Faculty Development Initiatives Grant (FDIG) Program
2013-2014 Faculty Development Initiatives Grant Recipients
Developing a Faculty Development Workshop to Enhance Clinical Feedback Relationships $5000
Stephane Voyer, Rose Hatala, Cary Cuncic and Deborah Butler
Feedback is a critical part of the educational process. A review of the educational literature points to a number of specific challenges teachers face when providing feedback in the context of clinical postgraduate education. For a variety of reasons, including high clinical workloads and competing time demands, residents tend not to be observed in the clinical setting. This is compounded by an educational system in which residents and faculty are typically engaged in transient relationships with one another. There is also a tendency for clinical teachers to focus on assessment of learning, rather than assessment for learning. Teachers are routinely dissatisfied with their experiences in giving feedback, just as learners complain about feedback that is both sparse and ineffective. These difficulties persist, despite a plethora of faculty development programs aimed at delivering effective feedback.
We have taken these challenges and used them as the foundation for a novel feedback system within the UBC Internal Medicine residency program. Three key features characterize the program: it is based on direct observation of resident performance, it fosters longitudinal educational relationships, and it uncouples formative assessment from summative evaluation. Although our broader research project addresses understanding feedback in the context of this novel system, the intent of this FDIG proposal is to use our insights to develop a more effective faculty development workshop focused on feedback in the clinical setting.
In pilot work undertaken this academic year, we implemented and are qualitatively assessing this novel system on a small scale. Three faculty members (SV, CC, RH) were each paired with three voluntary PGY-1 internal medicine residents. Throughout the year, each faculty member met with their respective residents on a regular basis (typically every 6-8 weeks), within the context of daily work on existing rotations, to observe their clinical performance. Each observation was preceded by a brief meeting to review the current learning plan, and to reflect on any issues arising since the previous meeting. Clinical observations were then conducted, usually lasting between one and three hours. This was followed by a debriefing session where the faculty member and resident discussed and debriefed about the observation itself, and revised the current learning plan. Throughout this cycle, qualitative data was collected. In our preliminary data analyses we have identified a number of themes that we feel may inform better faculty development focused on feedback: the changing role and perceptions of the faculty when not involved in the residents’ summative assessment, the impact of the longitudinal relationship on the credibility of the faculty’s feedback and changes in the nature and content of the feedback message.
In the 2013-14 academic year, we will expand the project to recruit 10 faculty members who will each work with 3 PGY-1 trainees (representing just over 50% of our internal medicine PGY-1 cohort). Faculty members will be recruited on a volunteer basis. As we anticipate high levels of interest, we plan to sample faculty members purposively based on gender and years of experience in clinical teaching. Similarly, we plan to sample residents purposively; we will sample based on age, gender, school of origin and IMG vs. Canadian-trained background. The feedback system will unfold as it has in the current year, with an ongoing focus on qualitative data analysis examining the system’s impact on both the resident’s and faculty’s perceptions of the feedback process. We will use case study methodology to carry out this work and we will collect several forms of data. These include: “field notes” taken by the faculty member during the observation periods, learning plans created by the resident and faculty member at the conclusion of each observation, audio recordings of the debriefing sessions, and focus group interview data (of both residents and faculty).
For this FDIG proposal, we will use the results of our qualitative data analyses to develop a faculty development workshop focused on feedback. Our intent is to share with faculty our insights into how the feedback relationship can (or can’t) be meaningfully improved and to develop a set of practical tips to improve feedback in the clinical setting. We plan to extract from our data the core aspects of the faculty and resident interactions that lead to successful feedback encounters. It is our intent to work collaboratively with the Office of Faculty Development to offer this workshop to a broad representation of faculty, perhaps as a novel ABC primer.
What Challenges Do Preceptors Experience in a Northern Family Medicine Program? $5000
Willa Henry, Joanna Bates, Eva Knell and Christie Newton
Family medicine has increased postgraduate training positions in northern and rural settings. These residency positions are filled by diverse trainees including Canadian medical graduates (CMG’s) intent on rural practice, CMG’s who were unmatched in the first iteration of CaRMS, and International Medical Graduates (IMG’s), including both immigrants and Canadians who have studied abroad. These trainees arrive with different career goals, undergraduate clinical and educational experiences, and pedagogical and cultural backgrounds. As well, northern and rural settings are often remote and isolated, presenting unique training demands and challenges for residents. Responsible for the day-to-day supervision and teaching of these residents as they adjust to training, preceptors in northern settings are likely to encounter their own particular set of challenges and challenges for residents. Responsible for the day to day superivsion and teaching, they are likely to face their own set of challenges.
In this study, we propose to build upon our exploratory research by conducting a series of semi-structured interviews with family medicine preceptors in northern settings to address the following research questions:
1) What challenges do preceptors encounter supervising and teaching residents in a northern rural family medicine program?
2) How do preceptors approach and address the challenges they encounter supervising and teaching residents in a northern rural family medicine program?
Data Collection and Analysis
We propose to conduct individual interviews with between 15 and 20 preceptors supervising residents in three northern family medicine training sites in BC: Prince George, Terrace and Fort St. John. Following ethics approval from UBC’s Behavioural Research Ethic’s Board, we will recruit participants by working with site administrators to send a letter of invitation to each site director and family medicine preceptor. To encourage participation, we will also consider introducing the study to preceptors at site meetings or hospital rounds. Preceptors who express interest in an interview will be sent a consent form to review and complete in advance of the interview and will be contacted by the RA to schedule interviews. Interviews will be conducted via phone or videoconference, and scheduled for 60 minutes at times that are most convenient for participants. All interviews will be conducted by the PI who is a trained qualitative researcher and follow a semi-structured approach. The interview transcripts will be thematically analyzed to identify and characterize the various challenges faced by preceptors supervising residents in northern family medicine training sites and the approaches they develop for addressing the challenges they encounter.
Consistent with most styles of qualitative research, analysis will be conducted in a recursive manner, with the researchers shifting between data collection and analysis. The entire research team will be involved in data analysis and interpretation.
Following the first six interviews, the team will read transcripts, review and adjust the interview protocol if required, and identify preliminary themes. The PI, working in close consultation with the entire research team, will prepare a thematic codebook and code all interviews as they are completed. Coding is an iterative process and we anticipate that the initial codebook will evolve over the course of data collection and analysis.
Medical Photography and Filming for the Clinician: Skills Enhancing Workshops $4000
Damian Duff, Geoffrey Blair, Rick Beauchamp, Julie Prendiville, Erik Skarsgard and Cindy Verchere
Increasingly, digital photographs and films are becoming a vital component of the modern health care record. Whether in the Pediatric Dermatology Clinic, the Operating Room at BC Children’s Hospital or the Gait Clinic at Sunny Hill Hospital, digital photographs and videos are vital and integral to patient diagnosis, treatment, and for monitoring a patient’s progress. Importantly, photographic images and film footage play a key role within clinical teaching of medical students and residents. It is important to note that many clinicians have not had any formal training in medical photography or film production yet it has become an essential skill in documenting disease progression or response to treatment.
The aim of this faculty development initiative is to furnish clinicians will new technical skills in medical photography and clinical filming. This will be achieved through a series of practical skills sessions delivered at the Oak Street Campus of the University of British Columbia. Emanating from a recent learning needs assessment conducted by UBC’s Office of Pediatric Surgical Evaluation and Innovation, we plan to deliver relevant workshops shaped and based upon the needs articulated by faculty as follows:
Introduction to Medical Photography (Module 1)
- Photography in the clinical setting
- Camera, lens, and software selection to meet clinical and academic needs
- Practical considerations in lighting, background, and patient positioning
- Capturing intricate clinical details and exquisite sharpness
- Storage and archiving for easy retrieval in concert with the health record
- Caring for camera equipment
Introduction to Medical Photography (Module 2)
- Hands-on medical photography skills lab
- Interactive coaching session with a professional medical photographer
- Practical skills to improve the quality of the clinical photo
- Questions, answers, and technical problem-solving
Introduction to Clinical Filming (Module 1)
- Introduction to organizing and storyboarding a clinical film
- Selecting the best equipment for your clinical filming needs
- Ensuring the raw footage supports the storyboard
- Narration and the clinical educational film
- Using features of professional editing software applications
Introduction to Clinical Filming (Module 2):
- Hands-On Clinical Filming Lab
- Film, edit, narrate and produce a clinical film in small groups
- Film presentation, peer feedback, and coaching from a professional film producer
Each session will be taught by professional photographers and film producers. The series will be structured in such a way so that the busy clinician will be able to fully participate. A working lunch will be provided. Each module will seek written evaluations based on stated CanMEDS objectives from the participants so that feedback may be integrated into subsequent sessions. To build interest and enthusiasm among the participants, following the skill-based workshops, a special educational round will be hosted by OPSEI where faculty may present their interesting medical photographs and clinical footage within a supportive clinical educational forum.