Who will be the faculty of the future? Results of a 5-year study growing educators using an immersive third postgraduate year (PGY-3) faculty development mini-fellowship

Abstract

Background: Residency education requires large numbers of skilled teaching faculty. Potential faculty can often be identified during residency training.

Aims: Employ a 4-week immersive faculty development mini-fellowship to enhance the teaching skills of selected PGY-3 residents and study outcomes over 5 years.

Methods: PGY-3 residents were competitively selected and completed the 4-week curriculum to increase skills in precepting, small group teaching, large group teaching, learner feedback/assessment, academic career development, and research.

Results: Fifteen residents completed the mini-fellowship over the 5-year study period. The curriculum was rated highly by the residents with mean ratings of curriculum components ranging from 4.5 to 4.9 on a 5-point scale. Eight residents (53%) were selected for faculty positions compared to a usual selection rate of 11%. Compared to new faculty without mini-fellowship completion, program directors rated the residents completing the mini-fellowship as better prepared to perform learner feedback (4.1 vs. 3.0, p ≤ 0.01) and to understand the conduct of research (3.6 vs. 2.5 p ≤ 0.01).

Conclusions: This study demonstrates short-term success at growing faculty with enhanced teaching skills during residency. While long-term retention in academic medicine cannot be predicted, this program represents one method to mitigate shortages of qualified junior residency faculty.

Introduction

Excellence in residency education is largely dependent upon the presence of highly qualified teaching faculty. The need for teaching skills development in Family Medicine and Internal Medicine residents has been outlined (Morrison et al. 2002). Likewise, the critical importance of developing teaching skills in “young academic surgeons” to create a cadre of future faculty physicians has been demonstrated (Staveley O’Carroll et al. 2004).

In 2005, the serious implications for faculty development and recruitment of the looming demographic transition from a generation of academicians with values formed as “boomers” to a generation with values derived as “generation x-ers” was described (Bickel & Brown 2005). In addition to faculty shortages, Bickel and Brown identified several faculty development challenges to include academic career advising, retaining men and women in academic careers, and “providing trainees and junior faculty with educational sessions designed to turn their intellectual capital into academic career capital (emphasis added).”

Table

Practice points

A shortage of qualified teaching faculty is anticipated in the future. Potential faculty can often be identified during residency training and while resident teaching skills can be improved, they do not necessarily improve in concert with clinical skills. A four-week immersive faculty development fellowship can improve teaching skills; particularly in learner feedback and in the conduct of research. Residents are more likely to pursue faculty positions after completion of a mini-faculty development fellowship while in residency training.

Teaching skills do not necessarily improve in concert with clinical skills, but resident teaching skills can be improved with dedicated instruction (Edwards et al. 1988; Wipf et al. 1995; Morrison et al. 2000). Several studies have shown that precepting and small group teaching techniques can be improved in residents utilizing brief instructional programs (Bing-You and Tooker 1993; Furney et al. 2001; Frattarelli and Kasuya 2003; D’Eon 2004; Morrison et al. 2004; Lacasse and Ratnapalan 2009).

Dental educators have also recognized an increasing, soon to be critical shortage of faculty. To address this issue, Bibb and Lefever (2002) developed an “apprentice teaching experience” to improve skills and encourage more dental graduates to pursue academic careers. Their pilot study suggested the great potential for a teaching skills program to develop future faculty. In fact, all but one of the 22 participants in their study indicated a desire to add teaching into their future career plans based on their academic elective experience during residency training.

The military health system sponsors family medicine residency programs at 17 sites across the United States and trains 402 residents in three-year specialty programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Military family medicine residency programs face challenges associated with a steady and predictable 20% turnover of faculty each year (Manaker et al. 2003). New faculty are expected to immediately assume an academic role that involves significant teaching and clinical responsibility. Ideally, incoming faculty would already have basic academic skills, aptitudes and experience upon joining a residency faculty staff, yet this is infrequently the case.

No formal educational programs exist to develop prospective family medicine military residency program faculty. To address this need, we investigated the educational outcomes of a one-month immersive faculty development mini-fellowship for senior (PGY-3) family medicine residents identified by their program directors as potential residency faculty. Our goal was to provide residency programs with family medicine physicians able to assume faculty roles immediately upon residency completion.

Background/curriculum development

The study encompassed a one-year pilot followed by five years of participant enrollment and data collection. A preliminary four-week pilot curriculum was developed and implemented by the investigators. Six faculty instructors and three PG-3 residents participated in the pilot program. Based on feedback from the faculty and residents, changes and enhancements to the curriculum were developed. The revised curriculum was utilized as the instructional methodology for the subsequent five-year study.

Selected residents spent four weeks, (200 hours), fully immersed in the faculty development fellowship to the exclusion of any other clinical activities or on-call responsibilities during the block. The curriculum centered on six major themes common to faculty development fellowships and identified in the pilot phase as crucial for the new faculty physician: clinical precepting, small group teaching, large group teaching, learner feedback and assessment, academic career development, and research skill development.

Clinic precepting (one-to-one teaching)

Residents studied multiple precepting techniques using readings, seminar discussions, and faculty modeling (Neher et al. 1992; Reilly 2007; Barrett and Gopal 2008). Practical experiences in implementing these precepting techniques were completed at two local residency programs with one-on-one faculty supervision.

Small group teaching

Residents also studied small group teaching techniques through readings, seminars, and modeling by faculty (Rotem & Manzie 1980). The residents then co-facilitated teaching sessions with a faculty member. The teaching sessions included a variety of medical student small groups or inpatient residency ward teams.

Large group teaching and lecture skills

Skills in lecture content development, preparation, and delivery to a group were studied through readings, discussions and seminars with faculty. The resident then attended three faculty lectures each utilizing different teaching methodologies. Residents then developed a core lecture with a faculty preceptor and delivered it during a third-year clerkship didactic seminar.

Learner feedback and assessment

Faculty advisor and mentoring skills were discussed in several seminars. Training and practice in assessing learning styles and delivering feedback was studied through readings, self-study of psychometric instruments and seminars (Whitman 1996; Martin and O’Donnell 1999). The resident then participated with a Uniformed Services University (USU) faculty in a full-day experience assessing learners during a station-based objective structured clinical exam (OSCE) exercise at the USU Simulation Center. During these experiences the residents were directly observed while they provided feedback to student learners. The faculty then provided feedback to the residents about the resident-to-student feedback. They also helped to write individual educational prescriptions with a faculty preceptor based on the OSCE for individual medical students.

Academic progression and career development

Review and application of a promotion and tenure document as well as the development of a career path in academic family medicine were discussed in one-on-one seminars. Several sample curriculum vitae were used for a “hands-on” assessment of potential promotability. During the four weeks each resident produced and finalized a formal academic curriculum vita (CV) and the framework of an educator's portfolio.

Scholarly activity and research training

Residents were required to develop or refine a scholarly project. This included case reports with associated literature review, clinical investigations, curriculum development, or educational research. One-on-one research mentoring sessions were conducted with various faculty members based on the individual project topic. A university biostatistician assisted with educational sessions on research design, research methodology, and statistical analysis. All residents were required to submit their scholarly project for faculty review.

Methods

Selection of residents

Nominations for the 4-week faculty development mini-fellowship were solicited annually from each of the 17 Military Family Medicine Residency Directors for five consecutive years. Residency Directors were asked to nominate one or two senior residents who they believed best possessed the aptitude and interest for a faculty position after graduation. In addition, nominees provided a CV, a letter of interest, and an outline for the scholarly project that they would pursue during the mini-fellowship. Each of these applicant packages was then scored by the entire mini-fellowship teaching faculty. The highest scoring applicant from each military service (Army, Navy, and Air Force) was selected for the 4-week mini-fellowship.

Institutional Review Board approval was obtained through the Uniformed Services University and informed consent was obtained from each of the participants.

Data collection

Each graduate of the faculty development mini-fellowship was contacted by the primary investigator (B.R.) at the conclusion of the four-week program and during the final month of their residency. They were questioned on the results of their post-residency job search and queried on the types and status of scholarly projects resulting from the fellowship experience. If the resident obtained a faculty position immediately following graduation (N = 8), the program director was interviewed at the end of one year of faculty service. The program director completed a questionnaire regarding the faculty member who had completed the mini-fellowship comparing them with peers who did not. Descriptive statistics and Wilcoxon signed-rank tests were calculated to explore differences between program directors’ perceptions of faculty who had or had not completed the faculty development mini-fellowship.

Results

Fifteen residents completed the immersive faculty development mini-fellowship over the 5-year study period. The ratings of the six core components of the mini-fellowship are shown in Table 1. The curriculum was well received by the residents, with mean ratings for each component ranging from 4.5 to 4.9 (SD 0.3–0.5) (1 = “poor” 5 = “excellent”). Eight residents (53%) were selected for faculty positions within two years of program completion. Six residents were selected for a faculty position immediately after residency graduation, one was selected after a one-year woman's health fellowship, and one was selected two years after completion of the mini-fellowship (Table 2). Another resident enrolled in a two year combined M.P.H. and faculty development training program.

Table 1.  PG-3 resident ratings (N = 15) of six core curricular topics of the faculty development fellowship

Core curriculum topic^a	M (SD)
Clinical precepting	4.7 (0.4)
Small group teaching	4.5 (0.5)
Large group teaching/lecture skills	4.9 (0.3)
Learner feedback and assessment	4.8 (0.4)
Academic career progression and career development	4.7 (0.4)
Scholarly activity	4.7 (0.5)

Note: ^aRatings on a 5-point Likert scale (1 = “poor” to 3 = “average” to 5 = “excellent”).

Table 2.  Jobs after residency graduation and at study conclusion

Subject	Job after residency graduation	Job at study conclusion
1	Clinical practice	Residency faculty
2	Residency faculty	Residency faculty
3	Clinical practice	Clinical practice
4	Clinical practice	MPH/Faculty development program
5	Residency faculty	Residency faculty
6	Woman's health fellowship	Residency faculty
7	Clinical practice	Clinical practice
8	Residency faculty	Residency faculty
9	Clinical practice	Clinical practice
10	Clinical practice	Clinical practice
11	Clinical practice	Clinical practice
12	Residency faculty	Residency faculty
13	Residency faculty	Residency faculty
14	Clinical practice	Clinical practice
15	Residency faculty	Residency faculty

Scholarly projects resulting from the faculty development fellowship are displayed in Table 3. All residents participated in a variety of scholarly activities. Nine residents (60%) designed a clinical investigation and nine residents (60%) had a written product accepted for presentation or publication.

Table 3.  Scholarly projects of PG-3 graduates of mini-fellowship

Participant #	Clinical investigation	Case report	Curriculum	Book chapter	Review article
1		S	W
2	D	S, A
3	D
4	D
5	D, S, A
6	D, S, A
7		S			S, A
8	D, S, A
9	D, S, A	S, A
10		S		W, A
11		S	W, I
12			W
13		S
14	D, S			W, A
15	D		W, I

Notes: D = designed; S = submitted for presentation or publication in peer-reviewed meeting or journal; A = accepted for presentation or publication; W = written; not submitted for peer review; I = implemented in residency program.

Results from the Program Director interview are displayed in Table 4. Mini-fellowship participants were perceived to be better prepared to assume their faculty roles compared with peers not completing the mini-fellowship. Wilcoxon signed-rank tests showed that the differences between the ratings were all statistically significant, except for ratings of understanding academic progression and career development (Table 4).

Table 4.  Program director (N = 8) teaching skill ratings of new faculty without and with faculty development mini-fellowship experience

Teaching skill^a	New faculty, no fellowship M (SD)	New faculty; fellowship M (SD)	Wilcoxon statistic	p value
Clinic precepting	3.5 (0.5)	4.1 (0.4)	15	0.03
Small group teaching	3.1 (0.4)	3.8 (0.5)	15	0.03
Lecture skills	3.1 (0.4)	4.0 (0.8)	15	0.04
Learner feedback and assessment	3.0 (0.0)	4.1 (0.6)	28	0.01
Understanding academic progression and career development	2.9 (0.6)	3.5 (0.5)	13	0.13
Scholarly activities	2.5 (0.5)	3.6 (0.5)	28	0.01

Notes: ^aProgram directors used 5-point Likert scale to rate teaching skill (1 = “not prepared” to 3 = “prepared and functioning at average junior faculty level” to 5 = “very well prepared and functioning well above average junior faculty level”).

Discussion

This study further validates the ability of a focused teaching intervention to improve the academic skills and aptitudes of residents. In addition, it led to an increased interest by participants in pursuing faculty positions after mini-fellowship completion. It is unique in its focus on military training programs and that residents were removed from their local training environment for an immersive one-month faculty development experience. This immersive experience significantly increased the skills of the graduates in learner assessment and feedback, the production of scholarly activities, and early success in the academic environment as judged by their program directors. These are typically difficult skills for new residency faculty to rapidly acquire.

Limitations of the study include that employing this program more broadly requires significant costs and time investment of faculty preceptors and the practical issue of removing a resident for four weeks from their primary residency program's call and continuity clinic schedule. Additionally, the program directors ratings were their personal perceptions and not validated by independent observers. Finally, the reasons why some residents did not select careers as faculty were not elucidated.

At the conclusion of the five-year study, eight of the fifteen graduates of the mini-fellowship were in residency faculty positions and one graduate was enrolled in a two-year M.P.H. and Faculty Development program with an expectation to transition to a faculty position at graduation. In contrast, as a point of comparison, for the three years preceding the start of this study, Air Force residency programs were averaging only 5 out of 45 (11%) residents moving immediately to residency faculty positions (Database of US Air Force Family Medicine Residency Graduates, Uniformed Services University Department of Family Medicine).

Long-term retention in academic medicine cannot be predicted by this study. However, the short-term success at growing high quality faculty suggests that future shortages of qualified junior residency faculty can be mitigated by investing in a one-month immersive faculty development experience for qualified residents during their final year of residency training.

Declaration of interest: The authors are all federal employees and report no conflicts of interest. The views expressed are those of the authors and not those of the Uniformed Services University, the US Navy, the US Air Force, the USPHS or the Department of Defense.