A Resource for Clinical Teachers

C linical teachers have the challenging and profound responsibility to convey the art and science of current medical practice. Fortunately, over the past four decades, a variety of programs have been developed to help them play this difficult role. Starting with the initial work of Miller and colleagues in the mid 1950s, 1 faculty-development programs to enhance instructional skills have been created for the large cadre of clinician-educators in this country. Since 1978, the Department of Health and Human Services and foundations such as the Kaiser Family Foundation, the Macy Foundation, and the Robert Wood Johnson Foundation have supported programs that emphasize teaching. Such initiatives have resulted in a wide variety of faculty-development programs operating at the institutional, regional, and national levels. The rationale for providing support for clinician-educators can be found in both the task of clinical teaching itself and the empirical studies of faculty-development programs. The task of teaching in general is complex and difficult. 2 Clinical teaching can be especially difficult. First, its intended outcome—the effective training of medical practitioners—imposes a ponderous responsibility on the clinical teacher. In the short term, effective clinical teaching is necessary to provide society with excellent care for patients currently in teaching hospitals. Over the long term, effective clinical teaching provides the underpinnings for the high quality of care given patients away from the academic center, who are treated long after physicians finish their formal training. Second, clinical teaching is laden with many educational challenges requiring a breadth of skills. Clinical teachers are expected to address a wide range of educational goals (knowledge, attitudes, and skills); to work with learners who vary greatly in their experience and abilities (students through fellows); to use a variety of teaching methods (lecturing, small–group discussion, and one-on-one teaching); and to teach in different settings (inpatient, outpatient, and lecture hall). 3-5 Moreover, clinical teaching is commonly compounded by the simultaneous requirement to deliver patient care. Given this complexity, clinical teachers need to be prepared with as many teaching skills as possible. Empirical studies provide further evidence for the value of faculty development. First, in evaluating many faculty-development programs, clinical teachers rate the experience as useful, and they recommend their experience to colleagues. 6,7 Second, evaluation measures show that such programs can improve teachers’ knowledge, skills, and attitudes. These measures include improvements in the following: self–reported knowledge and the use of educational terms before and after training, 8 retrospective ratings of knowledge and skills, 9,10 teacher ratings of self-efficacy in teaching specific content, 11 teacher behavior during problem-based tutorials, 12 teacher beliefs regarding problem-based methods, 13 ratings from videotapes of participants’ teaching, 3 and attitudes toward collaboration between community faculty and university programs. 14 Other unpublished data describe improvements in student ratings, 15 participants’ self-report 3 to 6 months after training regarding the concepts and skills taught in the program (T. A. DeWitt and M. Quirk, unpublished results), 16 and participants’ ability to use educational concepts when analyzing videotaped teaching scenarios (K. M. Skeff and G. A. Stratos, unpublished results). 17 In summary, the difficulty of clinical teaching coupled with the evidence that clinician-educators can improve in this role indicates the value of faculty-development programs. Although this rationale for using faculty-development methods is forceful, most medical faculty still have not participated in programs to improve teaching skills. Possible reasons include barriers to faculty participation and lack of knowledge about resources. To help more faculty benefit from available methods, we shall discuss potential barriers to participation in faculty-development programs, provide a summary of the types of available programs in primary care fields, describe characteristics of effective teaching-improvement methods, and recommend how to choose among teaching-improvement methods.