Medical Education Fellowships
Why Invest in an Educational Fellowship Program?
Searle, Nancy S. EdD; Hatem, Charles J. MD; Perkowski, Linda PhD; Wilkerson, LuAnn EdD
Dr. Searle is program director for faculty development and ambulatory education, Office of Curriculum, Baylor College of Medicine, and assistant professor, Departments of Pediatrics and Medicine, Baylor College of Medicine, Houston, Texas.
Dr. Hatem is director, Rabkin Fellowship in Medical Education, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center; director of medical education, Mount Auburn Hospital, and Harold Amos Professor of Medicine, Harvard Medical School, Boston, Massachusetts.
Dr. Perkowski is associate dean for curriculum and evaluation, and associate professor of family medicine and community health, University of Minnesota Medical School—Twin Cities, Minneapolis, Minnesota.
Dr. Wilkerson is senior associate dean for medical education, director of the Center for Educational Development and Research, director of the UCLA Faculty Fellowship in Medical Education, and professor of medicine at the David Geffen School of Medicine at UCLA, Los Angeles, California.
Correspondence should be addressed to Dr. Searle, Baylor College of Medicine, One Baylor Plaza, Room M301, Houston, TX 77030; e-mail: (email@example.com).
Expanding and refining the repertoire of medical school teaching faculty is required by the many current and changing demands of medical education. To meet this challenge academic medical institutions have begun to establish programs—including educational fellowship programs—to improve the teaching toolboxes of faculty and to empower them to assume leadership roles within both institutional and educational arenas. In this article, the authors (1) provide historical background on educational fellowship programs; (2) describe the prevalence and focus of these programs in North American medical schools, based on data from a recent (2005) survey; and (3) give a brief overview of the nine fellowship programs that are discussed fully in other articles in this issue of Academic Medicine. These articles describe very different types of educational fellowships that, nevertheless, share common features: a cohort of faculty members who are selected to participate in a longitudinal set of faculty development activities to improve participants’ teaching skills and to build a cadre of educational leaders for the institution. Evaluation of educational fellowships remains a challenging issue, but the authors contend that one way to evaluate the programs’ effectiveness is to look at the educational improvements that have been instigated by program graduates. The authors hope that the various program descriptions will help readers to improve their existing programs and/or to initiate new programs.
Leaders in medical education recognize the need for continuous improvement in medical curricula, in methods of instruction and evaluation, and in institutional culture in response to the changing needs of students and society. In addition, guidelines promulgated by accrediting bodies such as the Accreditation Council for Graduate Medical Education and the Liaison Committee for Medical Education continuously mandate educational change. National reports on the state of medical education regularly stimulate discussion of problems and solutions for better preparing physicians for a lifetime of practice.1 Another pressure for change in medical education is the movement from a hospital-based to an ambulatory/community-based teaching venue for clinical training.
Changes in the practice of medicine, in the health care needs of the population, in what is known about medical science, in health care finance, and in accreditation standards create the need for medical education programs that are capable of constant revision and renewal with the flexibility to include new topics such as improving communication skills and assuring professionalism. New methods of teaching and evaluation continue to emerge as research in education, psychology, and the neurosciences advances our understanding of how people learn.2 As a result, there is increasing interest among faculty members in using more active learning techniques (eg, small-group activities, team-based learning, individualized instruction using technology) as methods of instruction and assessing competency attainment. The use of medical simulation, virtual reality, standardized patients, and computer-based simulations are becoming increasingly necessary to train and certify physicians. Teaching in this environment requires an expansion of the educator’s toolbox, including new teaching skills and expertise in new topics.
Faced with these educational challenges, many medical schools have implemented or enhanced their faculty development programs with more frequent workshops on teaching skills or seminars on teaching approaches for new topic areas such as geriatrics or evidence based medicine.3,4 These efforts have been coupled with increasing attention to the ways in which teaching is funded and rewarded, such as mission-based management5 or the growth of academies of excellent educators.6 Traditionally, intellect and productivity in research and clinical duties have been valued far above a faculty member’s humanistic and educational qualities in terms of academic advancement.7 However, since 1990, there has been a growing interest among medical schools in broadening the definition of academic scholarship to include creative acts of teaching and the development of innovative educational strategies and materials.8–10 Changes in the system of academic advancement and increased attention to teaching excellence have been especially important as the ranks of clinical educators and clinical track faculty have grown to meet clinical productivity demands.11,12
In this article and nine others in this issue of Academic Medicine, we and our colleagues address a unique approach to faculty development designed to prepare faculty members as excellent teachers and educational leaders while strengthening their skills for academic advancement and increasing attention to the educational mission of the institution. This approach has been called by numerous names—faculty scholars programs, faculty fellowships, educational fellowships, medical education fellowships, master teacher programs—but all share the same features: a cohort of faculty members selected to participate in a longitudinal set of faculty development activities with the goals of improving the participants’ teaching skills and of building a cadre of educational leaders for the institution. Participants in these programs are usually called “fellows” or “scholars.” Both of those terms have been used in the ten articles that follow this introductory one.
The idea of fellowship programs in medical education for faculty members grew out of the need in the 1980s to develop a cadre of skilled teachers for emerging departments in Family Medicine, stimulated by funding from Health Resources and Services Administration grants.13–19 These early fellowship programs targeted graduating residents bound for faculty positions or experimented with innovative multicampus approaches for existing faculty. Over the past 25 years, the idea of educational fellowships has matured into a tool for stimulating reflective practice as a basis for individual teaching improvement and for developing educational leaders prepared to guide larger departmental or institutional change activities.
While traditionally faculty development in higher education has been carried out during a faculty member’s sabbatical leave, educational fellowships provide extensive training without having scholars take a sabbatical or be away from other professional responsibilities for an extended period of time. A fellowship typically lasts from one to two years with a cohort size as small as three or as large as twenty participants. Most educational fellowships include only medical faculty in their programs, but some also include residents, fellows, dentists, and other health professions faculty. Many programs require that participants complete and present an education project or an educational research study.
In the rest of this article, we describe the common features of educational fellowship programs and the prevalence and focus of such programs in North American medical schools, based on findings from a recent survey of those schools. We also give a brief overview of the nine fellowship programs discussed fully in later articles in this issue of Academic Medicine.
The Development of Educational Fellowships
Are educational faculty development programs, and fellowships in particular, an appropriate tool to cultivate continuous improvement and develop change agents? The definition of faculty development has changed over the last 15 years.3,20–24 Wilkerson and Irby3 define faculty development as “a tool for improving the educational vitality of academic institutions through attention to the competencies needed by individual teachers, and to the institutional policies required to promote academic excellence.” Steinert24 recommended in 2005 that “faculty development initiatives are to bring about change at the individual and the organizational level.” Several have suggested that changes in curricula as well as changes in teaching and evaluation methods cannot be made at the institutional level without faculty development.23,25–29
Clinical educators have specific educational needs that must be met for them to be successful. Jolly and Macdonald30,31 suggest that effective clinical teachers need expertise in clinical teaching, learning theory, and educational evaluation. Irby32,33 added that clinical teachers benefit from learning about a variety of teaching methods, the modeling of experienced teachers, and the development of content-specific teaching examples that can be incorporated into faculty development activities. Drawing upon the skills derived from the practice experience of clinical educators provides an essential perspective in educational faculty development. Physicians improve more than just their educational skills when they learn to teach. Hatem34 hypothesizes “that teaching and doctoring are fundamentally the same process and that caring for the learner and caring for the patient reflect identically parallel professional skills. Both endeavors require eliciting the learner/patient’s needs, stating the teacher/doctor’s agenda, use of appropriate diagnostic approaches, ongoing feedback/communication, and evaluation of outcomes.”
Strong leaders are needed to implement and support change.35 In addition to improving teaching skills, some educational fellowships have been created explicitly to develop educational leaders from an institution’s education faculty,36–39 and most fellowships include significant elements of leadership training in their curricula. In interviews conducted by Baldwin et al.40 to determine the faculty development needs of generalists to become educational leaders, they found that generalists felt undervalued by their specialist colleagues. They also identified, as a global need, a better understanding of and rewards for generalists’ academic activities as well as better networking with others and with nongeneralists. This may be one reason why more pediatricians and internal and family medicine generalists participate in faculty development activities—including educational fellowships—than do physicians in other disciplines.
In a survey of all dental schools in Canada, Harrison and Forgay41 found that those who had participated in educational faculty development activities to improve teaching had much more interest in learning more about teaching. They proposed that “there is a threshold of knowledge about a topic which, when traversed, unlocks awareness of the need for more successful or rewarding teaching methods.” This can be a two-edged sword when evaluating faculty development programs. Since many programs depend upon self-ratings, many faculty do not evaluate their new skills accurately because they are more aware of their deficiencies.42
Developing Positive Change Agents
Which faculty development strategies work best to develop faculty capable of improving the educational system? In particular, activities designed to train the trainer are an effective and efficient way to improve faculty members’ teaching and change-agent skills. Such activities are based on the diffusion theory of innovation,43 which suggests that the most effective change agents have characteristics similar to those of the target audience. Wilkerson’s and Irby’s3 comprehensive review in 1998 of strategies used in faculty development to improve teaching identified the following strategies as having a positive effect on a teacher’s knowledge, skills and attitudes about teaching:
* Longer (more than two days) rather than shorter workshops
* The use of student ratings and peer evaluation
* Educational fellowships
They found that fellowships usually involve activities designed to improve teaching and evaluation skills, to teach the principles of curriculum development and learning theories, and to provide training in educational leadership and scholarship. In addition to inculcating strong educational principles, educational fellowships develop a core of educators who know each other and can work together across departments for improvement of the educational program.
Educational Fellowship Programs Across North America
In 2005, we developed an online survey to determine both the prevalence and focus of educational fellowship programs in medical schools. We administered it to 140 public and private medical schools across North America. A total of 81 (58%) responded; of these, 42 (52%) reported having educational fellowships; of those, 4 reported they had begun their programs during academic year 2005–06. Of those that did not have a program, five were interested in beginning one. Participants were asked to describe the focus of their programs indicating whether specific topics were a primary, secondary, or tertiary focus or not a focus at all (see Table 1).
The finding that four of the 42 schools reported that they were just beginning a fellowship program, and five schools were interested in beginning one, shows an increasing interest in educational fellowships. Perhaps this interest is in response to some of the educational changes required in medical schools as reported earlier in this article.
Although there are trends across programs, it is obvious from our survey findings that educational fellowships vary widely in scope and mission. The range in length from two to 36 months and the range of total contact from 10 to 400 hours illustrate how different these programs are. It appears that successful programs must meet the needs and live within the resources of their institutions.
As is common in many faculty development activities, our findings indicate that satisfaction and self-assessment questionnaires continue to be the most common form of program evaluation for educational fellowships. Because of the detail and complexity required to describe and evaluate faculty development programs, including educational fellowships, it is difficult to attribute quality improvement or change directly to a particular program. As eloquently explained by Jolly in the International Handbook of Research in Medical Education, although many studies on faculty development programs attempt evaluation,
few have looked at replicable cause-effect linkages. This is understandable; as such investigations would be difficult. Faculty development is as much ad-hoc as programmatic and usually of finite length but with the potential to deliver infinite effects. Institutions generally do not fund faculty development to provide subjects for inevitably lengthy and costly research projects. Much of the scant research in this area was done in the 1980s, when resources were more generous.7, p. 960
We contend that one way to evaluate the effectiveness of faculty development fellowships is to look at what educational improvements have been instigated by program graduates and adopted by their institutions.
The Value of Educational Fellowships
The next nine articles in this issue report on educational fellowships at Harvard Medical School; McGill University Faculty of Medicine; the Medical College of Wisconsin; the David Geffen School of Medicine at UCLA; the University of California, San Francisco, School of Medicine; the University of Iowa Roy J. and Lucille A. Carver College of Medicine; the University of Michigan Medical School; the University of Washington School of Medicine; and a joint program carried out by Baylor College of Medicine, The University of Texas Medical School at Houston, and The University of Texas Dental Branch. All of these programs have produced a core of change agents in education. The programs described in these nine articles share core features but otherwise are quite different from one another. We hope this variety will be useful to readers as they compare these programs with their own, or perhaps pick and choose components to create new programs that may be useful in their specific medical school environments. Many of the programs described in this issue of the journal have been documented in the literature,3,36–39,44–48 but the authors did not describe their programs in those articles at the level of detail necessary for replication as suggested by Jolly.7 Details about costs and staffing needs will be found in the nine articles that follow. By comparing and contrasting these various programs, characteristics of success can be identified as well as directions for the future. These topics are discussed further by Gruppen et al. in the final article in this issue.
Why invest in an educational fellowship? Modern medical education is a professional enterprise. As we speak of medical schools and teaching hospitals, it is necessary that our faculty charged with teaching learners at all levels and overseeing our educational programs achieve the same high level of competence as that expected of clinical and research faculty members.49,50 Educational fellowships such as those described in this issue serve two important purposes: they can teach individual faculty members the expertise necessary to train physicians to meet contemporary practice and research needs, and can provide institutions a core of faculty members with the leadership skills to facilitate educational change and improvement in the academic medical environment of the 21st century.
Those who direct educational fellowships or are interested in learning more about educational fellowships are invited to attend a meeting of directors of medical education fellowships on Saturday, October 28th, in Room 210 at the Seattle Convention Center from 2–4 pm.
The authors thank Britta M. Thompson, PhD, Baylor College of Medicine, for her assistance with both the development of the survey and the statistical analysis of the survey data.
1 Association of American Medical Colleges Ad Hoc Committee of Deans. Educating Doctors to Provide High Quality Medical Care: A Vision for Medical Education in the United States. Washington, DC: AAMC; July 2004.
2 Bransford JD, Brown AL, Cooking RR, eds. How People Learn: Brain, Mind, Experience, and School. Washington, DC: National Academy Press; 1999.
3 Wilkerson L, Irby DM. Strategies for improving teaching practices: a comprehensive approach to faculty development. Acad Med. 1998;73:387–396.
4 Morahan PS, Gold JS, Bickel J. Status of faculty affairs and faculty development offices in U.S. medical schools. Acad Med. 2002;77:398–401.
5 Watson RT, Romrell LJ. Mission-based budgeting: removing a graveyard. Acad Med. 1999;74:627–640.
6 Irby DM, Cooke M, Lowenstein D, Richards B. The academy movement: a structural approach to reinvigorating the educational mission. Acad Med. 2004;79:729–736.
7 Jolly BC. Faculty development for curricular implementation. In: Norman GR, van de Vleuten, CPM, Newble DI, eds. International Handbook of Research in Medical Education. Boston, Mass: Kluwer Academic Publisher; 2002.
8 Boyer EL. Scholarship Reconsidered: Priorities of the Professoriate. Princeton, NJ: Carnegie Foundation; 1990.
9 Simpson D, Hafler J, Wilkerson L. Documentation systems for educators seeking academic promotion in U.S. medical schools. Acad Med. 2004;79:783–790.
10 Howell LP, Bertakis KD. Clinical faculty tracks and academic success at the University of California Medical Schools. Acad Med. 2004;79:250–257.
11 Beasley BW, Wright SM. Looking forward to promotion: characteristics of participants in the prospective study of promotion in academia. J Gen Intern Med. 2003;18:705–710.
12 Atasoylu AA, Wright SM, Beasley BW, et al. Promotion criteria for clinician-educators. J Gen Intern Med. 2003;18:711–716.
13 Bland CJ, Hitchcock MA, Anderson WA, Stritter FT. Faculty development fellowship programs in family medicine. J Med Educ. 1987;62:632–641.
14 Final funding priorities for grants for faculty development in family medicine-HRSA. 53 Federal Register 49929–49930 (1988).
15 McGaghie WC, Bogdewic S, Reid A, Arndt JE, Stritter FT, Frey JJ. Outcomes of a faculty development fellowship in family medicine. Fam Med. 1990;22:196–200.
16 Lindemann JC, Beecher AC, Morzinski JA, Simpson DE. Translating family medicine’s educational expertise into academic success. Fam Med. 1995;27:306–309.
17 Pinheiro SO, Liechty DK, Busch KV, Johnson ES, Dora DL, Butler RM. Institutional impact of a part-time faculty development fellowship program for osteopathic community-based physicians. J Am Osteopath. 2002;102:637–642.
18 Stageman JH, Bowman RC, Harrison JD. An accelerated rural training program. J Am Board Fam Pract. 2003;16:124–130.
19 Gjerde CL, Kokotailo P, Olson CA, Hla KM. A weekend program model for faculty development with primary care physicians. Fam Med. 2004 Jan; 36(1 suppl):S110–S114.
20 Allen DL. Faculty development. J Dent Educ. 1990;54:266–267.
21 ERIC, Educational Resources Information Consortium, Database definition. 1995. The Education Resources Information Center (ERIC), sponsored by the Institute of Education Sciences (IES) of the U.S. Department of Education, the premier database of journal and non-journal education literature. Available at: (http://www.eric.ed.gov/
). Accessed 27 July 2006.
22 Millard L. Staff development for a new communication and learning course. In: Towle A, ed. Effecting Change Through Staff Development. London: Kings Fund; 1993.
23 Rubeck RF, Witzke DB. Faculty development: a field of dreams. Acad Med. 1998;73:S32–S37.
24 Steinert Y. Learning together to teach together: interprofessional education and faculty development. J Interprof Care. 2005 May;19(5 suppl):60–75.
25 McLeod PJ, Steinert Y, Nasmith L, Conochie L. Faculty development in Canadian medical schools: a 10 year update. CMAJ. 1997;156:1419–1423.
26 Niemann LZ. Combining educational process and medical content during preceptor faculty development. Fam Med. 1999;31:310–312.
27 Farmer EA. Faculty development for problem-based learning. Eur J Dent Educ. 2004;8:59–66.
28 Bowe CM, Lahey L, Armstrong E, Kegan R. Questioning the “big assumptions.” Part I: Addressing personal contradictions that impede professional development. Med Educ. 2003;37:715–722.
29 Bowe CM, Lahey L, Kegan R, Armstrong E. Questioning the “big assumptions.” Part II: Recognizing organizational contradictions that impede institutional change. Med Educ. 2003;37:668–669.
30 Jolly BC, Macdonald MM. More effective evaluation of clinical teaching. Asses Eval High Educ. 1986;12:175–190.
31 Jolly BC, Macdonald MM. Education for practice: the role of practical experience in undergraduate and general clinical training. Med Educ. 1989;23:189–195.
32 Irby DM. How attending physicians make instructional decisions when conducting teaching rounds. Acad Med. 1992;67:630–638.
33 Irby DM. What clinical teachers in medicine need to know. Acad Med. 1994;69:333–342.
34 Hatem CJ. Teaching approaches that reflect and promote professionalism. Acad Med. 2003;78:709–713.
35 Ullian JA, Stritter FT. Types of faculty development programs. Fam Med. 1997;29:237–241.
36 Rosenbaum ME, Lenoch S, Ferguson KJ. Outcomes of a teaching scholars program to promote leadership in faculty development. Teach Learn Med. 2005;17:247–252.
37 Gruppen LD, Frohna PZ, Anderson RM, Lowe KD. Faculty development for educational leadership and scholarship. Acad Med. 2003;78:137–141.
38 Steinert Y, Nasmith L, McLeod PJ, Conochie L. A teaching scholars program to develop leaders in medical education. Acad Med. 2003;78:142–149.
39 Wilkerson L, Hodgson C. A fellowship in medical education to develop educational leaders at UCLA. Acad Med. 1995;70:115–116.
40 Baldwin CD, Levine HG, McCormick DP. Meeting the faculty development needs of generalist physicians in academia. Acad Med. 1995;70(1 suppl):S97–S103.
41 Harrison RL, Forgay MG. Self-perceived needs for faculty development in Canadian dental schools. J Dent Educ. 1990;54:240–243.
42 Skeff KM, Stratos GA, Mygdal W, et al. Faculty development a resource for clinical teachers. J Gen Intern Med. 1997;12(4 suppl):S56–S63.
43 Rogers EM. Diffusion of Innovations. 4th ed. New York, NY: Free Press; 1995.
44 Rosenbaum ME, Ferguson K, Lenoch S. A teaching scholars program to improve faculty development. Acad Med. 2001;76:572–573.
45 Gjerde CL, Albanese M, Howard NA. A faculty development program in basic teaching skills. Acad Med, 1999;74:610–611.
46 Morzinski J, Simpson D. Outcomes of a comprehensive faculty development program for local, full time faculty. Fam Med. 2003;35:434–439.
47 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.
48 Richards BF, Wilking AP, Kirkland TR. A four-month faculty development curriculum on teaching and learning. Acad Med. 1999;74:614–615.
49 Commonwealth Fund Task Force on Academic Health Centers. Envisioning the Future of Academic Health Centers. Boston, Mass: Commonwealth Fund; 2003.
50 Blue Ridge Academic Health Group. Reforming Medical Education: Urgent Priority for the Academic Health Center in the New Century. Atlanta, Ga: Emory University; 2003.
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