Faculty development a resource for clinical teachers
Faculty development a resource for clinical teachers
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教师发展是临床教师的资源
DOI：
10.1046/j.1525-1497.12.s2.8.x
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发表时间：
1997
影响因子：
5.7
通讯作者：
C. Bland
中科院分区：
文献类型：
--
作者：
K. Skeff;Georgette A. Stratos;Mygdal Wk;T. DeWitt;Manfred Lm;Mark E. Quirk;Roberts Kb;Larrie Greenberg;C. Bland
临床教师有挑战性和深刻的责任，以传达当前医学实践的艺术和科学。幸运的是，在过去的四十年里，已经制定了各种计划来帮助他们发挥这一困难的作用。从20世纪50年代中期米勒和他的同事们的初步工作开始，为这个国家的大量临床医生教育工作者建立了提高教学技能的教师发展计划。自1978年以来，卫生和人类服务部和基金会，如凯撒家庭基金会，梅西基金会和罗伯特伍德约翰逊基金会支持强调教学的计划。这些举措导致了各种各样的教师发展计划在机构，区域和国家层面上运作。
为临床医生教育者提供支持的理由可以在临床教学本身的任务和教师发展计划的实证研究中找到。教学任务一般是复杂和困难的。2临床教学可能特别困难。首先，它的预期结果-有效的培训医疗卫生工作者-强加给临床教师的责任。在短期内，有效的临床教学是必要的，为社会提供良好的照顾病人目前在教学医院。从长远来看，有效的临床教学为远离学术中心的患者提供高质量的护理提供了基础，这些患者在医生完成正式培训后很长时间内都在接受治疗。其次，临床教学充满了许多教育挑战，需要广泛的技能。临床教师应解决广泛的教育目标（知识、态度和技能）;与经验和能力差异很大的学习者一起工作（学生通过研究员）;使用各种教学方法（授课、小组讨论和一对一教学）;并在不同的环境（住院，门诊和演讲厅）进行教学。3 - 5此外，临床教学通常由于同时需要提供病人护理而变得复杂。鉴于这种复杂性，临床教师需要准备尽可能多的教学技能。
实证研究进一步证明了教师发展的价值。首先，在评估许多教师发展计划，临床教师的经验，作为有用的，他们推荐他们的经验colleagues.6，7第二，评估措施表明，这些计划可以提高教师的知识，技能和态度。这些措施包括以下方面的改进：自我报告的知识和培训前后教育术语的使用，8个知识和技能的回顾性评级，9个，10个教师在教学特定内容中的自我效能评级，11个教师在基于问题的教程中的行为，12个教师对基于问题的方法的信念，13个来自参与者教学录像带的评级，14其他未发表的数据描述了学生评分的改善，15名参与者在培训后3至6个月的自我报告中谈到了该计划中教授的概念和技能（T。a. DeWitt和M.怪癖，未发表的结果），16和参与者的能力，使用教育概念时，分析录像教学情景（K。M. Skeff和G. a. Stratos，未发表的结果）。17总之，临床教学的困难加上临床教育工作者可以提高这一角色的证据表明，教师发展计划的价值。
尽管使用教师发展方法的理由是有力的，但大多数医学教师仍然没有参加提高教学技能的计划。可能的原因包括教师参与的障碍和缺乏对资源的了解。为了帮助更多的教师受益于现有的方法，我们将讨论潜在的障碍，参与教师发展计划，提供一个总结的类型，在初级保健领域的可用程序，描述有效的教学改进方法的特点，并建议如何选择教学改进方法。
Clinical 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.