Physician-teacher characteristics associated with learner-centered teaching skills

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Practice points

Learner-centered medical education, wherein teachers are responsive to the needs of their trainees, makes sense intuitively and has been linked to improved academic performance, learner satisfaction, and the growth and development of medical learners. This paper describes a new learner-centeredness scale and the evidence for it's internal structure and content validity. Application of the scale to a large number of active physician-teachers allowed for the identifications of factors that are independently associated with being highly learner-centered. Future scholarly work in this area may attempt to determine which faculty development initiatives are most effective in improving physician-teachers’ learner-centeredness scores.

Table 1.  Characteristics of 262 Responding Physician Teachers

Demographics	Respondents (N ;= ;262)*
Male, n (%)	155 (61)
Age in years, mean (SD)	42 (6)
Non-Hispanic White, n (%)	208 (84)
Living with spouse/significant other, n (%)	207 (84)
Professional characteristics
Past participation in Johns Hopkins FDP, n (%)	178 (68)
General Internal Medicine/Geriatrics, n (%)	197 (82)
Currently has a medical school faculty appointment, n (%)	207 (82)
Instructor/Assistant Professor, n(%)	147 (56)
Total work hours by percentage in the past year:
Clinical effort, mean% (SD)	49 (31)
Teaching, mean% (SD)	16 (15)
Research, mean% (SD)	15 (24)
Non-educational administration, mean% (SD)	10 (19)
Educational program development, mean% (SD)	6 (11)
Taught medical students in past year, n (%)	206 (81)
Taught residents in past year, n (%)	210 (83)
Scholarly activity
Ever authored a scholarly publication, n (%)	195 (77)
Ever authored a scholarly publication related to education, n (%)	70 (28)

*Numbers may not total actual percentage due to item non-response.

Figure 1. The learner-centeredness scale (Cronbach's α for the learner-centeredness scale is 0.73).

Table 2.  Responding teaching physicians’ assessments of themselves with respect to the questions from the survey instrument related to learner-centeredness (n ;= ;252)*

Areas of physician self-assessment	Factor Analysis^†	mean score ±sd ^‡	Cronbach's α
Factor: Learner-centeredness Scale			0.73
Frequency of making an effort to organize lectures and presentations in a way which will maintain learner's interest.	0.81	3.7 ;± ;0.5
Frequency of considering the needs and interests of the intended audience before preparing a lecture or presentation.	0.75	3.7 ;± ;0.5
Frequency of asking learners what they would like to get out of teaching interactions.	0.71	2.7 ;± ;0.9
Frequency of working with learners to establish mutually agreed-upon goals, objectives, and ground rules.	0.64	2.8 ;± ;0.8
Frequency of changing a learning plan based upon the learner's needs.	0.53	2.9 ;± ;0.7
Frequency of assessing and focusing on the learner's needs rather than one's own agenda during precepting or one-on-one teaching encounters.	0.42	2.8 ;± ;0.6

*The self-assessments from ten physician teachers were not included in the factor analysis because they failed to answer all six questions. ^†Varimax rotation factor loading values for each item is listed. ^‡The mean score for each item is shown. The physician-teachers were asked how frequently they performed the specific behaviors (5-point Likert scale: 0 ;= ;never, 1 ;= ;rarely, 2 ;= ;sometimes, 3 ;= ;frequently, 4 ;= ;always).

Table 3.  Odds ratios demonstrating associations of select variables with being a learner-centeredness high scorer after categorizing the 252 physician teachers into “high” or “low” scorers on the learner-centeredness scale

Characteristic	Unadjusted odds ratios for being a high scorer^† (95% confidence interval)
Personal and Career Characteristics*
Non-Hispanic White (versus Non-Caucasian)	0.47 (0.23 - 0.97)
Professional/work goals written or reviewed in the last year (versus not)	2.33 (1.36–3.99)
“Always” or “Frequently” recognize own areas of weakness and use it as an opportunity for growth (versus less)	3.15 (1.80–5.49)
“Always” or “Frequently” identify available resources to meet my own learning needs (versus less)	3.54 (1.91–6.55)
Scholarship*
Faculty rank at or above Associate Professor (versus below)	1.99 (1.07–3.70)
Ever gave an oral presentation related to education at a national/regional meeting (versus not)	2.09 (1.17–3.74)
External funds for teaching in past 2 years (versus not)	3.24 (1.22–8.61)
Education Enjoyment*
Enjoys giving lectures and presentations (versus does not)	1.88 (1.11–3.18)
Enjoys mentoring (versus does not)	2.32 (1.37–3.92)
Working with Others*
“Always” or “Frequently” draw in those who don’t participate much when leading small groups (versus less)	3.05 (1.65–5.64)
“Always” or “Frequently” elicit input from those who might be affected by my decisions (versus less)	3.81 (1.65–8.79)
Teaching Proficiency*
Current proficiency “very good” or “excellent” in giving lectures or presentations (versus less)	3.32 (1.48–7.45)
Current proficiency “very good” or “excellent” in giving feedback to learners (versus less)	3.51 (1.62–7.57)
Current proficiency “very good” or “excellent” in eliciting feedback from learners (versus less)	4.95 (2.77–8.83)
Desirable Teaching Behaviors*
“Always” or “Frequently” let learners know my limitations as a teacher (versus less)	2.32 (1.39–3.87)
“Always” or “Frequently” assess whether my actions as a teacher correspond with my values (versus less)	2.47 (1.47–4.15)
“Always” or “Frequently” let learners know how different situations make me feel (versus less)	2.88 (1.72–4.82)
“Always” or “Frequently” spend time building supportive relationships with my learners (versus less)	3.21 (1.60–6.44)
“Always” or “Frequently” use different educational strategies based upon learning objectives and learners’ needs when planning a curriculum (versus less)	3.79 (1.73–8.33)
“Always” or “Frequently” express concern and support for my learners when they struggle (versus less)	4.65 (2.19–9.88)
“Always” or “Frequently” help learners identify resources to meet their learning needs (versus less)	4.69 (2.27–9.67)
“Always” or “Frequently” attempt to detect and discuss emotional responses of my learners (versus less)	5.53 (3.00–10.20)
Feedback*
“Always” or “Frequently” begin feedback sessions by asking learners to assess their performance (versus less)	2.51 (1.48–4.29)
“Always” or “Frequently” focus on specific areas for improvement, rather than generalizations (versus less)	3.66 (2.01–6.67)
“Always” or “Frequently” reflect on the validity of feedback after receiving feedback from a learner (versus less)	3.95 (1.95–8.01)

*These seven categories correspond to areas of inquiry in the questionnaire. ^†By comparing the responses of the low scorers (≤18; those below the median) and the high scorers (>18; those above the median), variables were identified that were associated with being a high scorer on the learner-centeredness scale.

Table 4.  Characteristics that are independently associated with being a high scorer on the ‘learner-centeredness scale’ (n ;= ;252)

Characteristic	Adjusted odds ratios for being a high scorer* (95% confidence interval)
“Always” or “Frequently” let learners know how different situations make me feel (versus less)	2.51 (1.16–5.45)
Ever gave an oral presentation related to education at a national/regional meeting (versus not)	2.60 (1.12–6.03)
“Always” or “Frequently” identify available resources to meet my own learning needs (versus less)	2.77 (1.07–7.19)
“Always” or “Frequently” reflect on the validity of feedback after receiving feedback from a learner (versus less)	2.77 (1.03–7.44)
“Always” or “Frequently” attempt to detect and discuss emotional responses of my learners (versus less)	2.91 (1.22–6.92)
“Always” or “Frequently” help learners identify resources to meet their learning needs (versus less)	3.66 (1.30–10.31)
Current proficiency “very good” or “excellent” in eliciting feedback from learners (versus less)	3.74 (1.65–8.48)
Current proficiency “very good” or “excellent” in giving lectures or presentations (versus less)	5.08 (1.32–19.58)

*Variables that were significantly associated (p ;< ;0.05) with high learner-centeredness in the domain-specific models were included in this multivariable model.