Good Clinical Teachers Likely to be Specialist Role Models: Results from a Multicenter Cross-Sectional Survey

Medical educational reform includes enhancing role modelling of clinical teachers. This requires faculty being aware of their role model status and performance. We developed the System for Evaluation of Teaching Qualities (SETQ) to generate individualized feedback on previously defined teaching qualities and role model status for faculty in (non) academic hospitals.(i) To examine whether teaching qualities of faculty were associated with their being seen as a specialist role model by residents, and (ii) to investigate whether those associations differed across residency years and specialties.Cross-sectional questionnaire survey amongst 549 Residents of 36 teaching programs in 15 hospitals in the Netherlands. The main outcome measure was faculty being seen as specialist role models by residents. Statistical analyses included (i) Pearson's correlation coefficients and (ii) multivariable logistic generalized estimating equations to assess the (adjusted) associations between each of five teaching qualities and 'being seen as a role model'.407 residents completed a total of 4123 evaluations of 662 faculty. All teaching qualities were positively correlated with 'being seen as a role model' with correlation coefficients ranging from 0.49 for 'evaluation of residents' to 0.64 for 'learning climate' (P<0.001). Faculty most likely to be seen as good role models were those rated highly on 'feedback' (odds ratio 2.91, 95% CI: 2.41-3.51), 'a professional attitude towards residents' (OR 2.70, 95% CI: 2.34-3.10) and 'creating a positive learning climate' (OR 2.45, 95% CI: 1.97-3.04). Results did not seem to vary much across residency years. The relative strength of associations between teaching qualities and being seen as a role model were more distinct when comparing specialties.Good clinical educators are more likely to be seen as specialist role models for most residents

The impact of training and working conditions on junior doctors' intention to leave clinical practice

Background: The shortage of physicians is an evolving problem throughout the world. In this study we aimed to identify to what extent junior doctors' training and working conditions determine their intention to leave clinical practice after residency training. Methods: A prospective cohort study was conducted in 557 junior doctors undergoing residency training in German hospitals. Self-reported specialty training conditions, working conditions and intention to leave clinical practice were measured over three time points. Scales covering training conditions were assessed by structured residency training, professional support, and dealing with lack of knowledge; working conditions were evaluated by work overload, job autonomy and social support, based on the Demand-Control-Support model. Multivariate ordinal logistic regression analyses with random intercept for longitudinal data were applied to determine the odds ratio of having a higher level of intention to leave clinical practice. Results: In the models that considered training and working conditions separately to predict intention to leave clinical practice we found significant baseline effects and change effects. After modelling training and working conditions simultaneously, we found evidence that the change effect of job autonomy (OR 0.77, p = .005) was associated with intention to leave clinical practice, whereas for the training conditions, only the baseline effects of structured residency training (OR 0.74, p = .017) and dealing with lack of knowledge (OR 0.74, p = .026) predicted intention to leave clinical practice. Conclusions: Junior doctors undergoing specialty training experience high workload in hospital practice and intense requirements in terms of specialty training. Our study indicates that simultaneously improving working conditions over time and establishing a high standard of specialty training conditions may prevent junior doctors from considering leaving clinical practice after residency training

The Impact of the Stanford Faculty Development Program on Ambulatory Teaching Behavior

CONTEXT: Faculty development has received considerable investment of resources from medical institutions, though the impact of these efforts has been infrequently studied. OBJECTIVE: To measure the impact of the Stanford Faculty Development Program in Clinical Teaching on ambulatory teaching behavior. DESIGN: Pre-post. SETTING AND PARTICIPANTS: Eight internal medicine faculty participating in local faculty development. INTERVENTION: Participants received 7 2-hour sessions of faculty development. Each session included didactic, role-play, and videotaped performance evaluation. MAIN OUTCOME MEASURE: Before and after the intervention, faculty were video-taped during a case presentation from a standardized learner, who had been trained to portray 3 levels of learners: a third-year medical student, an intern, and a senior medical resident. Teacher and learner utterances (i.e, phrases) were blindly and randomly coded, using the Teacher Learner Interaction Analysis System, into categories that capture both the nature and intent of the utterances. We measured change in teaching behavior as detected through analysis of the coded utterances. RESULTS: Among the 48 videotaped encounters, there were a total of 7,119 utterances, with 3,203 (45%) by the teacher. Examining only the teacher, the total number of questions asked declined (714 vs 426, P = .02) with an increase in the proportion of higher-level, analytic questions (44% vs 55%, P<.0001). The quality of feedback also improved, with less “minimal” feedback (87% vs 76%, P<.0005) and more specific feedback (13% vs 22%) provided. CONCLUSIONS: Teaching behaviors improved after participation in this faculty development program, specifically in the quality of questions asked and feedback provided