Faculty development has been identified as a critical need if we hope to advance competency-based education. Despite the small number of participants at a single institution, the model presented here has the possibility for making a significant contribution to future faculty development initiatives for two reasons. First, by supporting the time of the scholars, the program makes a statement about the value of medical education and the recognition that it requires a skill set to become an educator. While the need for requisite skill sets has long been recognized for training sub-specialists, this has not been the case for those taking on major roles in education and training. Second, despite a rich literature, little has been published about the effects on the learners of those who participated in the faculty development programs. By supporting a cadre of individuals to acquire the skills needed to be an educator as well as the skills needed to perform educational research to study the impact of applying those skills, this project serves as a model for developing a much needed community of medical education leaders.
Carol Carraccio, MD, MA
Excellence in medical student, resident, and fellow education is a primary goal of all academic departments of pediatrics.1 Pediatric residency programs, the major educational focus of most departments of pediatrics, must prepare graduates to assume a broad range of professional roles.2,3 These roles include provision and coordination of general pediatric and subspecialty care, the assumption of key leadership positions, the ability to function effectively in an ever-evolving health care delivery system, and the scholarly pursuit of new knowledge, including the discovery of cures and novel therapies for pediatric diseases. Pediatric residency programs must prepare trainees in an atmosphere in which faculty are called on to teach, role-model, and assess competencies to which they might not have been exposed during their training. Clinician-educators must balance the competing priorities of identifying time for teaching versus acquiring relative value units and must deal with regulations that increasingly limit the time allowable for on-site educational activities.4,5
To meet these challenges, progressive departments must identify innovative strategies to support the transition from time-based to criterion-based professional competency requirements.6 Departments must also recognize the unique challenges and opportunities that educating learners across the continuum of pediatrics (medical student–resident–fellow–faculty/practitioner) provide to departments and programs.7 Achieving excellence in pediatric education requires financial support, committed pediatric faculty, and a core of skilled educators who can design and deliver a comprehensive curriculum in educational theory and educational research. Educational research is critical if we hope to learn the impact of our efforts.
In 2008 we began with the vision that we could create a departmental program, ultimately named the Academy of Pediatric Education and Leadership (APEL), that would fulfill several objectives for our pediatric faculty. Our overarching goal for the APEL was to expand the number of pediatric faculty members who viewed education as their primary academic activity. The preliminary objectives for participants in the APEL program were to (1) acquire knowledge regarding contemporary educational theory and practice, (2) conduct effective educational research, and (3) gain an understanding of the scholarly activities and responsibilities that ensure academic promotion and retention. In the initial discussions of the APEL, we had proposed that the “L” would stand for “learning,” but during a faculty meeting the department chair misidentified “L” as “leadership.” We immediately realized the wisdom of this misidentification and adopted an additional objective: (4) to acquire the knowledge and skills that improve one's leadership abilities.
We modeled the APEL after existing, successful faculty-development programs including the medical scholars programs of the University of Michigan8 and the University of Utah School of Medicine and the Academic Pediatric Association Educational Scholars Program.9 Our first step in the modeling process was to identify members of the broader medical education community at the University of Utah who could serve as an advisory committee. Because we did not have a department of medical education from which to recruit faculty, we invited the director of the Graduate Medical Education Programs/Designated Institutional Official, an associate dean for medical student education, and the director of the university's Center for Teaching Learning Excellence to serve as advisors to the APEL program. With their guidance and through discussions with senior departmental educators, we created a comprehensive curriculum that would span the entire 1-year term of APEL scholars.
In our next step, we identified the scholars. We presented the objectives of the APEL at the Departmental Executive Committee (division chief's) meeting and invited division chiefs to nominate faculty members who were either self-identified or identified by the chiefs as exemplary or nascent educators. A potential barrier to faculty participation was removed when the department chair agreed to provide 10% salary support so that each scholar could participate in the APEL a half-day per week for an entire year. We ultimately received 4 nominations: 1 faculty member each from the divisions of pediatric neurology, emergency medicine, critical care, and general pediatrics. Potential scholars were required to submit applications that consisted of their curricula vitae, support letters from their division chiefs, and self-assessment statements describing their long-range career plans with regard to education. After review of the application materials, we invited the 4 faculty nominees into the inaugural class of APEL scholars. Because educating medical students and residents is a major role for our chief residents, we also invited our 3 chief residents to participate in the APEL. All of them accepted the invitations, which resulted in an inaugural APEL class of 7 scholars.
Meeting each Friday from 1 to 5 pm, the APEL has 2 major components: (1) content delivered to scholars through didactics, required readings, facilitated discussions, and workshops; and (2) educational research projects conducted by each scholar. The APEL curriculum includes 3 areas of focus.
Education: adult learning theory, teaching on rounds, writing goals and objectives, teaching in inpatient settings, teaching in ambulatory settings, receiving and giving feedback, case-based teaching, methods of evaluation, change theory, distance learning, technology in medical education, writing test questions, effective lecturing, the problem learner, observed structured clinical evaluation, and education through simulation.
Research: institutional review board/Health Insurance Portability and Accountability Act and educational exemption, survey research, principles of study design, qualitative research, critically appraising the literature, scientific writing, introduction to peer review, scientific presentation, obtaining intramural or extramural funding, medical biostatistics, and the ethics of publication.
Leadership: developing an educator portfolio (which each APEL scholar is expected to create during his or her tenure as scholar), the criteria and process of retention/promotion/tenure, leading teams/running meetings, time management, effective mentoring, principles of effective negotiation, developing a strategic plan, motivational interviewing, the pediatric alphabet (pediatrics RC [review committee], ACGME [Accreditation Council for Graduate Medical Education], ABP [American Board of Pediatrics], etc), and career/life balance.
Scholars are mentored individually by the group leaders (Drs Hobson, Carey, and Bale), and through this process the scholars have identified educational research projects that will be conducted during their term as APEL scholars. These projects include (1) creating a modular curriculum for education in core topics in child neurology, (2) promoting the Academic Associates Program, a means to provide experience for undergraduate students who are considering careers in medicine, (3) the use of simulation to evaluate and teach effective feedback, (4) developing a program to teach improved communication skills with adolescent patients, using teens as standardized patients, (5) piloting a new ward day-team/night-float structure for pediatric residents, and (6) creating an internal night-float team (“the resuscitation team”) for the NICU and normal newborn nursery. As indicated above, the new Accreditation Council for Graduate Medical Education regulations regarding resident duty hours and supervision provided rich opportunities for education research.
Each Friday afternoon session begins with didactic material from the comprehensive curriculum. Educators from the University of Utah Graduate Programs and School of Medicine comprise the APEL faculty; each faculty participant has volunteered his or her time to deliver material to the APEL scholars. The didactic sessions typically use half of the allotted time, and the remaining time is spent discussing the scholars' research projects. These rich and lively discussions enable APEL scholars to “workshop” their projects and obtain new ideas and perspectives from the other scholars. The group interactions, one of the most stimulating aspects of the APEL program, have led to collaboration and innovative educational strategies that can serve as models for delivering educational content in student and resident rotations.
The success of the APEL program will ultimately be assessed at several levels. At the most basic level we will determine the satisfaction of each scholar and faculty participant through formal written and verbal evaluations administered at the completion of the APEL year. The annual evaluations, as well as informal feedback, will guide us as we refine the coursework for future scholars. Through the scholar's creation of an educational portfolio and our review of the annual updates, we will be able to assess objectively each scholar's educational activities. We will pay particular attention to the scholar's educational role in the division (eg, creator or facilitator [“course master”] of medical student and/or resident curricula), the development of curricular materials (eg, syllabi or online resources), the dissemination of scholarly works (eg, national workshops, abstracts, manuscripts), the scholar's participation in educational research, and the scholar's success in obtaining intramural or extramural funding for educational research.
We will also be able to assess the effects of the APEL on student and resident learners through course evaluations, performance on standardized examinations (eg, the certifying examination of the American Board of Pediatrics), and the learners' own performance as teachers. Not only will we assess the program's progress annually, we anticipate critical assessments of the program at the 5- and 10-year time points. We fully anticipate that several years of the APEL program will be necessary before we can determine if we have successfully met its fundamental goal, which is to create a new community of educators who design, implement, and study educational innovations.
We thank Carol Carraccio, MD, and the members of the Initiative for Innovation in Pediatric Education committee for suggestions and for the opportunity to create the APEL program. We thank Edward B. Clark, MD (Department of Pediatrics, University of Utah), for guidance and support for this program. We also thank our inaugural class of APEL scholars for their energies and ongoing feedback: Kristen Day, MD, Ryan Donnelly, MD, Joni Hemond, MD, Jared Henricksen, MD, Maija Holsti, MD, MPH, Irene Kocolas, MD, and Denise Nielsen, MD.
- Accepted April 25, 2011.
- Address correspondence to James F. Bale Jr, MD, Pediatric Residency Office, 3rd Floor, Primary Children's Medical Center, 100 N Mario Capecchi Dr, Salt Lake City, UT 84113. E-mail:
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
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Accreditation Council for Graduate Medical Education. Common program requirements. Available at: http://acgme-2010standards.org/approved-standards.html. Accessed April 22, 2011
University of Michigan Medical School, Department of Medical Education. Graduate Medical Education Scholars Program (GMESP): healthcare administration & medical education. Available at: www.med.umich.edu/meded/programs/gmesp.htm. Accessed April 22, 2011
Academic Pediatric Association. APA Educational Scholars Program. Available at: www.academicpeds.org/education/education_scholars_program.cfm. Accessed April 22, 2011
- Copyright © 2011 by the American Academy of Pediatrics