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Innovation Reports

The Boston Children’s Hospital Academy: Development and Initial Assessment of a Hospital-Based Teaching Academy

Gooding, Holly C. MD, MSc; McCarty, Caitlin; Millson, Rebecca; Jiang, Hungyu PhD; Armstrong, Elizabeth PhD; Leichtner, Alan M. MD, MSHPEd

Author Information
doi: 10.1097/ACM.0000000000001095
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Abstract

Problem

Medical schools increasingly have recognized medical education as a distinct career track for faculty, with established criteria for productivity and advancement.1 An important part of this movement has been the creation of academies2 designed to stimulate educational innovation, develop the educational skills of faculty, promote collaboration, provide mentoring, and enhance promotion.3 Over half of U.S. medical schools surveyed in 2010 either had an established medical education academy or were planning to launch one.3 In contrast to these reports of a burgeoning number of medical-school-based academies, there is a paucity of articles describing such academies in hospital-based settings.4

Although medical school academies are an important vehicle for professional development for faculty, they present a number of challenges for hospital-based practitioners. Medical school academies often are focused more on undergraduate than graduate medical education. They may be geographically distant from where practitioners teach and practice, creating a barrier to in-person attendance at events and limiting opportunities for collaboration with nursing and other allied health faculty or with faculty actively engaged in patient safety and quality activities in the hospital. Finally, medical school academies may be less attuned to the career development needs of hospital-based clinical teaching faculty. In this report, we describe our attempt to create and initially assess a project-oriented hospital-based academy that overcomes these challenges.

Approach

When Harvard Medical School (HMS) established its academy in 2001,5 the founders recognized the challenge of reaching clinician–educator faculty at its many affiliates, so they suggested that daughter academies be developed at each of the major teaching hospitals affiliated with HMS. With the support of department and division chiefs, a panel of respected medical educators assembled to design the Boston Children’s Hospital (BCH) Academy in 2008. Early in this process, the panel members distinguished between creating an organization to support teachers and one to support educational scholars.1,6 The three primary goals of the new academy reflect this distinction in mission: (1) to recognize the role of medical educators, (2) to foster scholarship in medical education, and (3) to assist in the promotion of faculty by medical education criteria.

To achieve these goals, the panel members agreed on a number of design principles. First, selection to the academy should be based on a professed interest in pursuing a project in education, rather than on previous accomplishments, so as to not exclude junior faculty from consideration. While the first cohort of 54 members who were accepted to the academy in academic year 2008–2009 included a large number of senior faculty educators, each subsequent cohort of 11 to 17 incoming members typically was made up of junior faculty. Starting in 2010, trainees (residents and fellows) also were considered for membership, provided they had a minimum of one year with protected time to pursue an education project. Candidates could be nominated by their chief or be self-nominated, but those who were self-nominated had to secure endorsement from their chief in the form of a letter of support.

Second, the academy should emphasize innovation, leadership, and continuous improvement in education through project-based membership. To be accepted, scholar–member candidates have to propose a feasible project related to health professions education. To maintain membership, they have to document their progress toward completion of that project. More senior faculty can become scholar–members if they choose to pursue their own project but also can elect to be mentor members by providing support to the scholar–members. To maintain membership, mentor members have to actively mentor scholar–members and document their work.

Finally, membership should be reviewed annually to ensure members’ active participation and progress toward their professional goals. To document their progress, members submit an annual report to the academy leadership. For scholar–members, this report includes the title of their current project; an update on the project’s status; and their interval accomplishments, including education presentations and publications, awards, grants, and promotions. For mentor members, the report includes a list of their mentees and the mentees’ project titles as well as the mentor’s accomplishments. These annual reports also are used to justify the allocation of hospital resources for academy programming and to support applications for grants from external agencies.

A request for membership applications was distributed to all HMS and Harvard School of Dental Medicine faculty based at BCH in 2008; the annual request for new applications occurs in July. A committee of educators reviews the applications. From 2008 to 2014, 128 of 130 applicants have been accepted. The initial cohort of members represented 14 different hospital departments.* Although the academy initially was geared toward physicians, an unexpected benefit was the interest and participation of allied health professionals, including dentists (n = 1), psychologists (n = 4), and social workers (n = 1).

Semiannual retreats in October and April are the signature activities of the academy. These half-day programs include a keynote speaker, workshops, and presentations of members’ projects, as well as an opportunity for networking. Workshops cover topics designed to assist members with their projects (e.g., writing educational grants) or to support their career development (e.g., maintaining an educator’s portfolio). In addition, in 2012, a monthly project conference was added to provide members with feedback on their academy projects at any stage of completion. The annual reports to the academy are also used to identify those members who have published on their projects or presented them at national events. These individuals are publicly recognized with an award at the retreat.

The operating budget of the academy is approximately $35,000 per year and includes partial support for the director and an administrative assistant, office supplies, and expenses related to the retreats and project conferences. The academy has been able to offer one to two small pilot grants per year (up to $6,000 per project) to support selected projects (these awards are funded by an initial grant of $40,000 from the hospital).

To formally assess the impact of the academy, all active members from the first three cohorts (2008–2011) were asked to complete an electronic survey administered via SurveyMonkey in February 2012. The survey tool asked members to respond using a five-point Likert scale (strongly disagree, disagree, neutral, agree, strongly agree) to the statement “Membership in the BCH Academy has had a positive impact on my [insert dimension]” for each of 10 dimensions. Demographic information (e.g., gender, professional degree, and years since professional degree completion) was collected, and respondents were given the opportunity to respond to the open-ended statement “Please reflect on what membership in the Academy has meant to you.” De-identified responses were entered into a database and analyzed using SPSS Version 19 (IBM, Armonk, New York). The Cochran–Armitage trend test was used to evaluate the effect of years since professional degree completion and gender on responses. All tests were two sided, with a 0.05 significance level.

Members were also asked to submit all annual reports of educational activities and an updated curriculum vitae for review. Educational accomplishments were defined as presentations, publications, and grants, for which the primary subject was some aspect of education. When two or more members collaborated on a presentation or publication, the accomplishment was credited separately to each individual. A leadership role in education was defined as directorship of a course, clerkship, or training program, or participation in an educational policy setting group on a local, national, or international level.

The BCH committee on clinical investigation granted this study exemption from formal review.

Outcomes

Of the 67 members from the first three cohorts who were eligible to complete the survey, 65 responded (97% response rate) and 60 provided demographic data. The mean length of membership at the time of the survey was 2.4 years (standard deviation 0.8 years). Slightly more than half (33 of 60) of respondents were female. Fifteen were within 10 years of completing their final professional degree, 20 were within 11 to 20 years, 14 were within 21 to 30 years, and 11 had worked for more than 30 years. The variable “years since professional degree completion” had no effect on responses to any of the dimension items (all P values > .05). However, some differences in responses by gender were found. More female members agreed that academy membership had a positive impact on their personal identity as an educator (P = .02), on their chief’s perception of them as an educator (P = .04), and on the potential to be promoted (P = .04). See Figure 1 for a summary of all responses to the dimension items. One additional benefit of the academy, mentioned by six members in their open-ended responses, was the ability to network with educators from other departments.

Figure 1
Figure 1:
Responses to a 2012 survey of 65 members of the Boston Children’s Hospital (BCH) Academy. Members were asked to respond using a five-point Likert scale (strongly disagree, disagree, neutral, agree, strongly agree) to the statement “Membership in the BCH Academy has had a positive impact on my [insert dimension]” for each of the 10 dimensions listed. In the figure, strongly agree and agree responses were combined as agree, and strongly disagree and disagree responses were combined as disagree.

Respondents’ project proposals reflect the diversity of the membership, in terms of learner level and educational category (see Figures 2 and 3). Curriculum development projects aimed at residents were most common. Ten projects proposed Web-based or other technology platform designs, and 13 included simulation, most often high-fidelity simulation. Eleven projects related to patient safety and quality, including the creation of a project-based quality improvement curriculum for neurology residents and the training of coaches to assist clinicians in the management of adverse events and medical errors. Thirteen projects were interprofessional, including a conflict management curriculum for teams aimed at reducing medical errors in the cardiac intensive care unit; a joint curriculum for pediatric anesthesiology residents and nurse anesthetist students; and communication workshops for physicians, nurses, and psychologists regarding challenging conversations in pediatric care.

Figure 2
Figure 2:
Percentage of 65 projects submitted to the Boston Children’s Hospital Academy, 2008–2011, targeting each learner level. Projects that targeted multiple learner levels may appear in more than one category. Joint project efforts between two or more Academy members are listed only once. Abbreviations: UME indicates undergraduate medical education; GME-R, graduate medical education, resident; GME-F, graduate medical education, fellow; CME, continuing medical education, which includes fully licensed clinicians from any profession.
Figure 3
Figure 3:
Percentage of 65 projects submitted to the Boston Children’s Hospital Academy, 2008–2011, in each educational category. Each project was assigned to only one category based on its primary aim. Joint project efforts between two or more academy members are listed only once.

According to the annual reports, members participated in an average of 4.4 education presentations and 1.9 education publications over the course of their membership. They received a total of 39 grants (the majority external) to support their education projects and 50 education awards. Forty-eight members held leadership positions in education, and 11 were promoted at HMS during their tenure in the academy.

At this point in the history of the academy, we cannot directly attribute these impressive accomplishments, especially the achievement of promotion, to membership in the academy. However, these accomplishments help both characterize the individuals who may be interested in membership in a hospital-based teaching academy and establish a standard for other hospitals considering this model.

Next Steps

Our initial review indicates that the academy has begun to fulfill its goals. Most members agreed that it has created a community of educators, fostered networking, reinforced their identities as educators, and led to recognition by chiefs for this role. Many of these attributes were more often expressed by female than male faculty, which is in keeping with the literature on faculty development programs and mentorship for women in medicine generally.7 An unanticipated benefit has been the interprofessional nature of the academy, both in membership and in member projects. Given that health care increasingly is provided by teams and that academic medical centers are the training sites for many disciplines, hospital-based teaching academies could play an important role in the future expansion of interprofessional education.

Still, implementation of a hospital-based academy presents some challenges. Face-to-face events are logistically difficult to hold because of differences in schedules among clinicians for whom patient care takes priority. The other principal challenge facing such academies is financial. Health care reform has threatened the solvency of academic medical centers,8 and funding for clinical care and research often comes before funding for education. Therefore, the academy design must be lean, with support for educational projects from funding sources aligned with the hospital’s clinical care and research missions.

To address these challenges, we have begun to develop an online, social media platform to strengthen the academy community. We plan to share members’ accomplishments with the wider hospital community via the newsletter and hospital Web site. We also hope to grow the number of nonphysician members in the coming years and to foster collaboration between graduate medical education programs and the nursing and other allied health professional training programs colocated in our hospital. We intend to help members further align their projects with hospital goals by strengthening the academy’s relationships with existing patient safety and quality initiatives. Additional opportunities for fulfilling the hospital’s mission include projects focused on continuing professional education, the education of patients and families, and the education of the lay public. We plan to track individual project outcomes, such as improvements in learner performance or in patient care, adoption of curricula, and dissemination beyond our institution. Finally, we will enhance collaboration with the Office of Faculty Development to assist members in preparing for the annual review and promotion processes by implementing premeeting curriculum vitae review and coaching sessions.

Despite the challenges, our results confirm the utility of a hospital-based academy for the vast majority of its members. Our experience with the BCH Academy hopefully will encourage other hospitals to consider new organizations to support their communities of educators. Hospital-based academies offer the unique opportunity to build interprofessional communities of educational scholars, equipped to address graduate health professions education and the ultimate goal of improving patient safety and quality.

Acknowledgments: The authors would like to thank Currie Touloumtzis for her assistance with manuscript preparation and all of the Boston Children’s Hospital Academy members for their participation.

*Those departments include anesthesia, cardiology, dentistry, laboratory medicine, medicine, neurology, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, psychiatry, radiology, surgery, and urology.

References

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