Co-Director, Stanford Faculty Development Center for Medical Teachers (1985 - Present)
Director, Stanford University Geriatric Education Resource Center (1998 - Present)
PhD, Educational Psychology, UC Berkeley (1981)
MA, Developmental Psychology, San Francisco State University (1974)
BA, Psychology, UC Berkeley (1971)
Current Research and Scholarly Interests
Development and evaluation of faculty development programs for medical teachers
Teaching behaviors in the cardiac surgery simulation environment
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
2013; 145 (1): 45-53
To understand how teaching behaviors contribute to simulation-based learning, we used a 7-category educational framework to assess the teaching behaviors used in basic skills training.Twenty-four first-year cardiothoracic surgery residents and 20 faculty participated in the Boot Camp vessel anastomosis sessions. A portable chest model with synthetic graft and target vessels and a tissue-based porcine model simulated coronary artery anastomosis. After each 2-hour session on days 1 and 2, residents assessed teaching behaviors of faculty using a 20-item questionnaire based on the 5-point Likert scale. After session on day 1, faculty completed a self-assessment questionnaire. At 3 months, faculty completed self-assessment questionnaires regarding teaching behaviors in simulation and clinical settings. Each questionnaire item represents 1 or more teaching categories: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," "evaluation," "feedback," and "self-directed learning."Generally, resident ratings indicated that faculty showed positive teaching behaviors. Faculty self-assessment ratings were all lower (P < .025) than those assigned to them by the residents except for 1 component representative of "feedback," which approached significance (P = .04); 2 items, representative of "promoting understanding and retention" and "evaluation", had mean scores of less than 3. At 3 months, compared with self-assessment at Boot Camp, faculty ratings suggested improved teaching behaviors in their simulation settings in the following: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," and "evaluation." The simulation environment was perceived as more positive for technical skills training in certain aspects compared with clinical setting: instructor reviewed function and operation of equipment with learner before session (representative of "promoting understanding and retention") and instructor allowed the learner ample time to practice (representative of "control of session" and "promoting understanding and retention") (P < .025).Simulation-based skills training is perceived by residents to be associated with positive teaching behaviors. Faculty self-ratings indicate that they do not always use many of these teaching behaviors and that their performance can be improved. The simulation setting may provide greater opportunity for positive teaching behaviors compared with the clinical environment.
View details for DOI 10.1016/j.jtcvs.2012.07.111
View details for Web of Science ID 000312386300017
View details for PubMedID 23098747
A randomised controlled study of role play in a faculty development programme
2012; 34 (2): E123-E128
The Stanford Faculty Development Center at Stanford University has developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model.This study was designed to investigate the relative impact of role playing as an instructional technique within that course for facilitating change in teaching behaviours.From January 2009 to April 2010, six faculty development courses were delivered at Uppsala University Hospital to 48 physicians from different departments. The standard course presentation includes a range of instructional methods including short lectures, small group discussion, review of video re-enactments, role-play exercises and personal goal setting. For this study, participants were randomised to participate in (1) a 'standard' course with role play or (2) an 'alternative' course with no role play. The effects of the course on teaching performance were assessed with retrospective pre- and post-course self-ratings of 29 specific teaching behaviours.Self-assessment ratings indicated significantly greater positive changes in teaching behaviour among faculty who attended the standard course (with role play) as compared to those in the alternative course (p = 0.015).This study validates the commonly held view that role play is a useful instructional method for improving teaching.
View details for DOI 10.3109/0142159X.2012.644832
View details for Web of Science ID 000299701500005
View details for PubMedID 22289010
Clinical teaching improvement: The transportability of the Stanford Faculty Development Program
2009; 31 (8): E377-E382
The Stanford Faculty Development Center (SFDC) at Stanford University developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model. We were curious to see if cultural factors might influence the applicability and impact of the course when delivered to non-American participants by a facilitator from that culture.A Swedish anaesthesiologist at Uppsala University Hospital, Sweden, was trained in October 2004 at Stanford University. From January 2005 to March 2007 he delivered five faculty development seminar series at Uppsala University Hospital to 40 physicians from different departments. Participants rated the usefulness of the seminar series and retrospective pre- and post-seminar ratings were used to assess effects on participants' teaching skills and behaviours.Participants rated the seminars as highly useful (M = 4.8, SD = 0.4). Participants' ratings of their teaching ability indicated significant increases across a variety of clinical and non-clinical teaching settings (p < 0.001), and positive changes in teaching behaviours were found for all seven educational categories assessed (p < 0.001).This faculty development model is highly transportable to medical teachers in Sweden, and capable of producing positive results, consistent with those found in the United States.
View details for DOI 10.1080/01421590802638055
View details for Web of Science ID 000269784700032
View details for PubMedID 19811202
- Clinical teaching improvement: The transportability of the Stanford Faculty Development Program Medical Teacher 2009; 31 (8): 377-382
Practicing physician education in geriatrics: Lessons learned from a train-the-trainer model
Annual Meeting of the American-Geriatrics-Society
WILEY-BLACKWELL PUBLISHING, INC. 2007: 1281–86
Evidence of poor performance in the evaluation and management of common geriatric conditions suggests the need for changing physician behavior in these areas. Traditional lecture-style continuing medical education (CME) has not been shown to be effective. Expert faculty initially trained 60 nonexpert peer educators to conduct small-group, learner-centered CME using tool kits on memory loss, incontinence, and depression. Peer educators presented 109 community-based sessions to 1,309 medical practitioners. Surveys were administered to community participants immediately and 6 months after a session. Evidence of effectiveness included statistically significant increases in self-reported knowledge, attitudes, and office-based practices on the target topics at the time of training and at the 6-month follow-up (P<.001) and two-thirds of respondents reporting continued use of three or more tools at 6 months. Participants reported that the interactive presentation aided their understanding of and ability to use the tool kits more than an off-the-shelf review (mean rating+/-standard deviation 4.1+/-0.71, with 1 = not at all and 5 = significantly). After the formal evaluation period, additional information about the project dynamics and tool kits was obtained through a small interview sample and an on-line survey, respectively. Receiving copies of the tool kits was an important factor in enabling educators to offer sessions. Barriers to offering sessions included finding time, an audience, and space. Findings suggest that modest positive changes in practice in relation to common geriatric problems can be achieved through peer-led, community-based sessions using principles of knowledge translation and evidence-based tool kits with materials for providers and patients.
View details for DOI 10.1111/j.1532-5415.2007.01205.x
View details for Web of Science ID 000248544400018
View details for PubMedID 17661970
- Faculty development in medicine: A field in evolution TEACHING AND TEACHER EDUCATION 2007; 23 (3): 280-285
- Practicing physician education in geriatrics: Lessons learned from a train-the-trainer model Journal of American Geriatrics Society 2007; 55: 1281-1286
- Faculty development in medicine: A field in evolution Teaching and Teacher Education 2007; 23: 280-285
Faculty development in end-of-life care: Evaluation of a national train-the-trainer program
2006; 81 (11): 1000-1007
To address serious deficiencies in physician training in end-of-life care, the authors developed and disseminated a faculty development curriculum. The overall goals of this curriculum were to enhance physician competence in end-of-life care, foster a commitment to improving care for the dying, and improve teaching related to end-of-life care. The authors provide descriptions of the curriculum and the train-the-trainer programs (2000-2002) that successfully prepared 17 medical faculty as in-house end-of-life care faculty developers at institutions nationwide. They also report on a study of the effects of the 16-hour, end-of-life care curriculum delivered by trained facilitators to 62 faculty and residents at their home sites. Program evaluation showed that the home-site seminars enhanced the knowledge, skills, and attitudes of participating faculty and residents. When project evaluation concluded in 2003, trained facilitators had disseminated the 16-hour curriculum as well as modified versions of the curriculum to approximately 3,400 medical teachers. An adapted version of the curriculum is available on the Internet for use in health professions education. The importance of this type of faculty development effort was confirmed by the positive impact of the 16-hour curriculum on participants' knowledge, skills, and attitudes related to end-of-life care, the high ratings of the program's educational and clinical relevance, and the finding that, on average, more than 50% of the material was new to them.
View details for Web of Science ID 000241569300014
View details for PubMedID 17065869
- Embedding faculty development in teaching hospitals - Moving beyond the status quo JOURNAL OF GENERAL INTERNAL MEDICINE 2004; 19 (3): 286-287
Physician confidence and interest in learning more about common geriatric topics: A needs assessment
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
2001; 49 (7): 963-967
To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics.Written survey.Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).Seven hundred and fifty-eight physicians (547 ACP members, 211 AAFP members).For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five-point Likert scale.Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee-for-service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r =.44, P <.0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified.These findings provide useful information on the physician-learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.
View details for Web of Science ID 000170332700016
View details for PubMedID 11527489
- Factorial validation of an educational framework using residents' evaluations of clinician-educators 38th Annual Conference on Research in Medical Education (RIME) LIPPINCOTT WILLIAMS & WILKINS. 1999: S25–S27
Regional teaching improvement programs for community-based teachers
AMERICAN JOURNAL OF MEDICINE
1999; 106 (1): 76-80
Community-based clinical teachers provide an important cadre of faculty for medical education. This study was designed to examine the feasibility and value of an American College of Physicians-sponsored regional teaching improvement program for community-based teachers.We conducted five regional (Connecticut, New Hampshire/Vermont, New York, Ohio, and Virginia) 1- to 2-day teaching-improvement workshops for 282 faculty (49% community based, 51% university based). The workshops were conducted by regional facilitators trained by the Stanford Faculty Development Program using large group and small group instructional methods to teach participants a framework for analyzing teaching, to increase their repertoire of teaching behaviors, to define personal teaching goals, and to identify the educational needs of their teaching site. Participants used Likert ratings [1 (low) to 5 (high) scale] to assess workshop quality, facilitator effectiveness, and rewards for and barriers to teaching in their clinics. Using retrospective pre- and postintervention ratings, participants also assessed workshop impacts on teacher knowledge, attitudes, and skills. Finally, participants completed open-ended questions to identify recommended changes to improve their clinic as an educational site for students and residents.At all sites, participants evaluated the program as highly useful (4.6 +/- 0.6, mean +/- SD). Participants' ratings indicated that the program had a positive effect on their knowledge of teaching principles (4.0 +/- 0.9), an increase in their teaching ability (P <0.001), and an increase in their sense of integration with their affiliated institution (P <0.001).Regional training of university and community faculty can be an effective way of promoting the improvement of teaching and the collaboration between community-based teachers and academic centers. National physician organizations and regionally based facilitators can provide important resources for the delivery of such training.
View details for Web of Science ID 000078468300013
View details for PubMedID 10320121
How do you get to the improvement of teaching? A longitudinal faculty development program for medical educators
TEACHING AND LEARNING IN MEDICINE
1999; 11 (1): 52-57
View details for Web of Science ID 000078973400009
A pilot study of faculty development for basic science teachers
1998; 73 (6): 701-704
Relatively little research has focused on faculty development methods that assist basic science teachers to improve their instructional skills. This study was designed to assess the effectiveness for basic science faculty of a faculty development seminar series that had been previously shown useful for clinical teachers.The Stanford Faculty Development Program's seminars on clinical teaching were adapted for basic science instruction. Eight pathology faculty participated in a series of nine small-group seminars designed to provide teachers with knowledge of a framework for analyzing teaching and identifying areas for improvement, and skill-based training in specific teaching behaviors. Each seminar included (1) brief lectures, (2) review of videotaped reenactments of teaching interactions, (3) role-play exercises with videotape review, and (4) formulation of personal and departmental teaching goals.Program evaluation included multiple measures: participant self-assessment, student ratings of the participants, and blinded ratings of pre- and post-seminar videotapes of participants' classroom teaching. All measures indicated a positive effect of the intervention.Faculty development programs have significant potential to enhance basic science instructors' teaching effectiveness.
View details for Web of Science ID 000074383900028
View details for PubMedID 9653410
Factorial validation of a widely disseminated educational framework for evaluating clinical teachers
1998; 73 (6): 688-695
To examine an instrument for evaluating clinical teaching using factor analysis and to refine the validated instrument to a practical length.Factor analysis on a split sample of 1,581 student evaluations rating 178 teachers. The instrument was based on the seven-category Stanford Faculty Development Program's (SFDP's) clinical teaching framework and contained 58 Likert-scaled items, with at least seven items per category plus five items measuring "teacher's knowledge." Standard methodology for survey item reduction was used to remove items with low or complex factor loadings and iteratively remove items with low item-scale correlation. Results were replicated on the second sample.The seven original categories emerged and items originally categorized under "knowledge" statistically combined with "promoting self-directed learning." Over 73% of the variance was explained. Item reduction resulted in 25 items with overall internal consistency over .97 and internal consistency of constructs ranging from .82 to .95.Factor analysis of student ratings validated the seven-category SFDP framework. An abbreviated instrument to measure the seven categories is described. Results suggest that students may not systematically distinguish between their teachers' knowledge and their teachers' ability to promote self-directed learning, an important finding for both administrators and faculty development programs.
View details for Web of Science ID 000074383900026
View details for PubMedID 9653408
Beneficial and harmful effects of augmented feedback on physicians' clinical-teaching performances
1998; 73 (3): 324-332
To evaluate whether clinical-teaching skills could be improved by providing teachers with augmented student feedback.A randomized, controlled trial in 1994 included 42 attending physicians and 39 residents from the Department of Medicine at the Indiana University School of Medicine who taught 110 students on medicine ward rotations for one-month periods. Before teaching rotations, intervention group teachers received norm-referenced, graphic summaries of their teaching performances as rated by students. At mid-month, intervention group teachers received students' ratings augmented by individualized teaching-effectiveness guidelines based on the Stanford Faculty Development Program framework. Linear models were used to analyze the students' mean ratings of teaching behaviors at mid-month and end-of-month. Independent variables included performance ratings, intervention status, teacher status, teaching experience, and interactions with baseline ratings.Complex interactions with baseline performance were found for most teaching categories at mid-month and end-of-month. The intervention-group teachers who had high baseline performance scores had higher student ratings than did the control group teachers with similar baseline scores; the intervention group teachers who had low baseline performance scores were rated lower than were the control group teachers with comparable baseline scores. The residents who had medium or high baseline scores were rated higher than were the attending physicians with comparable baseline scores; the performance of the residents who had low baseline scores was similar to that of the attending physicians with comparable baseline scores.Baseline performance is important for targeting those teachers most likely to benefit from augmented student feedback. Potential deterioration in teaching performance warrants a reconsideration of distributing students' ratings to teachers with low baseline performance scores.
View details for Web of Science ID 000072534500028
View details for PubMedID 9526460
Use of faculty development to improve ambulatory-care education
1997; 19 (4): 285-292
View details for Web of Science ID 000071407000008
- Prioritizing areas for faculty development of clinical teachers by using student evaluations for evidence-based decisions 36th Annual Conference on Research in Medical Education HANLEY & BELFUS INC. 1997: S7–S9
- Faculty development - A resource for clinical teachers JOURNAL OF GENERAL INTERNAL MEDICINE 1997; 12: S56-S63
Clinical teaching improvement: past and future for faculty development.
1997; 29 (4): 252-257
Faculty development programs have focused on the improvement of clinical teaching for several decades, resulting in a wide variety of programs for clinical teachers. With the current constraints on medical education, faculty developers must reexamine prior work and decide on future directions. This article discusses 1) the rationale for providing faculty development for clinical teachers, 2) the competencies needed by clinical teachers, 3) the available programs to assist faculty to master those competencies, and 4) the evaluation methods that have been used to assess these programs. Given this background, we discuss possible future directions to advance the field.
View details for PubMedID 9110161
- Effective learning of geriatric medicine - A challenge to clinical teachers JOURNAL OF GENERAL INTERNAL MEDICINE 1996; 11 (7): 435-436
- THE EFFECT OF A CLINICAL TEACHING RETREAT ON RESIDENTS TEACHING SKILLS ACADEMIC MEDICINE 1994; 69 (5): 433-434
EVALUATION OF A MEDICAL-FACULTY DEVELOPMENT PROGRAM - A COMPARISON OF TRADITIONAL PRE/POST AND RETROSPECTIVE PRE/POST SELF-ASSESSMENT RATINGS
EVALUATION & THE HEALTH PROFESSIONS
1992; 15 (3): 350-366
View details for Web of Science ID A1992JK53000007
IMPACT OF A CLINICAL PREVENTIVE MEDICINE CURRICULUM FOR PRIMARY CARE FACULTY - RESULTS OF A DISSEMINATION MODEL
1992; 21 (4): 419-435
This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States.The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise.Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics.The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.
View details for Web of Science ID A1992JH41200003
View details for PubMedID 1409485
IMPROVING CLINICAL TEACHING - EVALUATION OF A NATIONAL DISSEMINATION PROGRAM
ARCHIVES OF INTERNAL MEDICINE
1992; 152 (6): 1156-1161
This study assessed a dissemination approach to improve clinical teaching. We hypothesized that (1) physicians from a variety of institutions nationwide could be trained to conduct teaching improvement seminars for faculty colleagues; (2) such seminars would be perceived as highly useful; (3) pre/post self-evaluations by faculty participants and evaluations of faculty participants by house staff/students would indicate improved teaching performance. Selected medical faculty completed 1 month of facilitator training at the Stanford Faculty Development Program, Palo Alto, Calif. They then delivered teaching improvement seminars for other faculty. From 1986 to 1988, 12 facilitators from 12 institutions trained 107 faculty at their home institutions in their initial seminar series. Their seminars were rated as highly useful by participants. Both faculty self-assessments and house staff/student ratings indicated improved teaching performance. We concluded that this dissemination approach provides one possible mechanism for ongoing teaching improvement within institutions across the country.
View details for Web of Science ID A1992HY95700004
View details for PubMedID 1599342
Process and product in clinical teaching: a correlational study.
Research in medical education : proceedings of the ... annual Conference. Conference on Research in Medical Education
1985; 24: 25-30
View details for PubMedID 3854734
Evaluation of attending physicians: three perspectives.
Research in medical education : proceedings of the ... annual Conference. Conference on Research in Medical Education
1984; 23: 277-281
View details for PubMedID 6571651
ASSESSMENT BY ATTENDING PHYSICIANS OF A SEMINAR METHOD TO IMPROVE CLINICAL TEACHING
JOURNAL OF MEDICAL EDUCATION
1984; 59 (12): 944-950
The authors in this article present assessments by attending physicians of a seminar method to improve clinical teaching. An experimental study was conducted to determine whether or not the seminar method (a) is perceived by attending physicians as beneficial, (b) modifies the physicians' attitudes toward teaching, (c) enables attending physicians to define needed teaching changes, (d) motivates them to improve their teaching performance, and (e) is perceived as having long-term benefits. Forty-six inpatient attending physicians from four California institutions participated in the study. The physicians were randomly assigned to an experimental group which attended a seminar on clinical teaching or to a control group which received no such intervention. Questionnaires completed by the physicians indicated that the teachers who experienced the seminar method perceived it as beneficial, improved their attitudes toward clinical teaching, determined needed teaching changes, attempted to implement new teaching approaches, and perceived long-term benefits.
View details for Web of Science ID A1984TX30500004
View details for PubMedID 6502663