EDUCATION AND TRAINING
Teaching Geriatric Fellows How to Teach: A Needs Assessment Targeting Geriatrics Fellowship Program Directors Veronica Rivera, MD,* Michi Yukawa, MD, MPH,†‡ Louise Aronson, MD, MFA,† and Eric Widera, MD†‡
The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine-question survey adapted from a 2001 survey issued to residency program directors inquiring about residents-as-teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6-week period. Of 144 ACGME-accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e-mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs. J Am Geriatr Soc 62:2377–2382, 2014.
Key words: geriatric fellowship; education; teaching From the *Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York; †Division of Geriatrics, University of California at San Francisco; and ‡Department of Veterans Affairs Medical Center, San Francisco, California. Address correspondence to Assistant Professor Veronica Rivera, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue-Box 1070, New York, NY 10029. E-mail: [email protected] DOI: 10.1111/jgs.13187
JAGS 62:2377–2382, 2014 © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society
A
lthough older adults are the fastest-growing segment of the population in the United States, in 2012, there were just 7,356 geriatricians nationally1 and only 275 geriatric fellows being trained in the 149 Accreditation Council for Graduate Medical Education (ACGME)-accredited geriatric fellowship programs.2 The American Geriatrics Society predicts that, by 2030, at least 30,000 geriatricians will be needed to care for an expected 21 million older Americans.1 In anticipation of this worsening shortfall of board-certified geriatricians available to serve the increasing numbers of older adults, there is growing recognition that geriatricians need the skills to educate other healthcare providers in the principles of geriatric medicine. The 2008 Institute of Medicine Report Retooling for an Aging America: Building the Health Care Workforce3 and the American Geriatrics Society Task Force on the Future of Geriatric Medicine, which identified “education of a health professions workforce to care for older persons”4 as a core value, have specifically suggested this as an educational priority. The ACGME Program Requirements for Graduate Medical Education in Geriatric Medicine are consistent with the core geriatrics value of education, mandating that “as fellows progress through their education, they should teach other health professionals and trainees, including allied health personnel, medical students, nurses, and residents.” These requirements also state that programs must “use performance data to assess fellows in teaching skills involving peers, patients, residents, and students.”5 Training geriatric medicine fellows as educators is further reflected in the End-of-Training Entrustable Professional Activities for Geriatric Medicine6 and Curricular Milestones for graduating geriatric fellows7 that the American Geriatrics Society and the Association of Directors of Geriatric Academic Programs recently developed. According to the curricular milestones, every graduating geriatric fellow should be able to “demonstrate the ability to teach patients, caregivers, and others about aging-related healthcare issues” upon completion of the 1-year clinical fellowship program.7 Because fellows are expected to demonstrate the ability to teach, it is important that fellowship programs
0002-8614/14/$15.00
2378
RIVERA ET AL.
provide instruction on teaching. Teaching-to-teach has been discussed widely in the residency literature and has been demonstrated in resident-as-teachers programs.8–12 These programs that provide instruction on teaching skills are varied but often include the following teaching methods: lectures, small-group discussion, reflection on videotaped skills, practice with peers, and role-playing. There is some evidence that these courses targeting residents improve resident self-assessed teaching behaviors, teaching confidence, and learner evaluations of residents.9 A randomized trial also showed that residents who received a 13-hour teaching curriculum had better teaching skills as judged by medical student raters than residents who did not receive the curriculum.13 Even though fellowship programs are required to train fellows to be educators, there are several potential challenges to including a teaching-to-teach curriculum in a geriatric fellowship program. A significant barrier is time in training, given that most geriatric fellowship programs are only 1 year long and must also ensure clinical competence of their trainees. Faculty time is also limited.14 Conceptual and attitudinal barriers, such as the belief that the purpose of fellowship training is not to learn teaching skills, may also limit improvement of medical education training for geriatric fellows. Finally, not all geriatricians may perceive teaching as part of their professional role; in a 2004 survey of fellowship-trained geriatricians, only 6% of respondents reported a need for more training in education skills.15 Surveys of geriatrics fellowship directors conducted in 2002 and 2007 described trends in geriatrics fellowship training generally but did not address teaching skills training in depth.16 Consequently, it remains unclear whether programs ensure that all geriatrics fellows graduate having demonstrated the ability to teach patients, caregivers, and others about aging-related healthcare issues. Therefore, the purpose of the current study was to assess whether fellows are being trained in how to teach others effectively, to assess the attitudes of program directors toward training fellows to be teachers, and to understand what fellowship programs can do to help facilitate this type of training for fellows.
METHODS Subjects Subjects were fellowship directors of 144 ACGME-accredited U.S. geriatric fellowship programs.
DECEMBER 2014–VOL. 62, NO. 12
rate their input on item phraseology, content, and sequence. The initial survey included 11 questions. The final survey requested information about characteristics of the programs, attitudes about the topic of teaching-to-teach, current training practices, and suggestions for future support in implementing this type of training. Appendix A includes the final questionnaire sent out to the fellowship directors. Institutional review board approval was received from the University of California at San Francisco.
Survey Administration One hundred forty-seven fellowship program director names and e-mail addresses were obtained from the Association of Directors of Geriatric Academic Programs. A link to the electronic survey was e-mailed to these individuals, and the survey was described as a medical education project about how geriatrics fellowships are training current geriatrics fellows to be effective educators. The e-mail was sent three times over a 6-week period between March and April 2012. After the first e-mail was sent out, it was discovered that there were 21 misidentified program directors; correct names and e-mail addresses were obtain for 18 of the 21. Corrections were made by contacting programs directly and by searching for updated contact information available on the Internet.
Statistical Analysis All data are presented as percentages based on number of responses to each question as numerators and number of surveys mailed as denominators. Chi-square tests were used to compare academic with community programs and internal medicine with family medicine programs to determine whether there were any differences in teaching instruction given to their geriatric fellows. The criterion for statistical significance was P ≤ .05. The data were analyzed using SPSS version 14 (SPSS, Inc., Chicago, IL).
RESULTS One hundred one of 144 program directors (70%) completed the survey, but not all respondents answered every question.
Table 1. Characteristics of Programs (N = 91) Characteristic
Survey Instrument A nine-question survey was adapted from a 2001 survey issued to residency program directors inquiring about a residents-as-teachers curriculum.17 The 2001 survey was used because content experts had validated it, it had been revised based on their feedback, it assessed matters pertinent to the study, and it was brief enough that participants were likely to respond. Feedback was solicited on the draft of the revised survey from two experts in geriatrics and medical education with considerable expertise in education evaluation methods who have collaborated with medical education faculty to design survey instruments for diverse geriatrics education initiatives. The instrument was revised to incorpo-
JAGS
Location Northeast Midwest South West Affiliation Academic Community Department Family medicine Internal medicine Length of training, years 1 2
n (%)
25 20 27 19
(27.4) (21.9) (29.7) (20.8)
76 (83.5) 15 (16.5) 23 (25.5) 67 (74.4) 90 (98.9) 1 (1.0)
JAGS
DECEMBER 2014–VOL. 62, NO. 12
TEACHING GERIATRIC FELLOWS HOW TO TEACH
2379
Figure 1. Number of hours of instruction per year.
Demographics Ninety-one of the 101 respondents provided information about their program’s characteristics. All four regions of the country were evenly represented. Most fellowship programs had academic affiliations and were based in departments of internal medicine (Table 1). One hundred one program directors reported on the size of their fellowship programs during the 2011–12 year. The majority of fellowship programs had between one and four fellows. The number of trainees ranged from one to nine fellows per year, with mean size of 3 2 fellows per year. Forty-five (44.6%) programs reported offering a second-year or higher clinician–educator training pathway.
Attitudinal Assessment The attitude of program directors about their trainees as educators was assessed by asking them to rate how strongly they felt about the statement: “It is important for all geriatric clinical fellows to leave fellowship as competent educators.” Of the 99 directors who responded, 34.4% strongly agreed with this statement, 49.5% agreed, 8.1% neither agreed nor disagreed, and 8.1% strongly disagreed. Survey respondents were given the opportunity to comment about their answer. Many elaborated that they supported the statement because there are so few geriatricians (n = 17) and geriatricians have a responsibility to teach others (n = 20). A few also noted (n = 7) that many of their trainees wanted to be in academic positions after their fellowship. One respondent who neither agreed nor disagreed with the statement claimed, “We have a workforce shortage and I feel there is just as strong of a need for strong clinicians who are going to be out in the community and not in academic teaching positions.”
Overall Characteristics of Curricula Ninety-three of 99 (93.9%) respondents said that they require all first-year fellows to teach, but only 55 of 100 (55%) of programs provide some type of formal instruction in teaching skills. When analyzed according to type of
program, 55% of academic programs, 29% of community programs, 39% of family medicine programs, and 54% of internal medicine programs offered teaching skills instruction. Academic programs offered teaching skills instruction more than community-based programs (P ≤ .001). Similarly, internal medicine programs provided teaching skills to fellows more than family medicine programs (P ≤ .001). There was no significant difference in the provision of some type of formal teaching instruction between programs that did and did not offer a second-year clinician– educator pathway. Of the 55 programs that provided formal instruction, 45 reported the number of hours of formal instruction that they provided. The number of hours of instruction over the course of the year varied widely, with 15 programs providing fewer than 5 hours of training, 10 programs providing 5 to 10 hours, eight programs providing 11 to 20 hours, and 10 programs providing more than 20 hours (Figure 1). The most commonly reported curricular elements were didactics, workshops, a teaching scholarly concentration, and direct observation and feedback. Other methodologies included online modules, teaching workshops at outside institutions, videotaped sessions, and teaching in the community at senior centers and nursing homes. For programs that did not have teaching-to-teach curricula, the reasons why this type of curriculum did not
Table 2. Reasons First-Year Fellows Do Not Receive Formal Instruction in Teaching Skills Reasons First-Year Fellows Do Not Receive Formal Instruction in Teaching Skills
Not the purpose of fellowship Lack of interest from fellows Fellow teaching skills are already adequate Fellow time constraints Faculty time constraints Insufficient faculty expertise to develop and implement curriculum Other Total who answered question
N (%)
9 3 4 16 19 7
(22.0) (7.3) (9.8) (39.0) (46.3) (17.1)
33 (80.4) 41
2380
RIVERA ET AL.
DECEMBER 2014–VOL. 62, NO. 12
Table 3. Ways to Help Start a Curriculum or Improve Current Curriculum Ways to Help Start a Curriculum or Improve Current Curriculum
No improvement needed More articles and online modules available on national databases such as Portal of Geriatrics Online Education Example of a model curriculum adaptable for your institution Faculty development precourse at American Geriatrics Society Annual Scientific Meeting Other Total who answered question
N (%)
9 (9.8) 39 (42.4) 60 (65.2) 41 (44.6) 32 (34.7) 92
exist were categorized (Table 2). Common reasons included fellow time constraints, faculty time constraints, and considering such curricula not consistent with the purpose of the fellowship.
Needs Assessment Seventy percent (67/96 programs) of program directors responded that their fellows would benefit from more instruction in teaching skills. Only 30% (29 programs) felt they had just the right amount of instruction. Specifically, 67% of academic programs, 79% of community programs, 61% of family medicine programs, and 73% of internal medicine programs felt that they could use more instruction. No fellowship directors felt that their fellows were receiving too much instruction. When asked what could help program directors start a curriculum or help them improve their current curriculum, respondents suggested more online resources (40%, 26/64 programs), creation of a model curriculum (63%, 40/64 programs), and a faculty development precourse at the annual American Geriatrics Society meeting (42%, 27/64) (Table 3).
DISCUSSION Most program directors believe that graduates of their geriatric medicine training program should leave fellowship as competent educators, but only half of programs provide formal instruction in teaching skills. Program directors identified several reasons for inadequate teachingto-teach curricula in their fellowship program: lack of time in fellowship, lack of faculty time, and insufficient local faculty expertise to develop and implement a curriculum on teaching. A minority considered a teaching curriculum to be inconsistent with the goals of a geriatric medicine training program. The majority of fellowship program directors want resources to help start a teaching-to-teach curriculum or to help improve their already existing curriculum, with 65% of respondents wanting an example of a model curriculum adaptable for their institution. Prior work done in residency programs demonstrates that teaching-to-teach curricula can be reproducible and accessible.11,12 In a literature review of resident-as-teacher curricula,12 reproducibility was defined as a “clear set of goals and objectives with descriptions of lesson plans and materials used
JAGS
(e.g., videos, PowerPoint slides, handouts).” The American Academy of Pediatrics has created a thorough residentsas- teacher workshop packet that is an example of a reproducible curriculum available to all pediatric training programs. They have created a toolkit, available online, that includes objectives, learning materials, and case-based workshops.18 A similar toolkit available to all fellowship program directors would be a product that could help fellowship directors implement this curriculum for their own programs. Also, just as some of the resident-as-teacher curricula are available on MedEd PORTAL, the survey found that fellowship program directors wanted articles and online modules available on sites such as the Portal of Geriatrics Online Education. In particular, the use of nationally accessible online learning modules developed to train geriatric fellows on how to teach may address the finding that some programs had a lack of faculty time and needed local expertise to develop and implement a teaching skills curriculum. The survey also indicated that program directors are interested in faculty development in teaching-to-teach. Supplementing a reproducible model curriculum with faculty development courses at the annual meeting of the American Geriatrics Society can further support local expertise in adapting national curriculum to individual programs. Based on the survey results, various current geriatric fellowship training programs may also be a resource for development of a model curriculum, because many already have formal instruction on teaching skills, and some already use online modules to provide this type of instruction. It would be worth studying these existing curricula and disseminating those that have proven to be effective. There are published examples of fellowship programs implementing parts of a teaching-to-teach curriculum during the first year of clinical training. A yearlong course to achieve excellence in teaching and career development was successfully implemented at the University of Rochester with the addition of just 3 hours of didactics per month plus project time.19 Another example comes from the Duke University Center for the Study of Aging and Human Development, which incorporated 10 educational skills seminars into a geriatrics grand round series for fellows and faculty.20 Of the 10 seminars, the ones specific to teaching skills were teaching tips for large-group instruction, facilitating learning in small groups, effective clinical teaching, the 1-minute preceptor model, and assessing and improving teaching. Once a reproducible teaching-to-teach model curriculum for geriatric fellowship programs is created, it will be essential to create an evaluation tool for this curriculum that will assess its application in different fellowship programs (large and small, academic and community). The model curriculum will also need to demonstrate improvement in teaching skills of geriatric fellows. This can be accomplished by adapting assessment tools that have been developed for residency training programs, such as objective structured teaching exercises, objective structured clinical examinations, direct observation, and videotaped evaluation.12 One possible beneficial outcome of a teaching-to-teach curriculum during fellowship might be to increase interest in the clinician–educator career path in academia; 45% of
JAGS
DECEMBER 2014–VOL. 62, NO. 12
fellowship programs offered a second-year clinician–educator training pathway, but despite programs such as the Donald W. Reynolds Consortium for Faculty Development to Advance Geriatrics Education, which has helped fund trainees pursuing a second-year educator pathway,21 few fellows opt to pursue a second year of training.22 A teaching-to-teach curriculum during fellowship may inspire more trainees to pursue careers in education after completion of training. This study has a number of limitations. The survey, designed to be brief to improve the response rate, did not explicitly define teaching skills or what was meant by formal teaching instruction. As a result, some program directors conflated teaching about teaching with teaching experience, and some respondents equated teaching skills with educational scholarship. For example, when asked about formal instruction, respondents had the option of didactics, workshops and retreats, teaching scholarly concentration, direct observation and feedback, and other. For other, some program directors reported teaching in the community setting as a way to provide formal teaching instruction. These sorts of responses highlight the great variability in how program directors may identify teaching-to-teach curricula. Furthermore, the aim was to assess teaching of teaching skills and not scholarship activities related to academic endeavors. Although these are related entities, the goal in teaching fellows how to teach is arguably different and applicable to all trainees, not merely those who enter academics. Had this been clearer in the survey, significantly fewer fellowship directors might have responded that they considered a teaching curriculum inconsistent with the goals of a geriatrics medicine training program. Finally, despite the fact that a brief survey was created, 30% of fellowship programs did not respond, and some of the respondents did not complete all of the survey questions. Although responses from nonresponders may have altered the results, the finding that only 55% of fellowship programs have formal instruction in teaching skills is similar to a longer general survey of geriatric fellowship program directors in 2007 that found that 62% of fellowships incorporated teaching skills training into their curriculum.16
CONCLUSION To ensure optimal care of all older adults, geriatricians must have the teaching skills to disseminate their expertise in the care of older adults effectively to interprofessional colleagues, patients, caregivers, policy-makers, and the public. This survey suggests that most geriatrics fellowships are not preparing geriatric medicine fellows for their roles as teachers. The development of a model teaching-to-teach curriculum that includes training materials, modules, and rigorous evaluation tools may help enable all programs regardless of size and academic affiliation to fulfill the mandate to provide teaching skills to our fellows.
ACKNOWLEDGMENTS Dr.Widera’s work is supported by the Health Resources and Services Administration.
TEACHING GERIATRIC FELLOWS HOW TO TEACH
2381
Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Rivera: conception and design, acquisition of subjects and data, analysis and interpretation of data, preparation of manuscript. Yukawa: analysis and interpretation of data, preparation of manuscript. Aronson: conception and design, revising the article critically for important intellectual content, preparation of manuscript. Widera: conception and design, acquisition of subjects and data, revising the article critically for important intellectual content, preparation of manuscript. Sponsor’s Role: Not applicable.
REFERENCES 1. American Geriatrics Society. Projected Future Need for Geriatricians, June 2012 [on-line]. Available at http://www.americangeriatrics.org/files/documents/Adv_Resources/GeriShortageProjected2012.pdf Accessed February 1, 2014. 2. Brotherton SE, Etzel SI. Graduate medical education, 2011–2012. JAMA 2012;308:2264–2279. 3. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: National Academies Press, 2008. 4. AGS Core Writing Group for the Task Force on the Future of Geriatric Medicine. Caring for older Americans: The future of geriatric medicine. J Am Geriatr Soc 2005;53:S245–S256. 5. ACGME program requirements for graduate medical education in geriatric medicine (family medicine or internal medicine), June 9, 2013 [on-line]. Available at https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/125–151_geriatric_medicine_07012014_1-YR.pdf Accessed May 24, 2014. 6. Leipzig RM, Sauvigne K, Granville LJ et al. What is a geriatrician? American Geriatrics Society and Association of Directors of Geriatric Academic Programs End-of-training entrustable professional activities for geriatric medicine. J Am Geriatr Soc 2014;62:924–929. 7. Parks SM, Harper GM, Fernandez H et al. American Geriatrics Society/ Association of Directors of Geriatric Academic Programs curricular milestones for graduating geriatric fellows. J Am Geriatr Soc 2014;62:930–935. 8. Bing-You RG, Tooker J. Teaching skills improvement programmes in US internal medicine residencies. Med Educ 1993;27:259–265. 9. Wamsley MA, Julian KA, Wipf JE. A literature review of “resident-as-teacher” curricula: Do teaching courses make a difference? J Gen Intern Med 2004;19:574–581. 10. Hill AG, Yu T, Barrow M et al. A systematic review of resident-as teacher programmes. Med Educ 2009;43:1129–1140. 11. Post RE, Quattlebaum G, Benich JJ. Residents-as-teachers curricula: A critical review. Acad Med 2009;84:374–380. 12. Bree KK, Whicker SA, Fromme HB et al. Residents-as-teachers publications: What can programs learn from the literature when starting a new or refining an established curriculum? J Grad Med Educ 2014;6:237–248. 13. Morrison EH, Rucker L, Boker JR et al. The effect of a 13-hour curriculum to improve residents’ teaching skills: A randomized control trial. Ann Intern Med 2004;141:257–263. 14. Bragg EJ, Warshaw GA, Meganathan K et al. The development of academic geriatric medicine in the United States 2005 to 2010: An essential resource for improving the medical care of older adults. J Am Geriatr Soc 2012;60:1540–1545. 15. Medina-Walpole A. Strengthening the fellowship training experience: Findings from a national survey of fellowship trained geriatricians 1990–1998. J Am Geriatr Soc 2004;54:607–610. 16. Bragg EJ, Warshaw GA, Meganathan K et al. National survey of geriatric medicine fellowship programs: Comparing findings in 2006–2007 and 2001–2002 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs’ Geriatrics Workforce Policy Studies Center. J Am Geriatr Soc 2010;58:2166–2172. 17. Morrison EH, Friedland JA, Boker J et al. Residents-as-teachers training in US residency programs and offices of graduate medical education. Acad Med 2001;76:S1–S4. 18. American Academy of Pediatrics. Residents as Teachers [on-line]. Available at http://www2.aap.org/sections/ypn/r/resident/pdfs/resasteachers.pdf Accessed May 24, 2014.
2382
RIVERA ET AL.
DECEMBER 2014–VOL. 62, NO. 12
19. Medina-Walpole A, Fonzi J, Katz PK. Academic career development in geriatric fellowship training. J Am Geriatr Soc 2007;55:2061–2067. 20. Pinheiro SO, Helfin MT. The geriatrics excellence in teaching series: An integrated educational skills curriculum for faculty and fellows development. J Am Geriatr Soc 2008;56:750–756. 21. Heflin MT, Bragg EJ, Fernandez H et al. The Donald W. Reynolds consortium for faculty development to advance geriatric education (FD-AGE): A
model for dissemination of subspecialty educational expertise. Acad Med 2012;87:618–626. 22. Geriatrics Workforce Policy Studies Center. Geriatric medicine fellowship programs, family medicine and internal medicine 1991/92–2011/12 [online]. Available at http://www.americangeriatrics.org/files/documents/gwps/ Table%203_2.pdf Accessed May 24, 2014.
APPENDIX A: QUESTIONNAIRE 1. Program Demographics: Location: __ Northeast __ Midwest __ South __ West Affiliation: __ Academic __ Community Department: __ Family Medicine __ Internal Medicine Required Length of Training: __1 year __2+ years 2. How many first-year fellows are currently in your ACGME-accredited Geriatrics fellowship? _____ 3. Does your program offer a second-year or higher clinical-educator training pathway? ____ Yes ____ No 4. How strongly do you agree/disagree with this statement? “It is important for all geriatric clinical fellows to leave fellowship as competent educators.” __Strongly Disagree __Disagree Agree
__Neither Agree nor Disagree__Agree
__Strongly
Why: _____________________________ 5. Does your fellowship require all first-year fellows to teach? __Yes __No 6. Do you require first-year fellows to receive formal instruction in teaching skills? __Yes __No A. If yes, approximately how many hours over the course of the year? _________ B. Please check all the REQUIRED and OPTIONAL components of formal teaching instruction available to your clinical fellows. Didactics Workshops/retreats Teaching scholarly concentration Direct observation and feedback Other _____________________
Required __ __ __ __ __
JAGS
Optional __ __ __ __ __
C. If no, why? Please check all that apply. __Not the purpose of fellowship __Lack of interest from fellows __Fellows’ teaching skills are already adequate __Fellow time constraints __Faculty time constraints __Insufficient faculty expertise to develop and implement curriculum __Other___________________ 7. How do you feel about the amount of teaching skills instruction your fellows receive? __They would benefit from even more instruction. __It is just about the right amount of instruction. __It is more instruction than they need. 8. What could help you start a curriculum for teaching fellows how to teach OR help you improve your current curriculum? Please check all that apply. __No improvement needed __More articles and online modules available national databases like POGOe __Example of a model curriculum adaptable for your institution __Faculty Development Pre-course at AGS __Other___________________ 9. Please provide any additional comments or thoughts that you would like to share with me about this area of geriatrics fellow training. ______________________________
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Teaching Geriatric Fellows How to Teach: A Needs Assessment Targeting Geriatrics Fellowship Program Directors Veronica Rivera, MD,* Michi Yukawa, MD, MPH,†‡ Louise Aronson, MD, MFA,† and Eric Widera, MD†‡
The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine-question survey adapted from a 2001 survey issued to residency program directors inquiring about residents-as-teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6-week period. Of 144 ACGME-accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e-mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs. J Am Geriatr Soc 62:2377–2382, 2014.
Key words: geriatric fellowship; education; teaching From the *Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York; †Division of Geriatrics, University of California at San Francisco; and ‡Department of Veterans Affairs Medical Center, San Francisco, California. Address correspondence to Assistant Professor Veronica Rivera, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue-Box 1070, New York, NY 10029. E-mail: [email protected] DOI: 10.1111/jgs.13187
JAGS 62:2377–2382, 2014 © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society
A
lthough older adults are the fastest-growing segment of the population in the United States, in 2012, there were just 7,356 geriatricians nationally1 and only 275 geriatric fellows being trained in the 149 Accreditation Council for Graduate Medical Education (ACGME)-accredited geriatric fellowship programs.2 The American Geriatrics Society predicts that, by 2030, at least 30,000 geriatricians will be needed to care for an expected 21 million older Americans.1 In anticipation of this worsening shortfall of board-certified geriatricians available to serve the increasing numbers of older adults, there is growing recognition that geriatricians need the skills to educate other healthcare providers in the principles of geriatric medicine. The 2008 Institute of Medicine Report Retooling for an Aging America: Building the Health Care Workforce3 and the American Geriatrics Society Task Force on the Future of Geriatric Medicine, which identified “education of a health professions workforce to care for older persons”4 as a core value, have specifically suggested this as an educational priority. The ACGME Program Requirements for Graduate Medical Education in Geriatric Medicine are consistent with the core geriatrics value of education, mandating that “as fellows progress through their education, they should teach other health professionals and trainees, including allied health personnel, medical students, nurses, and residents.” These requirements also state that programs must “use performance data to assess fellows in teaching skills involving peers, patients, residents, and students.”5 Training geriatric medicine fellows as educators is further reflected in the End-of-Training Entrustable Professional Activities for Geriatric Medicine6 and Curricular Milestones for graduating geriatric fellows7 that the American Geriatrics Society and the Association of Directors of Geriatric Academic Programs recently developed. According to the curricular milestones, every graduating geriatric fellow should be able to “demonstrate the ability to teach patients, caregivers, and others about aging-related healthcare issues” upon completion of the 1-year clinical fellowship program.7 Because fellows are expected to demonstrate the ability to teach, it is important that fellowship programs
0002-8614/14/$15.00
2378
RIVERA ET AL.
provide instruction on teaching. Teaching-to-teach has been discussed widely in the residency literature and has been demonstrated in resident-as-teachers programs.8–12 These programs that provide instruction on teaching skills are varied but often include the following teaching methods: lectures, small-group discussion, reflection on videotaped skills, practice with peers, and role-playing. There is some evidence that these courses targeting residents improve resident self-assessed teaching behaviors, teaching confidence, and learner evaluations of residents.9 A randomized trial also showed that residents who received a 13-hour teaching curriculum had better teaching skills as judged by medical student raters than residents who did not receive the curriculum.13 Even though fellowship programs are required to train fellows to be educators, there are several potential challenges to including a teaching-to-teach curriculum in a geriatric fellowship program. A significant barrier is time in training, given that most geriatric fellowship programs are only 1 year long and must also ensure clinical competence of their trainees. Faculty time is also limited.14 Conceptual and attitudinal barriers, such as the belief that the purpose of fellowship training is not to learn teaching skills, may also limit improvement of medical education training for geriatric fellows. Finally, not all geriatricians may perceive teaching as part of their professional role; in a 2004 survey of fellowship-trained geriatricians, only 6% of respondents reported a need for more training in education skills.15 Surveys of geriatrics fellowship directors conducted in 2002 and 2007 described trends in geriatrics fellowship training generally but did not address teaching skills training in depth.16 Consequently, it remains unclear whether programs ensure that all geriatrics fellows graduate having demonstrated the ability to teach patients, caregivers, and others about aging-related healthcare issues. Therefore, the purpose of the current study was to assess whether fellows are being trained in how to teach others effectively, to assess the attitudes of program directors toward training fellows to be teachers, and to understand what fellowship programs can do to help facilitate this type of training for fellows.
METHODS Subjects Subjects were fellowship directors of 144 ACGME-accredited U.S. geriatric fellowship programs.
DECEMBER 2014–VOL. 62, NO. 12
rate their input on item phraseology, content, and sequence. The initial survey included 11 questions. The final survey requested information about characteristics of the programs, attitudes about the topic of teaching-to-teach, current training practices, and suggestions for future support in implementing this type of training. Appendix A includes the final questionnaire sent out to the fellowship directors. Institutional review board approval was received from the University of California at San Francisco.
Survey Administration One hundred forty-seven fellowship program director names and e-mail addresses were obtained from the Association of Directors of Geriatric Academic Programs. A link to the electronic survey was e-mailed to these individuals, and the survey was described as a medical education project about how geriatrics fellowships are training current geriatrics fellows to be effective educators. The e-mail was sent three times over a 6-week period between March and April 2012. After the first e-mail was sent out, it was discovered that there were 21 misidentified program directors; correct names and e-mail addresses were obtain for 18 of the 21. Corrections were made by contacting programs directly and by searching for updated contact information available on the Internet.
Statistical Analysis All data are presented as percentages based on number of responses to each question as numerators and number of surveys mailed as denominators. Chi-square tests were used to compare academic with community programs and internal medicine with family medicine programs to determine whether there were any differences in teaching instruction given to their geriatric fellows. The criterion for statistical significance was P ≤ .05. The data were analyzed using SPSS version 14 (SPSS, Inc., Chicago, IL).
RESULTS One hundred one of 144 program directors (70%) completed the survey, but not all respondents answered every question.
Table 1. Characteristics of Programs (N = 91) Characteristic
Survey Instrument A nine-question survey was adapted from a 2001 survey issued to residency program directors inquiring about a residents-as-teachers curriculum.17 The 2001 survey was used because content experts had validated it, it had been revised based on their feedback, it assessed matters pertinent to the study, and it was brief enough that participants were likely to respond. Feedback was solicited on the draft of the revised survey from two experts in geriatrics and medical education with considerable expertise in education evaluation methods who have collaborated with medical education faculty to design survey instruments for diverse geriatrics education initiatives. The instrument was revised to incorpo-
JAGS
Location Northeast Midwest South West Affiliation Academic Community Department Family medicine Internal medicine Length of training, years 1 2
n (%)
25 20 27 19
(27.4) (21.9) (29.7) (20.8)
76 (83.5) 15 (16.5) 23 (25.5) 67 (74.4) 90 (98.9) 1 (1.0)
JAGS
DECEMBER 2014–VOL. 62, NO. 12
TEACHING GERIATRIC FELLOWS HOW TO TEACH
2379
Figure 1. Number of hours of instruction per year.
Demographics Ninety-one of the 101 respondents provided information about their program’s characteristics. All four regions of the country were evenly represented. Most fellowship programs had academic affiliations and were based in departments of internal medicine (Table 1). One hundred one program directors reported on the size of their fellowship programs during the 2011–12 year. The majority of fellowship programs had between one and four fellows. The number of trainees ranged from one to nine fellows per year, with mean size of 3 2 fellows per year. Forty-five (44.6%) programs reported offering a second-year or higher clinician–educator training pathway.
Attitudinal Assessment The attitude of program directors about their trainees as educators was assessed by asking them to rate how strongly they felt about the statement: “It is important for all geriatric clinical fellows to leave fellowship as competent educators.” Of the 99 directors who responded, 34.4% strongly agreed with this statement, 49.5% agreed, 8.1% neither agreed nor disagreed, and 8.1% strongly disagreed. Survey respondents were given the opportunity to comment about their answer. Many elaborated that they supported the statement because there are so few geriatricians (n = 17) and geriatricians have a responsibility to teach others (n = 20). A few also noted (n = 7) that many of their trainees wanted to be in academic positions after their fellowship. One respondent who neither agreed nor disagreed with the statement claimed, “We have a workforce shortage and I feel there is just as strong of a need for strong clinicians who are going to be out in the community and not in academic teaching positions.”
Overall Characteristics of Curricula Ninety-three of 99 (93.9%) respondents said that they require all first-year fellows to teach, but only 55 of 100 (55%) of programs provide some type of formal instruction in teaching skills. When analyzed according to type of
program, 55% of academic programs, 29% of community programs, 39% of family medicine programs, and 54% of internal medicine programs offered teaching skills instruction. Academic programs offered teaching skills instruction more than community-based programs (P ≤ .001). Similarly, internal medicine programs provided teaching skills to fellows more than family medicine programs (P ≤ .001). There was no significant difference in the provision of some type of formal teaching instruction between programs that did and did not offer a second-year clinician– educator pathway. Of the 55 programs that provided formal instruction, 45 reported the number of hours of formal instruction that they provided. The number of hours of instruction over the course of the year varied widely, with 15 programs providing fewer than 5 hours of training, 10 programs providing 5 to 10 hours, eight programs providing 11 to 20 hours, and 10 programs providing more than 20 hours (Figure 1). The most commonly reported curricular elements were didactics, workshops, a teaching scholarly concentration, and direct observation and feedback. Other methodologies included online modules, teaching workshops at outside institutions, videotaped sessions, and teaching in the community at senior centers and nursing homes. For programs that did not have teaching-to-teach curricula, the reasons why this type of curriculum did not
Table 2. Reasons First-Year Fellows Do Not Receive Formal Instruction in Teaching Skills Reasons First-Year Fellows Do Not Receive Formal Instruction in Teaching Skills
Not the purpose of fellowship Lack of interest from fellows Fellow teaching skills are already adequate Fellow time constraints Faculty time constraints Insufficient faculty expertise to develop and implement curriculum Other Total who answered question
N (%)
9 3 4 16 19 7
(22.0) (7.3) (9.8) (39.0) (46.3) (17.1)
33 (80.4) 41
2380
RIVERA ET AL.
DECEMBER 2014–VOL. 62, NO. 12
Table 3. Ways to Help Start a Curriculum or Improve Current Curriculum Ways to Help Start a Curriculum or Improve Current Curriculum
No improvement needed More articles and online modules available on national databases such as Portal of Geriatrics Online Education Example of a model curriculum adaptable for your institution Faculty development precourse at American Geriatrics Society Annual Scientific Meeting Other Total who answered question
N (%)
9 (9.8) 39 (42.4) 60 (65.2) 41 (44.6) 32 (34.7) 92
exist were categorized (Table 2). Common reasons included fellow time constraints, faculty time constraints, and considering such curricula not consistent with the purpose of the fellowship.
Needs Assessment Seventy percent (67/96 programs) of program directors responded that their fellows would benefit from more instruction in teaching skills. Only 30% (29 programs) felt they had just the right amount of instruction. Specifically, 67% of academic programs, 79% of community programs, 61% of family medicine programs, and 73% of internal medicine programs felt that they could use more instruction. No fellowship directors felt that their fellows were receiving too much instruction. When asked what could help program directors start a curriculum or help them improve their current curriculum, respondents suggested more online resources (40%, 26/64 programs), creation of a model curriculum (63%, 40/64 programs), and a faculty development precourse at the annual American Geriatrics Society meeting (42%, 27/64) (Table 3).
DISCUSSION Most program directors believe that graduates of their geriatric medicine training program should leave fellowship as competent educators, but only half of programs provide formal instruction in teaching skills. Program directors identified several reasons for inadequate teachingto-teach curricula in their fellowship program: lack of time in fellowship, lack of faculty time, and insufficient local faculty expertise to develop and implement a curriculum on teaching. A minority considered a teaching curriculum to be inconsistent with the goals of a geriatric medicine training program. The majority of fellowship program directors want resources to help start a teaching-to-teach curriculum or to help improve their already existing curriculum, with 65% of respondents wanting an example of a model curriculum adaptable for their institution. Prior work done in residency programs demonstrates that teaching-to-teach curricula can be reproducible and accessible.11,12 In a literature review of resident-as-teacher curricula,12 reproducibility was defined as a “clear set of goals and objectives with descriptions of lesson plans and materials used
JAGS
(e.g., videos, PowerPoint slides, handouts).” The American Academy of Pediatrics has created a thorough residentsas- teacher workshop packet that is an example of a reproducible curriculum available to all pediatric training programs. They have created a toolkit, available online, that includes objectives, learning materials, and case-based workshops.18 A similar toolkit available to all fellowship program directors would be a product that could help fellowship directors implement this curriculum for their own programs. Also, just as some of the resident-as-teacher curricula are available on MedEd PORTAL, the survey found that fellowship program directors wanted articles and online modules available on sites such as the Portal of Geriatrics Online Education. In particular, the use of nationally accessible online learning modules developed to train geriatric fellows on how to teach may address the finding that some programs had a lack of faculty time and needed local expertise to develop and implement a teaching skills curriculum. The survey also indicated that program directors are interested in faculty development in teaching-to-teach. Supplementing a reproducible model curriculum with faculty development courses at the annual meeting of the American Geriatrics Society can further support local expertise in adapting national curriculum to individual programs. Based on the survey results, various current geriatric fellowship training programs may also be a resource for development of a model curriculum, because many already have formal instruction on teaching skills, and some already use online modules to provide this type of instruction. It would be worth studying these existing curricula and disseminating those that have proven to be effective. There are published examples of fellowship programs implementing parts of a teaching-to-teach curriculum during the first year of clinical training. A yearlong course to achieve excellence in teaching and career development was successfully implemented at the University of Rochester with the addition of just 3 hours of didactics per month plus project time.19 Another example comes from the Duke University Center for the Study of Aging and Human Development, which incorporated 10 educational skills seminars into a geriatrics grand round series for fellows and faculty.20 Of the 10 seminars, the ones specific to teaching skills were teaching tips for large-group instruction, facilitating learning in small groups, effective clinical teaching, the 1-minute preceptor model, and assessing and improving teaching. Once a reproducible teaching-to-teach model curriculum for geriatric fellowship programs is created, it will be essential to create an evaluation tool for this curriculum that will assess its application in different fellowship programs (large and small, academic and community). The model curriculum will also need to demonstrate improvement in teaching skills of geriatric fellows. This can be accomplished by adapting assessment tools that have been developed for residency training programs, such as objective structured teaching exercises, objective structured clinical examinations, direct observation, and videotaped evaluation.12 One possible beneficial outcome of a teaching-to-teach curriculum during fellowship might be to increase interest in the clinician–educator career path in academia; 45% of
JAGS
DECEMBER 2014–VOL. 62, NO. 12
fellowship programs offered a second-year clinician–educator training pathway, but despite programs such as the Donald W. Reynolds Consortium for Faculty Development to Advance Geriatrics Education, which has helped fund trainees pursuing a second-year educator pathway,21 few fellows opt to pursue a second year of training.22 A teaching-to-teach curriculum during fellowship may inspire more trainees to pursue careers in education after completion of training. This study has a number of limitations. The survey, designed to be brief to improve the response rate, did not explicitly define teaching skills or what was meant by formal teaching instruction. As a result, some program directors conflated teaching about teaching with teaching experience, and some respondents equated teaching skills with educational scholarship. For example, when asked about formal instruction, respondents had the option of didactics, workshops and retreats, teaching scholarly concentration, direct observation and feedback, and other. For other, some program directors reported teaching in the community setting as a way to provide formal teaching instruction. These sorts of responses highlight the great variability in how program directors may identify teaching-to-teach curricula. Furthermore, the aim was to assess teaching of teaching skills and not scholarship activities related to academic endeavors. Although these are related entities, the goal in teaching fellows how to teach is arguably different and applicable to all trainees, not merely those who enter academics. Had this been clearer in the survey, significantly fewer fellowship directors might have responded that they considered a teaching curriculum inconsistent with the goals of a geriatrics medicine training program. Finally, despite the fact that a brief survey was created, 30% of fellowship programs did not respond, and some of the respondents did not complete all of the survey questions. Although responses from nonresponders may have altered the results, the finding that only 55% of fellowship programs have formal instruction in teaching skills is similar to a longer general survey of geriatric fellowship program directors in 2007 that found that 62% of fellowships incorporated teaching skills training into their curriculum.16
CONCLUSION To ensure optimal care of all older adults, geriatricians must have the teaching skills to disseminate their expertise in the care of older adults effectively to interprofessional colleagues, patients, caregivers, policy-makers, and the public. This survey suggests that most geriatrics fellowships are not preparing geriatric medicine fellows for their roles as teachers. The development of a model teaching-to-teach curriculum that includes training materials, modules, and rigorous evaluation tools may help enable all programs regardless of size and academic affiliation to fulfill the mandate to provide teaching skills to our fellows.
ACKNOWLEDGMENTS Dr.Widera’s work is supported by the Health Resources and Services Administration.
TEACHING GERIATRIC FELLOWS HOW TO TEACH
2381
Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Rivera: conception and design, acquisition of subjects and data, analysis and interpretation of data, preparation of manuscript. Yukawa: analysis and interpretation of data, preparation of manuscript. Aronson: conception and design, revising the article critically for important intellectual content, preparation of manuscript. Widera: conception and design, acquisition of subjects and data, revising the article critically for important intellectual content, preparation of manuscript. Sponsor’s Role: Not applicable.
REFERENCES 1. American Geriatrics Society. Projected Future Need for Geriatricians, June 2012 [on-line]. Available at http://www.americangeriatrics.org/files/documents/Adv_Resources/GeriShortageProjected2012.pdf Accessed February 1, 2014. 2. Brotherton SE, Etzel SI. Graduate medical education, 2011–2012. JAMA 2012;308:2264–2279. 3. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: National Academies Press, 2008. 4. AGS Core Writing Group for the Task Force on the Future of Geriatric Medicine. Caring for older Americans: The future of geriatric medicine. J Am Geriatr Soc 2005;53:S245–S256. 5. ACGME program requirements for graduate medical education in geriatric medicine (family medicine or internal medicine), June 9, 2013 [on-line]. Available at https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/125–151_geriatric_medicine_07012014_1-YR.pdf Accessed May 24, 2014. 6. Leipzig RM, Sauvigne K, Granville LJ et al. What is a geriatrician? American Geriatrics Society and Association of Directors of Geriatric Academic Programs End-of-training entrustable professional activities for geriatric medicine. J Am Geriatr Soc 2014;62:924–929. 7. Parks SM, Harper GM, Fernandez H et al. American Geriatrics Society/ Association of Directors of Geriatric Academic Programs curricular milestones for graduating geriatric fellows. J Am Geriatr Soc 2014;62:930–935. 8. Bing-You RG, Tooker J. Teaching skills improvement programmes in US internal medicine residencies. Med Educ 1993;27:259–265. 9. Wamsley MA, Julian KA, Wipf JE. A literature review of “resident-as-teacher” curricula: Do teaching courses make a difference? J Gen Intern Med 2004;19:574–581. 10. Hill AG, Yu T, Barrow M et al. A systematic review of resident-as teacher programmes. Med Educ 2009;43:1129–1140. 11. Post RE, Quattlebaum G, Benich JJ. Residents-as-teachers curricula: A critical review. Acad Med 2009;84:374–380. 12. Bree KK, Whicker SA, Fromme HB et al. Residents-as-teachers publications: What can programs learn from the literature when starting a new or refining an established curriculum? J Grad Med Educ 2014;6:237–248. 13. Morrison EH, Rucker L, Boker JR et al. The effect of a 13-hour curriculum to improve residents’ teaching skills: A randomized control trial. Ann Intern Med 2004;141:257–263. 14. Bragg EJ, Warshaw GA, Meganathan K et al. The development of academic geriatric medicine in the United States 2005 to 2010: An essential resource for improving the medical care of older adults. J Am Geriatr Soc 2012;60:1540–1545. 15. Medina-Walpole A. Strengthening the fellowship training experience: Findings from a national survey of fellowship trained geriatricians 1990–1998. J Am Geriatr Soc 2004;54:607–610. 16. Bragg EJ, Warshaw GA, Meganathan K et al. National survey of geriatric medicine fellowship programs: Comparing findings in 2006–2007 and 2001–2002 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs’ Geriatrics Workforce Policy Studies Center. J Am Geriatr Soc 2010;58:2166–2172. 17. Morrison EH, Friedland JA, Boker J et al. Residents-as-teachers training in US residency programs and offices of graduate medical education. Acad Med 2001;76:S1–S4. 18. American Academy of Pediatrics. Residents as Teachers [on-line]. Available at http://www2.aap.org/sections/ypn/r/resident/pdfs/resasteachers.pdf Accessed May 24, 2014.
2382
RIVERA ET AL.
DECEMBER 2014–VOL. 62, NO. 12
19. Medina-Walpole A, Fonzi J, Katz PK. Academic career development in geriatric fellowship training. J Am Geriatr Soc 2007;55:2061–2067. 20. Pinheiro SO, Helfin MT. The geriatrics excellence in teaching series: An integrated educational skills curriculum for faculty and fellows development. J Am Geriatr Soc 2008;56:750–756. 21. Heflin MT, Bragg EJ, Fernandez H et al. The Donald W. Reynolds consortium for faculty development to advance geriatric education (FD-AGE): A
model for dissemination of subspecialty educational expertise. Acad Med 2012;87:618–626. 22. Geriatrics Workforce Policy Studies Center. Geriatric medicine fellowship programs, family medicine and internal medicine 1991/92–2011/12 [online]. Available at http://www.americangeriatrics.org/files/documents/gwps/ Table%203_2.pdf Accessed May 24, 2014.
APPENDIX A: QUESTIONNAIRE 1. Program Demographics: Location: __ Northeast __ Midwest __ South __ West Affiliation: __ Academic __ Community Department: __ Family Medicine __ Internal Medicine Required Length of Training: __1 year __2+ years 2. How many first-year fellows are currently in your ACGME-accredited Geriatrics fellowship? _____ 3. Does your program offer a second-year or higher clinical-educator training pathway? ____ Yes ____ No 4. How strongly do you agree/disagree with this statement? “It is important for all geriatric clinical fellows to leave fellowship as competent educators.” __Strongly Disagree __Disagree Agree
__Neither Agree nor Disagree__Agree
__Strongly
Why: _____________________________ 5. Does your fellowship require all first-year fellows to teach? __Yes __No 6. Do you require first-year fellows to receive formal instruction in teaching skills? __Yes __No A. If yes, approximately how many hours over the course of the year? _________ B. Please check all the REQUIRED and OPTIONAL components of formal teaching instruction available to your clinical fellows. Didactics Workshops/retreats Teaching scholarly concentration Direct observation and feedback Other _____________________
Required __ __ __ __ __
JAGS
Optional __ __ __ __ __
C. If no, why? Please check all that apply. __Not the purpose of fellowship __Lack of interest from fellows __Fellows’ teaching skills are already adequate __Fellow time constraints __Faculty time constraints __Insufficient faculty expertise to develop and implement curriculum __Other___________________ 7. How do you feel about the amount of teaching skills instruction your fellows receive? __They would benefit from even more instruction. __It is just about the right amount of instruction. __It is more instruction than they need. 8. What could help you start a curriculum for teaching fellows how to teach OR help you improve your current curriculum? Please check all that apply. __No improvement needed __More articles and online modules available national databases like POGOe __Example of a model curriculum adaptable for your institution __Faculty Development Pre-course at AGS __Other___________________ 9. Please provide any additional comments or thoughts that you would like to share with me about this area of geriatrics fellow training. ______________________________
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
