Searle, Nancy S. EdD; Thompson, Britta M. PhD; Perkowski, Linda C. PhD
Times are changing in academic medicine; this includes how we teach, what we teach, who we teach, and those who teach. The Educational Scholars Fellowship Program (ESFP) is an example of how a program has evolved to accommodate the needs of faculty who find themselves in this milieu of educational change. This program is sponsored jointly by Baylor College of Medicine, The University of Texas Medical School at Houston (UTMS-H), and The University of Texas Dental Branch at Houston (Dental Branch), three institutions of the Texas Medical Center located within two blocks of each other.
Origin of the Program
The current program grew out of the Master Teacher Fellowship Program (MTFP), which was begun at Baylor in response to curricular change. Several forces, including an awareness of the national movement for reform of medical education,1–4 the Liaison Committee on Medical Education site visit in 1991, and internal curriculum reviews, led to the creation of an integrated curriculum at Baylor in the mid 1990s.5 Early in the planning of this change in curriculum, the need for faculty development was identified, and the MTFP became the cornerstone of the faculty training and education program.
The program has undergone several iterations. It began in 1995 when the Dean of Baylor College of Medicine expressed his desire to improve teaching and support educational change at Baylor by asking Dr. Andrew Wilking, a graduate of Stanford’s faculty development program, to create a curriculum with the help of medical educators at The University of Texas at San Antonio. The MTFP began with a four-month curriculum developed in-house and known as the “Basic Sciences of Teaching and Learning,” followed by materials from the Stanford Teaching Skills Workshops, and finishing with an independent educational research project.6 Also in 1996, the MTFP came under the auspices of the Committee for Educator Development (CED), chaired by Dr. Joan Friedland, a graduate of the Harvard-Macy Institute. The committee was charged with creating a proteaching environment at Baylor College of Medicine. The first fellows invited to participate in the program were midlevel faculty with medical teaching experience. From 1995 to 2000, the program graduated between 11 and 17 fellows yearly.
By 2000, UTMS-H began discussing the development of a program similar to Baylor’s MTFP. Rather than duplicating efforts and to address the declining number of MTFP graduates, which had dropped from 17 in 1995 to 11 in 2000, UTMS-H was invited to join the Baylor program. The joint program graduated 12 fellows in the first year (2001), while only eight were graduated during the second year (2002). The MTFP fellows met weekly for 12 months with a set curriculum and then met one or two times per month for six months with a primary emphasis on their educational projects. There was always an overlap of new fellows beginning the program in the fall and the older fellows not finishing until the following January. In February 2003, just after graduation, the MTFP was suspended for one year to evaluate its place in the entire offering of faculty development activities, which had continued to expand, to determine if the program should continue and, if so, in what form.
During that year, using surveys and interviews of former graduates and significant stakeholders, the CED identified the following factors that appeared to contribute to the decrease in enrollment in the MTFP from 1995 to 2002:
* Faculty time: With the increased clinical responsibilities of teaching faculty, the time commitment of as much as three hours per week for 15 months made participation in the program difficult for many. As an example, while early in the program the chair of the Department of Family and Community Medicine allowed three of his faculty to participate, by 2001, only one could participate.
* Other faculty development offerings: By 2002, Baylor and UTMS-H had developed a joint faculty development program that offered more than 100 hours per year on a two-year cycle of educational workshops. Faculty could commit more easily to a two- to three- hour workshop or four three-hour sessions of a mini-fellowship than to the time required for the MTFP. In addition, participants were free to choose a curriculum suitable to their individual needs.
The Educational Fellows Scholarship Program
With the support of the dean of medical education at Baylor and the associate dean for education at UTMS-H, the CED addressed the issues listed above. In 2003, a masters of education in teaching with an emphasis in the health sciences was established by the School of Education at the University of Houston, with courses offered on the Baylor campus. To avoid confusion over the word “masters” and to make the curriculum more flexible, the name and the program structure were changed. Also in 2003, and again to pool resources, the Dental Branch was asked to participate in the program and the ESFP was born. This new program was aimed at increasing the pool of applicants and making better use of resources, since the amount of time faculty spent developing and conducting sessions for a group as small as eight people, as was true for the MTFP classes, could better be spent developing and conducting workshops open to many others in addition to those in the ESFP. In addition, allowing fellows to participate in the workshops and also receive credit for the fellowship would help to strengthen the workshops and would better tailor a curriculum to the specific educational needs of the fellows.
The basic goals of the ESFP are similar to those from the MTFP and are to enhance the educational mission of each of the participating schools by enhancing the fellows’
* knowledge of current educational theories, guiding principles, and practical techniques;
* skills as educators (ie, lecturing, facilitating, evaluating, designing, planning);
* attitudes in regards to (1) their role as educational leaders and (2) the art and science of teaching and learning in promoting a culture of educational excellence; and
* self-reflection in response to informal and formal feedback about their teaching.
The ESFP is funded by the dean of medical education at Baylor through the Office of Curriculum at approximately $50,000 per year including salaries. UTMS-H provides approximately $20,000 including salaries, and the Dental Branch provides about $12,000 including salaries. The program, which falls under the auspices of the CED, currently consists of a director from Baylor and co-directors from UTMS-H and the Dental Branch with input from an advisory committee consisting of one senior faculty member from each school. The directorship will rotate in future sessions among the three schools.
A total of 91 people graduated from the MTFP; including 62 MDs, 18 PhDs, five MD/PhDs, and six with other degrees; 80 were from clinical departments and 11 were from basic science departments. In comparison, graduates from the first class of the ESFP in 2005 included 10 MDs and 1 DDS, all of whom were from clinical departments. This first class enrolled 14 members but one moved away before completing the program and two have not yet met all of the graduation requirements. The current class of 17 ESFP fellows includes 9 MDs, 4 PhDs, 1 MD/PhD, 2 DDSs and 1 other; 15 from clinical and 2 from basic science departments.
To facilitate small-group work, the class size maximum of the ESFP is 20 with nine slots available to Baylor, nine to UTMS-H, and two slots for the Dental Branch. If schools do not fill their slots, the slots can be filled by one or more of the other schools. Qualified applicants are self-nominated and apply through their own institutions with the support of their department chairs. Selection by a joint committee of the directors is based on an evaluation of how well the applicant meets the admission criteria and then on a first-come, first-served basis until the class is filled. Admission criteria include (1) a faculty appointment or, in cases for fellows, the likelihood of a faculty appointment; (2) the ability to commit 10% professional time to the program guaranteed by the applicant’s department chair; and (3) evidence of a commitment to education in teaching, instructional design, course development, educational research, and/or administration through the submission of a personal statement.
While the MTFP targeted midlevel faculty who had experience teaching, the ESFP is open to faculty of all ranks and to nonfaculty fellows interested in the educational goals of the program. The current class of 17 includes a department chair and two fellows. Applicants are not required to have previous teaching experience. In addition to increasing the applicant pool, allowing those just beginning their teaching career to learn appropriate teaching skills could decrease the development of poor teaching techniques in beginning teachers. Part of the strength of the program is the development of a cohort across disciplines and institutions who are interested in educational scholarship. Having a variety of faculty of differing ranks and teaching experience increases the opportunities for the fellows to learn from one another.
Instruction and program specifics
All three directors have graduate degrees in education. Baylor provides staff support at .25 FTE and faculty support at .25 FTE; UTMS-H provides faculty support at .15 FTE; and the Dental Branch provides faculty support at .15 FTE. Additional resources include access to a large medical education library and funding to help support fellows’ individual educational projects. Fellowship sessions rotate between each of the three campuses, which are all within walking distance of each other.
The 24-month fellowship begins at the end of September with an all-day retreat usually held off campus. Three-hour sessions are held on campus for four successive Friday afternoons through October. The fellowship program does not meet again until January. Eighteen three-hour sessions are held once a month for the next 20 months, except in the months of July for both years. The directors, as well as faculty from all three institutions (who are dedicated educators from various programs, former fellows, and national medical education experts), teach in the program and provide mentoring for the fellows.
The CED has created a faculty development program that includes not only the ESFP but also course offerings for faculty from Baylor, UTMS-H, and the Dental Branch, which allows them opportunities to expand their teaching and educational leadership skills through extensive selection of workshops and other activities.7 The courses are taught by faculty from all institutions. In addition, the CED oversees Baylor’s Educator from Peer Coaching and Review Program8 and a criterion-based awards program to reward excellence in teaching and evaluation, educational leadership, the development of enduring educational materials, and educational research.9
Consistent with accepted adult learning theory,10 the fellows provide input to help target and design the curriculum for the ESFP. The summer before the program begins, a questionnaire of possible session topics is sent to the fellows for their feedback. The results of the questionnaire, the evaluations from the previous fellows, topics available from other faculty development offerings, and the educational expertise of the directors all influence the content of the curriculum. Session topics for the current session (2005–2007) of the ESFP include:
* Teaching: writing goals and objectives, curriculum design, team-based learning, small-group teaching, giving feedback; helping the difficult learner, and remediation and study skills.
* Evaluation: measuring outcomes, evaluating residents’ progress towards competency as required by the Accreditation Council for Graduate Medical Education, program evaluation, performance-based evaluation, writing effective multiple-choice questions, focus-group evaluation.
* Educational scholarship: educational research, understanding educational statistics, and documenting teaching using a teaching portfolio.
* Preparation of an independent educational project: can be educational research or product.
The abilities and knowledge of the instructors are factors that affect the topic offerings on the questionnaire used by the ESFP fellows to indicate their curricular interests. As an example, after four of the faculty who are involved in teaching the fellows graduated with an MEd degree from the program mentioned above, and after the Office of Curriculum hired a full-time, faculty-level evaluation specialist, this group of five felt confident offering in-depth topics in educational research to the fellows, topics that were not offered to the graduates of the MTFP. Another driving force in the curriculum comprises the educational needs of the various institutions at the time. Because of the interest in PBL in the 1990s, the MTFP had many more sessions on the topic of small-group teaching than the single session offered to the ESFP.
A typical three-hour fellowship session includes a prereading assignment of two or three journal articles on the topic of the day, approximately an hour of discussion about fellows’ projects and reflections on their teaching experiences and teaching workshops they may have attended since the last session, presentation of the topic-of-the-day, including active learning techniques, and assigned homework to reinforce and to give a practical application of the topic. At the end of each session, fellows anonymously evaluate both the presentation approach and the content presented. These evaluations are used to improve instruction and/or change content where needed in future ESFP sessions.
Graduation requirements include 80% attendance (by hours) at all ESFP activities, participation as a student in 24 hours of their choice of educational workshops, peer review of their teaching four times using methods formulated in Baylor’s Educator Peer Coaching and Review Program,8 helping to plan and/or conduct a faculty development workshop, keeping a reflective journal with a minimum of 24 entries, conducting one or two educational journal club sessions (depending upon the size of the class), completing an education-related project (including a written, structured abstract outlining purpose, methods, results, and applicability), and presenting a poster at an educational symposium held at Baylor or elsewhere. The graduation requirements are rigorous to enable the fellows upon completion of the ESFP to earn up to nine hours of graduate-level course work from Baylor that will be accepted as electives by the University of Houston School of Education, or perhaps another graduate program, towards completion of a graduate degree.
To assess the impact of the fellowship on graduates, an evaluation instrument was developed that included 10 open-ended questions regarding the impact of the fellowship on graduates’ large and small-group or one-on-one teaching, evaluation skills, educational leadership in their department and in the college, educational research, preparation of enduring educational material, use of educational literature, networking with other faculty, and tendency to reflect on teaching experiences and practices. This instrument was administered in 2001 via e-mail to MTFP fellows who were graduated in 1996 to 2000 (one to five years after graduation). The same survey was administered in 2005 as an online survey to MTFP fellows who were graduated in 2003 (two years after graduation) and to the only class of ESFP graduates six months after graduation. The response rate from the MTFP was 59% (54 of 91) and was 64% (7 of 11) for the ESFP.
Open-ended questions were analyzed using the constant comparative method. Data were first analyzed into units of data, and these units were transformed into categories and themes related to each question, as described.11 All data were read and independently coded by two researchers who identified emerging categories and themes. In addition, each answer was classified as either a positive impact or little or no impact.
Graduates from both the MTFP and ESFP indicated several areas in which the program had positively affected them. Figure 1 provides an overview of the percentage of graduates who indicated a positive impact in each of the specified areas from each program, respectively. As Figure 1 indicates, most graduates from both programs reported that the program had positively affected them in many areas of education. However, differences were noted between each program in some areas.
Almost all of the graduates from both the MTFP and the ESFP indicated that they reflected on their teaching efforts on a more consistent basis and had a greater understanding and awareness of their strengths and weaknesses. An MTFP fellow reflected that she had “always been a person who reflected on my personal experiences—I’ve kept a journal since high school—the fellowship helped me to appreciate self-reflection as a professional development tool as well.” An ESFP graduate indicated that the program had a “large impact for me. I have found the reflection component invaluable and have been able to be quite regimented about it.” These data indicate that in this area, the ESFP had an impact similar to that of the MTFP.
Most of the graduates from both programs indicated that the fellowship had a positive impact on their ability to teach in both large-group and small-group settings. All the ESFP graduates, and approximately 86% of the MTFP graduates, felt that they had improved their large-group teaching skills, including their ability to deliver quality lecture presentations, interact with learners in a large group, and have confidence in their abilities. A graduate of the MTFP wrote that her ability had “vastly improved. Better audience targeting, better audiovisual aids, better organization. I used to think I had to teach everything I knew in one lecture.” An ESFP graduate suggested that her experiences in the ESFP had “provided new educational strategies to use in large group learning for students and residents. I have had an opportunity to share learning and other educational methods with faculty. The feedback from students/residents has been 95% positive.”
More than 85% of the MTFP graduates indicated improvements in their small-group teaching skills while 71% of the ESFP graduates indicated a positive impact in this area. Of those who indicated an impact, most wrote about improvements in their teaching skills, knowledge about this type of teaching, understanding of learner needs, and confidence. One MTFP graduate indicated that the MTFP had “definitely improved my skills in this setting; my one-one-one teaching flows much better; and my skill at facilitating small groups has dramatically increased also my confidence in small-group facilitation has greatly increased.” An ESFP graduate reflected that she had “developed more confidence in my teaching skills over the past couple of years. The ESFP allowed me to attend workshops that otherwise would have been difficult given my clinical constraints. These workshops exposed me to teaching theories, styles and techniques that I have incorporated into small-group teaching.” These data indicate that both the ESFP and MTFP had a positive impact on graduates’ large-group and small-group/one-on-one teaching abilities, with more ESFP graduates indicating an impact on their large group abilities while more MTFP graduates indicated an impact on their small-group/one-on-one teaching abilities.
Evaluation of learners.
Graduates from both the MTFP and ESFP had similar perceptions regarding the impact of the fellowship on their ability to evaluate learners, with more than 85% indicating a positive impact in this area. Graduates of both programs indicated that participation in the program had improved their ability to construct multiple-choice items, increased their understanding of the different types of evaluation methods, and heightened their awareness of the importance of providing feedback. One participant from the MTFP summarized her experiences as helping “in a practical sense. Learning about test construction, the pros and cons of different types of question formats and written and verbal interval performance evaluation forms gave me a way to critique the work done with objectivity and without bias.” ESFP participants indicated similar responses, such as “I have developed skill in giving feedback to learners, both verbal and written; formative and summative (actually know the difference now). I understand what feedback learners want and need and have tailored my response to this.” These results indicate that both the ESFP and MTFP graduates perceived that their respective programs had a similar impact on their ability to evaluate and provide feedback to learners.
“Invaluable!!! Otherwise I would never have found other aspiring clinician educators.” This quote from an ESFP graduate was indicative of both the ESFP and MTFP programs on networking. Most (ESFP = 86%, MTFP = 81%) of the graduates from both programs felt that they had developed relationships with peers and mentors with whom to pursue interdisciplinary projects and share ideas. As one MTFP graduate summarized, “this was one of the most rewarding parts of the fellowship, and most beneficial for all of us. It is eye-opening to learn about other faculty’s experience and daily activities, and to use that knowledge to improve our own teaching. I strongly encourage this interaction, and consider it essential for a successful MTFP.” These results indicate that both ESFP and MTFP perceived that the program had a positive impact on their educational networking opportunities and abilities.
Educational research and use of educational literature.
All of the ESFP graduates suggested that the program had a positive impact on their ability in the areas of educational research (100%) and most felt it had such an impact on their use of educational literature (86%). Many had presented at local or national meetings and were either in the process of writing or had already written educational manuscripts for publication. In terms of using educational literature, one graduate noted, “the journal club is really the key component and very good.” While some graduates from the MTFP indicated that they had “some presentations and one paper that probably [would] not have occurred without the fellowship,” more than half suggested that the program had little or no impact in these areas, instead noting an “awareness that this field exists.” Also, there was no educational journal club included in the MTFP curriculum. The differences noted between the ESFP and MTFP graduates in these two areas may reflect the exposure each group had to educational research topics and to the educational literature in the educational journal club.
Enduring educational materials.
Interestingly, graduates in the MTFP seemed to indicate slightly more impact on their creation of enduring educational materials than did those in the ESFP. Most indicated the creation or improvement of syllabi and/or course-related materials. One MTFP graduate wrote, “In addition to ‘new and improved’ syllabus components for existing and new lectures, I have authored and helped author web-based PBL cases.” Those who indicated an impact suggested that through the respective program, they were able to incorporate multimedia or other unique components to existing curricula. These results suggest that both programs affected graduates in the area of enduring educational materials, specifically those in the MTFP.
Graduates of both programs suggested that they had become involved in educational leadership opportunities within their departments and at the larger college level, specifically becoming involved through committee participation, course or program directorships, and curricular redesign at the college level, with all graduates from the ESFP and approximately two thirds to three fourths of those from the MTFP indicating a positive impact. Within the MTFP program, graduates indicated that they had become directors of educational efforts. One indicated that the MTFP had a “dramatic impact—I became the residency program director, which I had never considered previously; [I am] also revising the didactic program for our residents and working on revising their evaluation; and trying to get faculty to evaluate the residents more specifically and constructively.” Another MTFP graduate felt he had become a “champion for educational leadership and education initiatives.” Graduates from the ESFP program were also affected, with one summarizing his comments about becoming an educational leader by remarking that this was “probably the largest impact. I’m the only ESFP person in my faculty group. Others look to me for leadership and expertise. Other colleagues are applying for the next ESFP class.” These results suggest that graduates of both programs believe that their program had a positive impact on their individual educational leadership opportunities. The differences noted between the ESFP and the MTFP, while interesting, may reflect differences between the administration of the questionnaire; MTFP graduates completed the questionnaire one to five years after the program, while ESFP graduates completed it after only six months. These results may reflect the realities of leadership opportunities encountered by the MTFP graduates compared with the anticipated opportunities of the newly graduated ESFP fellows.
The Fellowship Model: A Unique Opportunity
Findings from research
The results of our study indicate that participation in both the MTFP and the ESFP programs had a positive impact on fellows’ knowledge and skills in education. Changing the program by adding an institution allowed us to further pool resources and increase the applicant pool. This increase in the applicant pool and a change in the format so that the fellowship met once a month rather than once a week seemed to be associated with a rise in enrollment in the program. Decreasing the number of contact hours between directors and other teachers with fellows gave the teaching faculty more time to teach in workshop courses open to all faculty. These changes did not appear to affect the program negatively (as reported in Figure 1). Over half of the graduates from both the MTFP and the ESFP indicated a positive impact in each educational category area with the exception of the MTFP graduates’ responses to the use of educational literature and educational research. We believe that ESFP graduates indicated a positive impact in the use of educational literature because of the additional requirement, which began in 2003, to participate in an educational journal club. Additionally, ESFP fellows may have felt more confident in educational research activities because of the increased depth with which educational research was covered in the fellowship and because of the practical application of what they had learned in the recent completion of their educational projects.
In addition, results from the ESFP should be considered preliminary, since the fellowship has graduated only one cohort of faculty and data were collected only six months after the cohort had graduated from the program. However, our data suggest that participants perceive that the fellowship is valuable and has an impact on their educational abilities similar to that observed for the MTFP and may have improved it (eg, educational research skills).
Fellows as educational leaders
While most of the survey data gathered provided anecdotal information, what can be stated explicitly is that fellows in both programs have become agents for change at their given institutions; we are convinced that the programs helped some of the graduates reach the point where they could initiate such activities. As examples, graduates have founded and are members of Baylor’s Academy of Distinguished Educators; they developed and serve as mentors in Baylor’s peer coaching program; they have received national grant support for and have helped disseminate nationally a new teaching method in medical education (team-based learning); they have helped develop and are recipients in all categories of Baylor’s criterion-based Fulbright & Jaworski L. L. P. Faculty Excellence award; they are recipients of UT Health Science Center’s Teaching with Technology Small Grant Awards; they have developed cases for and teach in both medical school’s PBL programs; and one has become the first faculty member nationally to use team-based learning in a dental school course. Further, graduates have implemented a humanism project for medical students made changes within their respective medical education programs, incorporated technology into programs and sites for medical training, implemented an undergraduate online evaluation program, and have taken a leadership role in developing and overseeing clinical skills exams. In addition, the Liaison Committee on Medical Education site visit reports for both The University of Texas Medical School at Houston and the Baylor College of Medicine in 2004 and 2005, respectively, cited our joint faculty development activities as “noteworthy achievements” in each school’s individual report. The Baylor report stated: “An array of faculty development programs provides excellent opportunities for enhancement of teaching skills and advancement within the institution.”
Graduates benefit the school by serving as educational leaders who are not only agents for change, but are trained educators leading and developing educational activities that bring positive recognition to the their schools and programs and provide a credible voice to chairs, deans, and school administrators concerning educational issues. In addition, some fellows have individual agreements with their department chairs concerning their present and future educational activities in their departments and some are expected to serve as teaching role models for other departmental faculty.
This collaborative fellowship provides an opportunity for the development of a strong network of supportive colleagues and scholars who work within their respective institutions to innovate, assume educational leadership roles, and enhance the educational culture of academic medicine. The evolution of this program, from one that addressed the faculty educator development needs of one medical school in the mid-1990s to a more flexible model that includes faculty and fellows from three institutions, reflects the changing needs of faculty as well as those of other health professions schools. The ESFP’s strengths lie in the effective use of resources across three schools; the opportunity for an interinstitutional and interdisciplinary collaborative network; the flexibility of the curriculum offerings; and the positive impact on fellows’ knowledge, skills and leadership in medical and dental education. The evolution of this program represents a cost-effective and educationally sound response to the changing needs of faculty educators. Based upon the evaluations conducted, it is evident that the ESFP meets the current needs of the faculty. We anticipate that the ESFP will change in the future as the needs and interests of the faculty evolve.
For further information about the ESFP, contact Nancy Searle at (firstname.lastname@example.org) and/or see our Web site at (http://www.bcm.edu/fac-ed/ESFP/index_esfp.htm).
The authors wish to acknowledge, from Baylor, Drs. Rebecca Kirkland, Andrew Wilking, Joan Friedland, and Boyd Richards, without whose vision and support the MTFP and the ESFP programs would not have been possible. In addition, the authors would like to recognize Drs. Allison Ownby and Alan Levine, co-directors of the current fellowship, and Dr. Paula O’Neill, of The University of Texas Dental Branch.