Kelley M. Skeff, MD, PhD

All Publications

• Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record. Journal of healthcare management / American College of Healthcare Executives Skeff, K. M., Brown-Johnson, C. G., Asch, S. M., Zionts, D. L., Winget, M., Kerem, Y. 2022

  Abstract

  GOAL: Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR.METHODS: In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR "distressing events" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies.PRINCIPAL FINDINGS: Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed.PRACTICAL APPLICATIONS: Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.

  View details for DOI 10.1097/JHM-D-21-00070

  View details for PubMedID 35984408

• A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication. Journal of general internal medicine Mazer, L. M., Storage, T., Bereknyei, S., Chi, J., Skeff, K. 2017; 32 (2): 182-188

  Abstract

  Patient history-taking is an essential clinical skill, with effects on diagnostic reasoning, patient-physician relationships, and more. We evaluated the impact of using a structured, timeline-based format, the Chronology of Present Illness (CPI), to guide the initial patient interaction.To determine the feasibility and impact of the CPI on the patient interview, written notes, and communication with other providers.Internal medicine residents used the CPI during a 2-week night-float rotation. For the first week, residents interviewed, documented, and presented patient histories according to their normal practices. They then attended a brief educational session describing the CPI, and were asked to use this method for new patient interviews, notes, and handoffs during the second week. Night and day teams evaluated the method using retrospective pre-post comparisons.Twenty-two internal medicine residents in their second or third postgraduate year.An educational dinner describing the format and potential benefits of using the CPI.Retrospective pre-post surveys on the efficiency, quality, and clarity of the patient interaction, written note, and verbal handoff, as well as open-ended comments. Respondents included night-float residents, day team residents, and attending physicians.All night-float residents responded, reporting significant improvements in written note, verbal sign-out, assessment and plan, patient interaction, and overall efficiency (p < 0.05). Day team residents (n = 76) also reported increased clarity in verbal sign-out and written note, improved efficiency, and improved preparedness for presenting the patient (p < 0.05). Attending physician ratings did not differ between groups.Resident ratings indicate that the CPI can improve key aspects of patient care, including the patient interview, note, and physician-physician communication. These results suggest that the method should be taught and implemented more frequently.

  View details for DOI 10.1007/s11606-016-3928-3

  View details for PubMedID 27896691

• Restructuring the patient's history: enhancing the consultant's role as a teacher. Gastroenterology Skeff, K. M. 2014; 147 (6): 1208-1211

  View details for DOI 10.1053/j.gastro.2014.10.022

  View details for PubMedID 25449214

• Reassessing the HPI: The Chronology of Present Illness (CPI) JOURNAL OF GENERAL INTERNAL MEDICINE Skeff, K. M. 2014; 29 (1): 13–15

  View details for PubMedID 23949574

  View details for PubMedCentralID PMC3889925

• Teaching behaviors in the cardiac surgery simulation environment JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Fann, J. I., Sullivan, M. E., Skeff, K. M., Stratos, G. A., Walker, J. D., Grossi, E. A., Verrier, E. D., Hicks, G. L., Feins, R. H. 2013; 145 (1): 45-53

  Abstract

  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 MEDICAL TEACHER Johansson, J., Skeff, K. M., Stratos, G. A. 2012; 34 (2): E123-E128

  Abstract

  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

• "Teaching as a Competency": Competencies for Medical Educators ACADEMIC MEDICINE Srinivasan, M., Li, S. T., Meyers, F. J., Pratt, D. D., Collins, J. B., Braddock, C., Skeff, K. M., West, D. C., Henderson, M., Hales, R. E., Hilty, D. M. 2011; 86 (10): 1211-1220

  Abstract

  Most medical faculty receive little or no training about how to be effective teachers, even when they assume major educational leadership roles. To identify the competencies required of an effective teacher in medical education, the authors developed a comprehensive conceptual model. After conducting a literature search, the authors met at a two-day conference (2006) with 16 medical and nonmedical educators from 10 different U.S. and Canadian organizations and developed an initial draft of the "Teaching as a Competency" conceptual model. Conference participants used the physician competencies (from the Accreditation Council for Graduate Medical Education [ACGME]) and the roles (from the Royal College's Canadian Medical Education Directives for Specialists [CanMEDS]) to define critical skills for medical educators. The authors then refined this initial framework through national/regional conference presentations (2007, 2008), an additional literature review, and expert input. Four core values grounded this framework: learner engagement, learner-centeredness, adaptability, and self-reflection. The authors identified six core competencies, based on the ACGME competencies framework: medical (or content) knowledge; learner- centeredness; interpersonal and communication skills; professionalism and role modeling; practice-based reflection; and systems-based practice. They also included four specialized competencies for educators with additional programmatic roles: program design/implementation, evaluation/scholarship, leadership, and mentorship. The authors then cross-referenced the competencies with educator roles, drawing from CanMEDS, to recognize role-specific skills. The authors have explored their framework's strengths, limitations, and applications, which include targeted faculty development, evaluation, and resource allocation. The Teaching as a Competency framework promotes a culture of effective teaching and learning.

  View details for DOI 10.1097/ACM.0b013e31822c5b9a

  View details for Web of Science ID 000295357000017

  View details for PubMedID 21869655

• Barriers to Effective Teaching ACADEMIC MEDICINE DaRosa, D. A., Skeff, K., Friedland, J. A., Coburn, M., Cox, S., Pollart, S., O'Connell, M., Smith, S. 2011; 86 (4): 453-459

  Abstract

  Medical school faculty members are charged with the critical responsibility of preparing the future physician and medical scientist workforce. Recent reports suggest that medical school curricula have not kept pace with societal needs and that medical schools are graduating students who lack the knowledge and skills needed to practice effectively in the 21st century. The majority of faculty members want to be effective teachers and graduate well-prepared medical students, but multiple and complex factors-curricular, cultural, environmental, and financial-impede their efforts. Curricular impediments to effective teaching include unclear definitions of and disagreement on learning needs, misunderstood or unstated goals and objectives, and curriculum sequencing challenges. Student and faculty attitudes, too few faculty development opportunities, and the lack of an award system for teaching all are major culture-based barriers. Environmental barriers, such as time limitations, the setting, and the physical space in which medical education takes place, and financial barriers, such as limited education budgets, also pose serious challenges to even the most committed teachers. This article delineates the barriers to effective teaching as noted in the literature and recommends action items, some of which are incremental whereas others represent major change. Physicians-in-training, medical faculty, and society are depending on medical education leaders to address these barriers to effect the changes needed to enhance teaching and learning.

  View details for DOI 10.1097/ACM.0b013e31820defbe

  View details for Web of Science ID 000288966200015

  View details for PubMedID 21346500

• Global Health Training and International Clinical Rotations During Residency: Current Status, Needs, and Opportunities ACADEMIC MEDICINE Drain, P. K., Holmes, K. K., Skeff, K. M., Hall, T. L., Gardner, P. 2009; 84 (3): 320-325

  Abstract

  Increasing international travel and migration have contributed to globalization of diseases. Physicians today must understand the global burden and epidemiology of diseases, the disparities and inequities in global health systems, and the importance of cross-cultural sensitivity. To meet these needs, resident physicians across all specialties have expressed growing interest in global health training and international clinical rotations. More residents are acquiring international experience, despite inadequate guidance and support from most accreditation organizations and residency programs. Surveys of global health training, including international clinical rotations, highlight the benefits of global health training as well as the need for a more coordinated approach. In particular, international rotations broaden a resident's medical knowledge, reinforce physical examination skills, and encourage practicing medicine among underserved and multicultural populations. As residents recognize these personal and professional benefits, a strong majority of them seek to gain international clinical experience. In conclusion, with feasible and appropriate administrative steps, all residents can receive global health training and be afforded the accreditation and programmatic support to participate in safe international rotations. The next steps should address accreditation for international rotations and allowance for training away from continuity clinics by residency accreditation bodies, and stipend and travel support for six or more weeks of call-free elective time from residency programs.

  View details for Web of Science ID 000267655100013

  View details for PubMedID 19240438

• Clinical teaching improvement: The transportability of the Stanford Faculty Development Program MEDICAL TEACHER Johansson, J., Skeff, K., Stratos, G. 2009; 31 (8): E377-E382

  Abstract

  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

• Faculty development in medicine: A field in evolution TEACHING AND TEACHER EDUCATION Skeff, K. M., Stratos, G. A., Mount, J. F. 2007; 23 (3): 280-285

  View details for DOI 10.1016/j.tate.2006.12.019

  View details for Web of Science ID 000246002400005

• The chromosomal analysis of teaching: the search for promoter genes. Transactions of the American Clinical and Climatological Association Skeff, K. M. 2007; 118: 123-132

  Abstract

  The process of teaching is ubiquitous in medicine, both in the practice of medicine and the promotion of medical science. Yet, until the last 50 years, the process of medical teaching had been neglected. To improve this process, the research group at the Stanford Faculty Development Center for Medical Teachers developed an educational framework to assist teachers to analyze and improve the teaching process. Utilizing empirical data drawn from videotapes of actual clinical teaching and educational literature, we developed a seven-category systematic scheme for the analysis of medical teaching, identifying key areas and behaviors that could enable teachers to enhance their effectiveness. The organizational system of this scheme is similar to that used in natural sciences, such as genetics. Whereas geneticists originally identified chromosomes and ultimately individual and related genes, this classification system identifies major categories and specific teaching behaviors that can enhance teaching effectiveness. Over the past two decades, this organizational framework has provided the basis for a variety of faculty development programs for improving teaching effectiveness. Results of those programs have revealed several positive findings, including the usefulness of the methods for a wide variety of medical teachers in a variety of settings. This research indicates that the development of a framework for analysis has been, as in the natural sciences, an important way to improve the science of the art of teaching.

  View details for PubMedID 18528496

• Benefits of resident work hours regulation ANNALS OF INTERNAL MEDICINE Skeff, K. M., Ezeji-Okoye, S., Pompei, P., Rockson, S. 2004; 140 (10): 816-817

  View details for PubMedID 15148069

• Lymphatic biology and disease: is it being taught? Who is listening? Lymphatic research and biology Rockson, S. G., Granger, D. N., Skeff, K. M., Chaite, W. 2004; 2 (2): 86-95

  View details for PubMedID 15615490

• How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting? JOURNAL OF GENERAL INTERNAL MEDICINE Simon, S. R., Davis, D., Peters, A. S., Skeff, K. M., Fletcher, R. H. 2003; 18 (9): 730-735

  Abstract

  To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process.Qualitative analysis of transcribed interviews.Harvard Medical School, Boston, Mass.Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors.Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching.Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient.These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.

  View details for Web of Science ID 000185189600008

  View details for PubMedID 12950482

  View details for PubMedCentralID PMC1494919

• Regional teaching improvement programs for community-based teachers AMERICAN JOURNAL OF MEDICINE Skeff, K. M., Stratos, G. A., Bergen, M. R., Sampson, K., Deutsch, S. L. 1999; 106 (1): 76-80

  Abstract

  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 Elliot, D. L., Skeff, K. M., Stratos, G. A. 1999; 11 (1): 52-57

  View details for Web of Science ID 000078973400009

• Factorial validation of a widely disseminated educational framework for evaluating clinical teachers ACADEMIC MEDICINE Litzelman, D. K., Stratos, G. A., Marriott, D. J., Skeff, K. M. 1998; 73 (6): 688-695

  Abstract

  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

• A pilot study of faculty development for basic science teachers ACADEMIC MEDICINE Skeff, K. M., Stratos, G. A., Bergen, M. R., Regula, D. P. 1998; 73 (6): 701-704

  Abstract

  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

• Beneficial and harmful effects of augmented feedback on physicians' clinical-teaching performances ACADEMIC MEDICINE Litzelman, D. K., Stratos, G. A., Marriott, D. J., Lazaridis, E. N., Skeff, K. M. 1998; 73 (3): 324-332

  Abstract

  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 MEDICAL TEACHER Stratos, G. A., Bergen, M. R., Albright, C. L., Skeff, K. M., Owens, D. K. 1997; 19 (4): 285-292

  View details for Web of Science ID 000071407000008

• Faculty development - A resource for clinical teachers JOURNAL OF GENERAL INTERNAL MEDICINE Skeff, K. M., Stratos, G. A., Mygdal, W., DEWITT, T. A., Manfred, L., Quirk, M., Roberts, K., Greenberg, L., Bland, C. J. 1997; 12: S56-S63

  View details for Web of Science ID A1997WV43400009

  View details for PubMedID 9127245

• Clinical teaching improvement: past and future for faculty development. Family medicine Skeff, K. M., Stratos, G. A., MYGDAL, W. K., DeWitt, T. G., Manfred, L. M., Quirk, M. E., Roberts, K. B., Greenberg, L. W. 1997; 29 (4): 252-257

  Abstract

  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

• THE EFFECT OF A CLINICAL TEACHING RETREAT ON RESIDENTS TEACHING SKILLS ACADEMIC MEDICINE Litzelman, D. K., Stratos, G. A., Skeff, K. M. 1994; 69 (5): 433-434

  View details for Web of Science ID A1994NM04500067

  View details for PubMedID 8086087

• omparison of clinical teaching skills used by residents and attending physicians in inpatient and lecture settings Teaching and Learning in Medicine Berman J, Bergen MR, Skeff KM 1993; 53 (3): 149-157
• EVALUATION OF A MEDICAL-FACULTY DEVELOPMENT PROGRAM - A COMPARISON OF TRADITIONAL PRE/POST AND RETROSPECTIVE PRE/POST SELF-ASSESSMENT RATINGS EVALUATION & THE HEALTH PROFESSIONS Skeff, K. M., Stratos, G. A., Bergen, M. R. 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 PREVENTIVE MEDICINE Albright, C. L., Farquhar, J. W., Fortmann, S. P., Sachs, D. P., Owens, D. K., Gottlieb, L., Stratos, G. A., Bergen, M. R., Skeff, K. M. 1992; 21 (4): 419-435

  Abstract

  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 Skeff, K. M., Stratos, G. A., Berman, J., Bergen, M. R. 1992; 152 (6): 1156-1161

  Abstract

  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

• Evaluation of a medical faculty development program: a comparison of traditional pre/post and retrospective pre/post self-assessment ratings Evaluation and the Health Care Professions Skeff KM, Bergen MR, Stratos GA 1992; 15 (3): 350-366
• The Stanford faculty development program for medical teachers: a dissimination approach to faculty development for medical teachers Teaching and Learning in Medicine Skeff KM, Stratos GA, Bergen MR, Albright CL, Berman J, Sox HC, Farquhar JW 1992; 4 (3): 180-187
• RETROSPECTIVE VERSUS ACTUAL PRE-COURSE SELF-ASSESSMENTS EVALUATION & THE HEALTH PROFESSIONS Levinson, W., Gordon, G., Skeff, K. 1990; 13 (4): 445-452

  View details for Web of Science ID A1990EJ26400006

• USING THE PATIENTS HISTORY TO ESTIMATE THE PROBABILITY OF CORONARY-ARTERY DISEASE - A COMPARISON OF PRIMARY CARE AND REFERRAL PRACTICES AMERICAN JOURNAL OF MEDICINE Sox, H. C., Hickam, D. H., Marton, K. I., Moses, L., Skeff, K. M., Sox, C. H., NEAL, E. A. 1990; 89 (1): 7-14

  Abstract

  According to probability theory, the interpretation of new information should depend on the prior probability of disease. We asked if this principle applies to interpreting the history in patients with chest pain. We compared the prevalence of coronary artery disease (CAD) in patients who had similar histories but who came from populations with different disease prevalence.We studied two high-disease-prevalence populations (patients referred for coronary arteriography) and two low-disease-prevalence populations (patients from primary care practices). We used clinical characteristics of one arteriography population to develop a logistic rule for estimating the probability of coronary artery narrowing. The number of clinical findings determined the logistic score, which was proportional to the prevalence of CAD.The prevalence of CAD was much lower in the primary care population than in the arteriography population, even when patients with similar logistic scores, and thus similar clinical histories, were compared.A clinician must take account of the overall prevalence of disease in the clinical setting when using the patient's history to estimate the probability of disease. Failure to observe this caution may lead to errors in test selection and interpretation.

  View details for Web of Science ID A1990DN17900002

  View details for PubMedID 2242131

• Enhancing teaching effectiveness and vitality in the ambulatory setting. Journal of general internal medicine Skeff, K. M. 1988; 3 (2): S26-33

  View details for PubMedID 3361368

• EVALUATION OF THE SEMINAR METHOD TO IMPROVE CLINICAL TEACHING JOURNAL OF GENERAL INTERNAL MEDICINE Skeff, K. M., Stratos, G., Campbell, M., Cooke, M., JONES, H. W. 1986; 1 (5): 315-322

  Abstract

  The effects of a seminar method to improve the teaching of ward attending physicians were evaluated. Forty-six attending physicians from four institutions were randomly assigned to experimental and control groups. The method was evaluated to assess its effects on attending physicians' performances and attitudes, and impact on learners. Evaluation methods included ratings of videotapes of ward rounds, teachers' subjective assessments of both their teaching performances and their experiences in the study, and trainee ratings. Videotape ratings, the teachers' own assessments, and the trainees' assessments of the attending physicians' impact on learning were significantly different, favoring the experimental group (p less than 0.05). It is concluded that the seminar method can provide the basis for effective and feasible approaches for improving clinical teaching by attending physicians.

  View details for Web of Science ID A1986D839500009

  View details for PubMedID 3772621

• Process and product in clinical teaching: a correlational study. Research in medical education : proceedings of the ... annual Conference. Conference on Research in Medical Education Skeff, K. M., Campbell, M., Stratos, G. 1985; 24: 25-30

  View details for PubMedID 3854734

• ASSESSMENT BY ATTENDING PHYSICIANS OF A SEMINAR METHOD TO IMPROVE CLINICAL TEACHING JOURNAL OF MEDICAL EDUCATION Skeff, K. M., Campbell, M., Stratos, G., JONES, H. W., Cooke, M. 1984; 59 (12): 944-950

  Abstract

  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

• Evaluation of attending physicians: three perspectives. Research in medical education : proceedings of the ... annual Conference. Conference on Research in Medical Education Skeff, K. M., Campbell, M., Stratos, G. 1984; 23: 277-281

  View details for PubMedID 6571651

• EVALUATION OF A METHOD FOR IMPROVING THE TEACHING PERFORMANCE OF ATTENDING PHYSICIANS AMERICAN JOURNAL OF MEDICINE Skeff, K. M. 1983; 75 (3): 465-470

  Abstract

  The effects of an intensive feedback method on the teaching performance of ward attending physicians were evaluated. Sixty-four attending physicians were randomly assigned to one of four experimental groups: (1) intensive feedback, (2) videotape control, (3) questionnaire feedback, or (4) questionnaire control. The method was evaluated using the teachers' subjective assessments, ratings of videotapes of ward rounds, and trainee ratings. Seventy-five percent of the intensive feedback group rated their treatment definitely beneficial in contrast to less than 13 percent of teachers in other groups (p less than 0.001). The intensive feedback group received higher post-treatment videotape ratings than the videotape control group, both on ratings of specific categories of teacher behavior (p = 0.03) and on ratings of overall teaching performance (p = 0.08). More intensive feedback teachers (40 percent) than videotape control teachers (6 percent) improved their personally identified problem teaching behaviors (p less than 0.05). Trainee ratings showed no significant difference between study groups. It is concluded that attending physicians can improve their teaching performance. Intensive feedback is one possible method of achieving that goal.

  View details for Web of Science ID A1983RG77800016

  View details for PubMedID 6614032

• A study of the implicit criteria used in diagnosing chest pain. Medical decision making Hickam, D. H., Sox, H. C., Marton, K. I., Skeff, K. M., Chin, D. 1982; 2 (4): 403-414

  Abstract

  Although previous studies have reported the prevalence of coronary artery disease among patients with typical and atypical angina, criteria for the definition of these chest pain syndromes have not been well described. We studied the implicit criteria used by physicians to classify patients with chest pain. Five internists reviewed the histories of 190 subjects admitted to the hospital for elective coronary arteriography and rated each history as indicating either high or low risk of coronary disease. We applied logistic discriminant analysis to these ratings to create a decision rule for the classification of patients with anginal syndromes. The prevalence of confirmed coronary artery disease in subjects classified by the rule as at high risk was 0.83; the prevalence was 0.57 in subjects classified as at low risk. These prevalences are similar to those found for typical and atypical angina in previous large studies. We conclude that this linear model represents the physicians' decisions and provides criteria for defining anginal pain syndromes in certain settings.

  View details for PubMedID 6820677