the comprehensive faculty development program transitioned to its current half-day per month program. Using a modular approach, this program focuses exclusively on clinician–educator competencies in curriculum, teaching, leadership, evaluation, and learner assessment. Instructional methods combine interactive, face-to-face sessions modeling a range of instructional strategies with between-session assignments now supported through an e-learning platform. All participants complete a required project, which addresses a divisional or departmental need, meets standards associated with scholarship, and is submitted to a peer-reviewed forum. To date, over 115 faculty members have enrolled in MCW’s faculty development programs. Program evaluation over the 15-year span has served to guide program revision and to provide clear evidence of program impact. A longitudinal evaluation of comprehensive program graduates from 1993 to 1999 showed that 88% of graduates’ educational projects were implemented and sustained more than one year after program completion. Since 2001, each participant, on average, attributes more than two peer-reviewed presentations and one peer-reviewed publication to program participation. Based on 15 years of evaluation data, five tenets associated with program success are outlined.

The faculty development programs for Medical College of Wisconsin (MCW) primary care faculty have evolved according to internal and external needs over the last 15 years. In the late 1980s, as patient care began its transition from hospital-based towards ambulatory-based settings, the need for strong ambulatory-based education for medical students and residents was recognized throughout the academic medicine community. By 1991, MCW’s primary care faculty members were responsible for two months of ambulatory-based clerkships for 200 third-year students, and also for the education of internal medicine, pediatrics, and family medicine residents.

Over the following decade, MCW’s primary care clinicians faced increasing curriculum and teaching responsibilities with the implementation of first- and second-year medical student early patient contact programs, the creation of rural ambulatory tracks for required third-year rotations, and the expansion of the fourth-year medicine subinternships into pediatrics and family medicine. In support of these educators, family medicine department leaders at MCW implemented a comprehensive faculty development program in 1991. Their goal was to provide development for and recognition of primary care medical educators on a clinician–educator career path. The faculty development activities were initiated with and evolved through extramural funding from the U.S. Department of Health and Human Services intended for faculty development for primary care clinicians in family medicine and general pediatrics/general internal medicine, who are our primary participants.

Between 1991 and 2000, we designed, implemented, and evaluated a two-year, comprehensive faculty development program to prepare family physicians (and later, general pediatricians and general internists) for their academic roles as clinician–educators, clinical researchers, and academic leaders. As faculty roles became increasingly differentiated and academic recognition for educators expanded at MCW,1,2 we added advanced faculty development initiatives in medicine/pediatrics for educators, and in family medicine for educators, administrative leaders, and clinical researchers. In light of further demands on faculty time and the development of a separate full-time research fellowship at MCW, we more recently refocused our programs around developing and sustaining the professional vitality of primary care clinician–educators using a modular structure to target education-specific competencies in teaching, curriculum design and evaluation, and scholarship.

The bedrock of MCW’s primary care faculty development programs since 1991 has been fivefold:

(1) strong and active support and endorsement from primary care department leaders and senior faculty;

(2) a commitment from department and program leaders and participants to focus on the educational competencies needed to achieve excellence within the many roles of the clinician–educator (ie, leader, curriculum developer, author of learner assessments, program evaluator)3;

(3) the creation and recognition of outstanding durable educational products that fulfill MCW’s mission and meet criteria for clinician–educators’ academic promotion2;

(4) a team of faculty development program leaders who are responsive to the evolving needs of our participants and institutions; and

(5) sustained extramural funding for primary care faculty development from the U.S. Department of Health and Human Services.

In this article, we describe the evolution of MCW’s faculty development programs over the 15-year period between 1991 and 2006. We begin with a brief historical review of our programs, highlighting key features and outcomes. With this as background, we describe our current modular-based faculty development program for clinician–educators and we discuss selected outcomes using several specific session examples to illustrate our interactive faculty development session format. The five longitudinal bedrock elements sustaining our programs are interwoven throughout the article.

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A Comprehensive Faculty Development Program: 1991–2001

Our primary care faculty development program began in 1991 as a comprehensive, 1.5-day per month, two-year core curriculum, focused on competencies in education, research, writing, administration, professional academic skills, and technology. The specific competencies were derived from the research literature on faculty development and are delineated in detail in Bland et al.4 and in Family Medicine’s April 1997 dedicated issue on faculty development.5 Enrollment in the comprehensive program was initially limited to full-time family medicine faculty. In 1996, however, we opened enrollment to general internal medicine and general pediatrics faculty after we recognized the need to expand the program to these specialties and obtained additional funding from the U.S. Department of Health and Human Services.

During the two-year comprehensive curriculum, each participant was required to complete one project focused on medical education and one focused on research. Participants successfully completed projects by submitting an abstract or paper to a peer-reviewed conference, or publishing an abstract or paper in a journal or summary report for internal review. In addition, participants completed a variety of assignments throughout the two-year program, including an analysis of a local organizational problem with a literature-referenced proposed strategy to solve that problem, an updated curriculum vitae (CV) in promotion-ready format, and an Educator’s Portfolio demonstrating teaching accomplishments and outcomes.6 The program format was classroom-based and used a combination of lectures, demonstrations, teaching simulations,7 small-group discussions, and readings. Assigned senior faculty mentors guided the participants’ development of professional academic skills.8–10

A total of 54 primary care faculty members completed the comprehensive program between 1991 and 2001; 42 were family medicine faculty and 12 were internal medicine or pediatrics faculty, with an average of seven participants per cohort. A longitudinal evaluation of the comprehensive program’s family medicine graduates from 1993–1999 showed that 88% of graduates’ educational projects were implemented and sustained more than one year after program completion. A pre-post program analysis of these graduates’ CVs found more than a twofold pre- to post-program increase in the number of administrative leadership roles at the local, regional and national levels, and a more than threefold increase in publications.11

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An Advanced Faculty Development Program for Clinician–Educators: 1994–2002

Upon completing the comprehensive program, the initial graduates expressed the need to sustain their professional vitality and to further develop their competencies in clinical research, medical education, and academic leadership. Beginning in 1994, we implemented several models for advanced faculty development in family medicine in response to these graduates’ expressed needs. Replicating our format for the comprehensive program, these advanced programs required participants to complete ongoing assignments during the two-year duration of the programs, and ultimately to complete a capstone project suitable for publication in a peer-reviewed journal.

However, because of the restraints placed on physicians’ time by their clinical duties, and because of faculty development program resource constraints, the advanced programs in clinical research and academic leadership were discontinued in 1997. Our advanced education program in family medicine was reduced to one half-day per month from 1997 to 2001. A parallel program for advanced educators in medicine/pediatrics was established in 1996 and was supported through 2002. These advanced programs for educators focused on competencies in educational program evaluation, systematic inquiry approaches and analysis applied to educational problems, effective use of educational technologies, and scholarship to be responsive to the needs of the participants and the medical college.12,13

During the initial two years of our advanced education faculty development (AE-FD) in family medicine, seven faculty participated in the program. Each of the seven participants selected a current task or project to which they applied the knowledge and skills gained through the AE-FD coursework. Evaluation data gathered at the end of the two-year, 60-classroom-hour program showed that, while attendance and participation was high, improvement in targeted competencies and academic productivity remained limited. Participants reported that the seminar format in which they listened and provided feedback to each other on their respective projects “just didn’t stick.” To determine how most effectively to restructure the AE-FD program, an intensive needs assessment using structured interviews with each continuing program participant and selected senior department leaders revealed individual educator and institutional needs, which ranged from improving educator competencies to achieving academic promotion.

To address these intersecting individual and institutional needs, we implemented a “co-investigator” faculty development model, which focused on a critical educational question for each AE-FD program.14 Family medicine AE-FD participants (n = 6) agreed to focus on the question, “Can one have a successful career as an educator in academic medicine?” General pediatrics and general internal medicine participants (n = 6) focused on answering the question, “What are effective and efficient clinical teaching strategies for ambulatory-based primary care physicians?” Participants in each program attended monthly half-day faculty development seminars over a three- to four-year period focused around how to conduct a systematic and scholarly inquiry designed to answer these central questions. Following this model, participants clarified the questions, analyzed and summarized the pertinent literature, tested hypotheses and approaches, analyzed data, and summarized results. By the end of these AE-FD programs, participants had gained competencies in critical appraisal of the medical literature, new teaching and feedback strategies, educational research design, qualitative interviewing and protocol analysis, using hand-held technology for teaching and data collection, survey design, quantitative data analysis, educational project management, and scholarly dissemination.

Concurrently, program participants continued their individual work on other educational projects and initiatives. Participants used the seminar time to obtain constructive feedback on these projects and translate their work into educational scholarship in the form of durable educational products (eg, ambulatory care curriculum syllabi, submission packet for M4 elective, carbonless feedback forms) or peer-reviewed publications and presentations.

Outcomes from these parallel AE-FD programs for family medicine faculty and for general medicine/general pediatrics faculty were tracked by multiple-data sets and sources, including self-reported target-specific competencies and traditional academic criteria. Self-assessment of competencies as educators were consistently rated 1.2 to 1.5 points higher on pre-post Likert scale ratings, averaging from 4.5 to 5.0 (1 = no experience/knowledge; 6 = exceptional experience/knowledge).

All AE-FD graduates have assumed leadership positions, which range from local roles as course or clerkship director, director of medical student education, departmental vice-chair or division chief, and chair of medical college-wide education committees; to regional positions in medical education as chairs of specialty societies; to a national role as editor of a medical-education–related journal. From 1996 to 2001, AE-FD program participants’ authored 35 peer-reviewed publications, including those that emerged from program projects.15–21 Participants also served as institutional pioneers, creating durable educational products that have been disseminated nationally through selected peer-reviewed repositories. Additional publications specific to the AE-FD project teams’ work have continued to emerge since program completion.22–24

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Excellence in Clinical Education and Leadership (ExCEL): 2001 to Present

Today’s Excellence in Clinical Education and Leadership (ExCEL) faculty development program evolved in response to both increasing clinical demands on faculty time and role differentiation, not just between clinical investigators and educators, but also among educator roles. Faculty and their respective departments or divisions could no longer make a two-year, 1.5-day per month time commitment to a comprehensive faculty development program, nor could we staff and sustain advanced educator faculty development programs. However, most departments and individuals could commit one half-day per month for a four- to five-month period to a program focused on a single educational topic. Accordingly, we developed the ExCEL module concept around discrete modules addressing targeted educator and institutional needs. Each ExCEL module was designed to stand alone, but could also be attended as one in a sequence of related modules to create a longitudinal program. For example, a faculty member whose primary educational role was clinical teaching could enroll in our module on the practice and profession of teaching, but might not enroll in a subsequent module on curriculum development or educational program evaluation.

The ExCEL program remains firmly grounded in the competencies, methods, and program evaluation strategies derived from published literature associated with educator-oriented faculty development. It also draws heavily on our own evidence-based best practices that emerged from our comprehensive and AE-FD programs:

* project- and product-oriented instruction with between-session assignments sequenced to match stages of project development;

* blended learning combining face-to-face interaction with e-mail, phone, and online instruction; and

* continuous program evaluation to formatively guide program revision and summatively demonstrate the impact of MCW’s medical education programs on our participants’ progress toward academic promotion.

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An Overview of ExCEL Modules, Objectives, and Methods

The ExCEL faculty development approach began in Fall 2001 with Teaching and Educational Technology as the first of four topic-specific modules designed to run in a two-year repeating cycle. However, over time, we revised the modules in response to participant feedback and new opportunities to improve the alignment of instruction with institutional priorities and accreditation mandates. To date, six discrete modules (Appendix 1) have been offered. Participants can enroll on a module-by-module basis to accommodate individual schedules, competency needs, and to promote rapid cycle project completion.

Each ExCEL module is sequenced so that participants complete capstone projects tightly linked to the department’s mission, vision, and priorities, as well as MCW’s promotion criteria for clinician–educators. Each ExCEL module has 10–15 specific learning objectives,4 which are achieved by using multiple methods of instruction consistent with established principles and research. Specifically, these methods include seminars, simulations, computer labs, online units, peer critiques, and interactive lectures, and they are selected based on:

* principles of adult learning, and findings from research on physician learning that suggest participants are problem- or task-oriented, and that instruction should be active and draw on participants’ past experiences25,26;

* research findings specific to effective methods for faculty development, such as project-based learning with mentoring9 and the need to develop and sustain colleague networks to facilitate academic success27;

* emerging standards and best practices for designing distance, Web-based electronic learning28,29;

* an aligned organizational strategy of linking faculty development to the educational priorities of the department, its annual review, and its incentive structure3; and

* MCW’s expanded promotion criteria for clinician–educators.2

As educators, faculty development program instructors and program staff strive to model and demonstrate the behaviors and values we seek to instill in our participants. For example, consistent with literature on colleague networks,27 we encourage collaboration among program participants and between participants and staff. Program evaluation data, including session evaluations, are periodically shared with participants and discussed to model teaching as scholarship and to demonstrate the need for teachers and learners to optimize learning through responsiveness to formative and summative evaluation data, program participants’ needs, and external influences.

Between the monthly half-day sessions, participants are required to complete readings, e-learning units, and project-related assignments. Ongoing contact with program staff in person, via phone, fax, e-mail, Web site, and Web-based online discussions are used to provide individual guidance and feedback to monitor trainee competencies and ensure project completion.

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Innovative ExCEL Teaching Strategies

Engaging clinicians who may have literally run from their clinical or attending responsibilities to four hours of face-to-face faculty development is challenging. Compounding this challenge is the need for faculty development instructors to model the educational principles and practices we teach, including responding to feedback, capturing and sustaining learner interest, and selecting teaching strategies that maximize transfer of learning. As our comprehensive, advanced and ExCEL programs have evolved, we have tried a number of instructional strategies to enhance participants’ learning. To illustrate how we as teachers have modeled the need to take risks, we describe several of our creative teaching strategies that have proven successful based on participant evaluations and peer reviews from presentations at regional and national meetings below.

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“Wisconsin State Fair Chocolate Judging”

Developing learner assessment instruments requires educators to determine what is to be assessed, identify measurement criteria, develop assessment tools, and recognize potential sources of measurement error. However, these concepts and the associated constructs of reliability and validity are often difficult for participants to grasp. To provide a common language for these key principles, we developed an exercise called “Wisconsin State Fair Chocolate Judging”30 to lead off our module on educational measurement.

The exercise unfolds in a stepwise progression. Participants begin by selecting criteria associated with “outstanding chocolate.” Then, working in small groups, participants develop an anchored rating scale for each criterion before actually training participants to judge the chocolate using the established scale criteria. All participants than taste and rate a sample of preselected chocolates, some of which are easily recognizable to highlight bias, and others which are blue ribbon recipients from the Wisconsin State Fair to illustrate validity. A post-rating analysis and debriefing illustrates possible threats to measurement error by addressing order effects, sampling, rater fatigue, and bias. This three-hour exercise provides a low-threat, high-involvement overview of key educational measurement principles and terminology. The vivid, shared experience provides the foundation for subsequent instruction regarding selection of criterion, rating scales, rater training, concepts of reliability and validity, and threats and sources of measurement error.

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“Not So Easy OSCE”

Our “Not So Easy OSCE” exercise illustrates how the principles of measurement apply to the development and implementation of a standardized patient (SP) case. Participants in the Educational Measurement module break into small groups and design an SP case in one afternoon. They must determine objectives, write an SP script, create a door sign, establish a performance checklist, and develop an SP training guide. By afternoon’s end, the participants have “trained” a real SP and piloted the case in one of the other small groups. Throughout the session, participants are reminded to consider issues of reliability and validity, including sources of measurement error, as they design the cases, train the SPs, and pilot the cases.

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“Teaching Procedural Skills: Tacit Knowledge and the Magic Pinky”

To highlight demonstration as a teaching skill, we use an exercise entitled “Teaching Procedural Skills: Tacit Knowledge and the Magic Pinky” in our Practice and Profession of Teaching module. Each participant receives a one-foot length of rope and observes as the instructor performs a magic trick. The instructor winds the rope around the last finger on his or her right hand and then, “magically,” when the rope is pulled tighter, the finger is released. Following observation of this procedural skill, participants practice and then teach the magic pinky skill,31 highlighting the role of tacit knowledge in procedural skills teaching (if the rope is not looped in the correct direction, it may break the finger), transfer (performing the trick on the left hand), and practice (repeating the skill to achieve mastery) with feedback.

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“Standardized Ambulatory Teaching Situations”

Since the early 1990s, we have adapted the standard SP methodology to create a series of Standardized Ambulatory Teaching Situations (SATS)7 for primary care physicians. Each situation represents a teaching interaction and requires participants to “teach” standardized students about a patient. Medical students are recruited and trained as standardized students using case-specific guides to allow them to portray scripted “difficult learners,” “disorganized class presenters,” “missed/omitted physical exams,” and “feedback recipients.” Each SATS portrayal runs less than eight minutes. Participants teach the standardized students and then observe their colleagues teaching the same standardized cases. Following the simulation, the teaching objectives, strategies, and outcomes are reviewed, and each participant receives specific feedback from their standardized students, peers, and educational consultants. This powerful exercise provides opportunities for faculty to experiment with new teaching strategies and to observe others teaching in a low-stakes training environment. SATS were most recently used in the Practice and Profession of Teaching ExCEL module to highlight both teaching skills and teacher professionalism.

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“Clinical Teaching Incidents”

Building on the success of the co-investigator model we implemented in the advanced education modules, we have incorporated a shared question or project into the ExCEL modular structure, most recently through the use of “Clinical Teaching Incidents” in our Practice and Profession of Teaching Module. Consciously or not, every teacher develops a repertoire of scripted recitations, or teaching scripts, that are specific to particular patient conditions or diseases, learner levels, and contexts.32,33 These case- or situation-specific teaching scripts allow an experienced educator’s teaching to look effortless and reduce immediate cognitive demands on the clinical teacher, as the teacher is indeed teaching from memory. The scripts also include common learner errors associated with the case content; objectives for each level of learner and associated teaching strategies, such as questions or mini-lectures; and resources like reference materials, case books, and Web sites.

Building on the concept of case-based teaching scripts, the Profession and Practice of Teaching module participants write and electronically submit weekly clinical teaching vignettes using a critical incident approach.34 According to this approach, participants include a brief description of a teaching situation, the intended teaching objectives (framed specifically to the Accreditation Council for Graduate Medical Education competencies with a focus on professionalism and systems-based practice), what the teacher did in the situation, and a critical analysis of the strengths and weaknesses of each teaching interaction. These incidents are then reviewed by and discussed with colleagues and experienced teachers during ExCEL’s face-to-face sessions. The discussions and assignments are explicitly and transparently structured to model how teachers translate their key assumptions about teaching,35 learning, and the use of teaching as a form of scholarly inquiry36,37 through selection of teaching methods. Participants have disseminated this strategy locally by using critical teaching incidents for pediatrics grand rounds, medicine division retreats, and teaching and evaluating professionalism for residency education.

Consistent with ExCEL’s commitment to model teaching as a form of scholarship, in 2005 we set out to compile a collection of our participants’ clinical teaching incidents. All of that year’s ExCEL participants selected one of their weekly incidents to develop into a final project for the module. The selected incident was expanded into a written case study that was informed by readings, structured interviews with expert clinical teachers, and contained written responses from program participants and instructors. These cases were then collated into a Critical Teaching Incident Casebook38 to demonstrate our assumptions that teaching is a process of design and redesign, that there is a need to make discussions of teaching publicly available, and that durable products about teaching are a form of educational scholarship. The Critical Teaching Incident Casebook was accepted with acclamation by the Association of American Medical Colleges’ (AAMC) MedEdPORTAL.39

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Faculty Development Instructors and Staff

Over the last 15 years, the individuals involved as leaders and instructors in our faculty development programs have come from diverse backgrounds. Our team has included graduate-trained educators and board-certified physicians from an array of disciplines (medical writing and editing, education, psychology) and specialties (medicine, family medicine, pediatrics), and has spanned the faculty ranks from assistant professor to professor. Two PhD–educators have been continuously responsible for program leadership and evaluation since 1991; in the mid-1990s they were joined by two clinician–educators who also continue to provide program leadership today.

The synergy which emerges from this diversity of faculty and continuity of leadership stems from the unwavering commitment and passion from all team members to improve medical education through the development and recognition of primary care clinical educators. Consistent with the principles of partnership outlined by Maurana and Goldenberg,40 senior PhD and MD leaders share responsibility, take risks as educators, seek to build trust and consensus among team members, and focus on changing the program as needed to meet evolving department and institutional needs. As team members, each individual’s contributions are seen as enhancing, rather than challenging or duplicating, others’ contributions or roles, whether during regular staff meetings or teaching in our program modules. This partnership perspective is essential given the need to maximize limited resources and the vagaries of the extramural funding for the 2.3 FTE program staff and instructors.

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ExCEL Outcome Evaluation

Our modules have evolved in response to formative evaluation data gathered from participants at the end of each session and module. Outcome-specific program data is gathered using multiple methods. At the conclusion of each module, participants complete a retrospective pre-post assessment to provide summative data regarding the degree to which participants achieved the targeted module competencies. Program attendance and project completion are monitored, along with tracking of submission of presentations, durable products, abstracts, and papers to peer-reviewed forums. Our data support that our ExCEL modular structure with open enrollment by module strategy is responsive to the needs of participants and matched to their educational roles. It enhances their competencies as educators, supports rapid cycle project completion to address local education needs, and guides translation of those projects and activities into peer-reviewed educational scholarship.

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Enrollment and Completion

The flexible enrollment structure of the ExCEL program has enabled us to exceed our enrollment expectations. Enrollment averages 23 primary care faculty members per module, and ranges from 16 to 33. To date, a total of 185 participants representing 64 individual faculty members drawn from our funded targets of family medicine, general pediatrics, and medicine, have enrolled in one of the ExCEL modules. Across all modules, the average completion rate is 85% (n = 155), defined as attendance at more than 60% of sessions and completion of the final project. The open enrollment approach makes it difficult to determine the number of modules completed by each faculty member. To date, 37 faculty members have completed at least two modules with 57% of those participants completing four or more modules. The most common reasons for not completing a module include a personal or family issue, inability to meet module requirements, or new faculty roles or responsibilities limiting available time and/or congruence with new role expectations.

Participants are allowed up to six months after the last module session to submit their projects. However, 93% of participants submit their completed projects by the end of the module. To understand the key elements associated with rapid-cycle project completion, we asked participants across the first three modules to list “the main factors that motivated/helped you to complete your project.” Content analysis of the responses revealed four major interrelated elements that continue to be structured into all ExCEL modules41:

(1) alignment of project focus and scope with a division or department need and participant interest;

(2) guidance from ExCEL instructors regarding “what I could realistically accomplish in five months,” which inspired us to frame the project into “digestible units” within the module and stage projects across multiple modules;

(3) a sequenced program structure with clear deadlines and realistic monthly homework assignments, combined with ongoing feedback during the monthly sessions and one-on-one consultations with instructors; and

(4) public accountability of participants and their work, including required project presentations to peers and instructors at the final session.

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Competencies as Educators

Retrospective pre-post self-assessment of module-specific objectives yields an average gain score of 2.0 per module on a 6-point scale (1 = no experience/knowledge to 6 = exceptional experience/knowledge). To assess whether we are advancing primary care education and educators at MCW, scholarly activity in the form of accepted presentations and publications in peer-reviewed forums is monitored at three-year intervals. We have found that over time, the success of working with participants on translating and disseminating their ExCEL-related projects into durable forms of educational scholarship suitable for peer review has increased. The 23 family medicine faculty members who participated in the ExCEL program between July 2001 and June 2004, averaged more than two peer-reviewed presentations at regional or national forums and collectively achieved eight publications. Starting a year later, the 30 medicine/pediatrics participants between July 2002 and June 2005 averaged five accepted peer-reviewed presentations at regional national meetings and published more than 20 articles and 50 abstracts presenting the outcomes of activities directly supported by the ExCEL program in peer-reviewed journals.

Concurrently, all participants accepted significant MCW clinical and educational leadership positions, including medical student course/clerkship directors, resident or fellowship program directors, medical director of campus or community-based clinics, and election or selection to faculty governance committees. Follow-up data reveal that these individuals are now accepting regional and national leadership roles in medical education, typically in their specialty-affiliated organizations, including the Wisconsin Academy of Family Physicians, Ambulatory Pediatrics Association, Society of Teachers of Family Medicine, and Society of General Internal Medicine. While tracking data for more recent participants is in process, our 2004–05 participants continue to successfully translate their ExCEL activities into educational scholarship; 10 of their durable products were accepted to the AAMC’s MedEdPORTAL between May and November 2005.

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Faculty Development Program Staff Outcomes

Like participants, all instructors are actively encouraged to transform program-associated materials and activities into products suitable for submission to peer-reviewed forums to advance scholarship in the field of faculty development and to improve themselves as educators. In addition to more than 30 peer-reviewed publications and presentations associated with work emerging from our faculty development activities since 2001, instructors have actively collaborated on dissemination of durable educational products over the last 15 years of faculty development program experience.

Beginning in 1990 with the development of our SATS case workbooks, associated trigger video, and instructor videos, and, in 1992, with the first edition of the nationally recognized Educator Portfolio Compendium (now in its fourth edition), we have continuously generated durable educational projects and submitted them for peer review. Most of our early materials were submitted to the Society of Teachers of Family Medicine Bookstore for peer review and dissemination (seven accepted products), and more recent materials have been submitted to the AAMC’s MedEdPORTAL (two accepted products).

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Lessons in Long-Term Success

Over our 15-year evolution of faculty development programmatic offerings, our bedrock principles remain constant: (1) the support and endorsement by department leadership; (2) the alignment of educator roles, institutional needs, and excellence; (3) the creation and recognition of durable educational materials linked to institutional needs; (4) a multidisciplinary faculty development team; and (5) the use of extramural funding to enhance program structure and local creditability. Emerging from these principles are four faculty development practice tenets for success, which we have illustrated throughout this article: adaptability, project-oriented faculty development, risk-taking role models, and evaluation.

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Adaptability

The structure for faculty development programs must be flexible and quickly adaptable to respond to changing demands. Our transition to modular-based, tightly focused topics has increased enrollment and allowed experienced educators to enroll in modules to upgrade or learn new knowledge and skills. To achieve this flexibility, faculty development leaders and instructors must see themselves as partners in a shared mission to effectively leverage resources, adapt to changing environments, and advance medical education.

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Project-oriented faculty development

Shared project work, which began with our advanced education groups and is now embedded as rapid project cycle completion within the ExCEL modules, has served as a powerful instructional strategy that is responsive to individual, departmental, and institutional needs.

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Risk-taking role models

As educators, faculty development leaders and instructors must model behaviors that advance education. Role modeling must include public sharing of educational imperfections and mistakes. Risks associated with recognizing when participants are not learning, testing new instructional methods and strategies to engage participants as active learners, allowing transparency of instruction and evaluation for quality improvement, and sharing lessons learned with one’s scholarly community are key attributes to educator role modeling.

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Evaluation

Formative and summative program evaluation is vital to the sustained success of the program. Evaluation provides the data to insure that programs are responsive to needs and can demonstrate the impact of the programs for accountability in economically constrained environments.

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Investing in educational excellence

Faculty development program leaders, instructors, and participants share a common vision: improving health through excellence in medical education. Aligning this vision with institutional priorities using a faculty development format responsive to the needs of clinician–educators has resulted in participant projects that meet MCW’s mission of excellence in education through innovation in curriculum, evaluation, and educational measurement, and that advance our participants as educators through leadership and academic advancement as scholars. Achieving and sustaining educational excellence will remain at the center of our faculty development programs and our medical school.

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References

1 Levinson W, Branch WT, Kroenke K. Clinician-educators in academic medical centers: a two-part challenge. Ann Intern Med. 1998;129:59–64.

2 Simpson D, Marcdante KW, Duthie EH, Sheehan KM, et al. Valuing educational scholarship at the Medical College of Wisconsin. Acad Med. 2000;75:930–934.

3 Labovitz G, Rosansky V. The Power of Alignment: How Great Companies Stay Centered and Accomplish Great Things. Hoboken, NJ: John Wiley & Sons; 1997.

4 Bland CJ, Schmitz CC, Stritter FT, Henry RC, Aluise JJ. Successful Faculty in Academic Medicine. New York, NY: Springer; 1990.

5 Bland CJ, Simpson D, eds. Dedicated issue on faculty development. Fam Med. 1997;29:213–293.

6 Simpson D, Morzinski J, Beecher A, Lindemann J. Meeting the challenge to document teaching accomplishments: the educator’s portfolio. Teach Learn Med. 1994;203–206.

7 Simpson D, Lawrence S, Krogull R. Using Standardized Ambulatory Teaching Situations for faculty development. Teach Learn Med. 1992;4:58–61.

8 Morzinski J, Simpson D, Bower D, Diehr S. Faculty development through formal mentoring. Acad Med. 1994;69:267–269.

9 Bower D, Morzinski J, Diehr S, Simpson D. Support-challenge-vision: a model for faculty mentoring. Med Teach. 1998;20:595–597.

10 Morzinski J, Diehr S, Bower D, Simpson D. A descriptive, cross-sectional study of formal mentoring for family medicine faculty. Fam Med. 1996;28:434–438.

11 Morzinski J, Simpson D. Outcomes of a comprehensive faculty development program for local, full time faculty. Fam Med. 2003;35:434–439.

12 Simpson D, Morzinski J. An advanced faculty development program for academic physicians at the Medical College of Wisconsin. Fam Med. 1997;29:283.

13 Simpson D. Medical faculty as teacher: implications for faculty development. In: Distlehorst LH, Dunnington GL, Folse JR, eds. Teaching and Learning in Medical and Surgical Education: Lessons Learned for the 21st Century. Mahwah, NJ: Lawrence Erlbaum; 2000:151–159.

14 Wendelberger K, Simpson D, Headrick L. Building faculty skills as educators: a total quality management approach. Acad Med. 1997;72:464–465.

15 Heidenreich C, Lye P, Simpson D, Lourich M. The search for effective and efficient ambulatory teaching methods through the literature. Pediatrics. 2000;105:231–237.

16 Krippendorf R, Simpson D, Schiedermayer D. Promoting reflective teaching with personal digital assistants. Acad Med. 1999;74:577.

17 Schum TR, Krippendorf RL. Feedback notes: a system for feedback to students and residents. Advanced Education Faculty Development Group. Acad Med. 2000;75:556–557.

18 Rediske V, Simpson D, Lawrence S, et al. The use of Web-based instruction to enhance the clinical teaching of community preceptors. Acad Med. 1999;74:103–104.

19 Meurer LN, Bower DJ, Rediske VA, et al. Career satisfaction among family-physician-educators. Acad Med. 1998;73(Suppl):S70–S71.

20 Bower DJ, Bertling CJ. Advanced Education Group. Using Palm Pilots as teaching tool during a primary care clerkship. Acad Med. 2000;75:541–542.

21 Simpson DE, Rediske VA, Beecher A, et al. Understanding the careers of physician educators in family medicine. Acad Med. 2001;76:259–265.

22 Lye P, Biernat K, Bragg D, Simpson D. A pleasure to work with—an analysis of written comments on student evaluations. Ambul Pediatr. 2001;1:128–131.

23 Lye P, Heidenreich C, Wang-Cheng R, Bragg D, Simpson D, Advanced Faculty Development Group. Experienced clinical educators improve their clinical teaching effectiveness. Ambul Pediatr. 2003;3:93–97.

24 Schum TR, Krippendorf RL, Biernat KA. Simple feedback notes enhance specificity of feedback to learners. Ambul Pediatr. 2003;3:9–11.

25 Knox AB. Helping Adults Learn. San Francisco, Calif: Jossey-Bass; 1987.

26 Slotnick H, Kristjanson A, Raszkowski RR, Moravec R. A note on mechanisms of action in physicians’ learning. Prof Educ Res Q. 1998;19:5–12.

27 Morzinski JA, Fisher JC. A nation-wide study of the influence of faculty development programs on colleague relationships. Acad Med. 2002;66:402–406.

28 Watts MM. Technology: Taking the Distance out of Learning. New Directions for Teaching and Learning. San Francisco, Calif: Jossey-Bass; 2003:94.

29 Bruce L. The Standards Approach: Planning for Excellence in Distance Education. Syllabus. 2003;17:29–31.

30 Simpson DE, Meurer LN. A “sweet approach” to understanding basic principles of educational measurement. Paper presented at: STFM Annual Meeting; April 2001; Denver, Colo.

31 Cassidy J, Stround M. The Klutz Book of Magic. Palo Alto, Calif: Klutz; 1990.

32 Irby DM. What clinical teachers in medicine need to know. Acad Med. 1994;69:333–342.

33 Marcdante K, Simpson D. How pediatric educators know what to teach: the use of teaching scripts. J Ambul Pediatr Assoc. 1999;104:S148–150.

34 Brookfield S. Becoming a Critically Reflective Teacher. San Francisco, Calif: Jossey-Bass; 1995.

35 Hutching P, Shulman LS. The scholarship of teaching: new elaborations, new developments. Change. 1999;31(5):10–16.

36 Hutchings P. Using Cases to Improve College Teaching: A Guide to More Reflective Practice. Washington, DC: American Association for Higher Education; 1993.

37 Shulman LS. Teaching as Community Property: Essays on Higher Education. San Francisco, Calif: Jossey-Bass; 2004.

38 Simpson D, McLaughlin C, eds. Critical Teaching Incident Casebook: Advancing the Scholarship of Teaching through Critical Analyses and Reflection of ACGME Competency Based Teaching Cases. 1st ed. Milwaukee, Wis: Medical College of Wisconsin; 2005.

39 Chandler C, ed. AAMC MedEdPORTAL (Providing On-line Resources to Advance Learning). Available at: (www.aamc.org/mededportal). Accessed July 31, 2006.

40 Maurana CA, Goldenberg K. A successful academic-community partnership to improve the public’s health. Acad Med. 1996;71:425–431.

41 Simpson D, Goodell M, Morzinski J. Project oriented faculty development: in service of the departmental mission. Paper presented at: 36th Annual Spring Conference of the Society of Teachers of Family Medicine; September 21-24, 2003; Atlanta, Ga.

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