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The growth of hospitalists nationally continues at an unprecedented pace.1 In academic medical centers, the development of hospital medicine groups either as independent divisions or as part of divisions of general internal medicine (DGIM) reflects this trend. Drivers for growth in the academic setting include housestaff work hour restrictions, increased need for oversight on teaching services, development of nonhousestaff services, surgical comanagement, and greater emphasis on efficiency, quality, and safety.26 These drivers have created tremendous opportunities for hospitalists, but the rapid growth has also created challenges to achieving traditional academic success.7, 8
While hospitalists feel the traditional academic pressures to produce new knowledge and teach, the extraordinary need to expand clinical services has resulted in a young hospitalist workforce, with most lacking fellowship training. At the same time, there are few senior mentors available. Taken together, many academic hospital medicine (AHM) programs find themselves populated by large cadres of junior faculty without the support, training, and mentoring they need to succeed in a faculty career.9 For hospital medicine groups, the risk to faculty recruitment, retention, productivity, and morale is high.
In this article, we describe the development and implementation of a multifaceted Faculty Development (FD) program whose goal was to provide our faculty with clinical, educational, leadership, and scholarly skills that would promote academic output and foster work satisfaction.
Methods
Problem Identification
The University of California, San Francisco (UCSF) Medical Center operates nearly 800 beds across 2 hospitals (Parnassus and Mount Zion campuses). The UCSF Division of Hospital Medicine (DHM) provides care on the teaching service (90% of all ward months covered by a hospitalist faculty), a nonhousestaff medical service based at Mount Zion,4 a palliative care service,10 a medical consultation service, a neurosurgical comanagement service, a procedure service, and comanagement on advanced heart failure and cancer services. Like many AHM groups, ours has experienced explosive growth, more than doubling in faculty size in 3 years (50+ faculty by July 2010).
In addition, many of our new faculty joined the division directly after residency training whereas our early hospitalists were mostly former chief residents and/or fellowship‐trained. During a 2‐year period, our division lost several faculty to burnout from clinically heavy positions or because they felt their ultimate academic success was in doubt. During a 2008 divisional retreat, the single greatest need identified was to invest in the development of our first‐year faculty who were felt to be at greatest risk for burnout, dissatisfaction, and failing to integrate into the divisional mission. Based on this result, we set out to develop a program to meet this pressing need.
Needs Assessment
We formed a FD steering committee comprised of faculty from all ranks and career paths in our division (eg, educator, administrator, and investigator), with overrepresentation of recent hires to ascertain how best to meet their needs. Information from the division retreat provided the basis for the program and its priorities. The FD steering committee then outlined ideas that guided program development, which included:
New faculty should be required to meet regularly with assigned faculty mentors during their first year, and expectations for that relationship should be outlined for both parties
New faculty should be required to attend dedicated sessions that build their teaching skills
New faculty should receive a specially designed first year curriculum to provide learnings focused on high‐yield and relevant topics
New faculty should receive a set of goals, or scholarly expectations, for their first year that would foster a partnership between individual faculty and the division to meet those goals
The division should create new structures for FD that promote collaboration, sharing of personal and professional growth and challenges, and a culture of continuous learning
All of the activities that comprise our new FD program must be aligned with our stated mission: to provide the highest quality clinical care, education, system improvements, and research that benefit our patients and trainees by developing successful academic hospitalist faculty.
Program Goals and Objectives
Our DHM FD program established the goal to provide our new faculty with clinical, educational, leadership, and scholarly skills that would promote academic output and foster work satisfaction. From a broader divisional standpoint, the goal was simply to create new FD structures that fostered the division's commitment to the program. The primary objectives of the program were for new faculty to:
Increase their knowledge, skills, and attitudes about key academic hospitalist domains following participation in the program;
Demonstrate successful production of scholarly output, participation in a hospital committee, and participation in a quality or safety improvement initiative by the end of their first year;
Report high levels of satisfaction with the FD program and their first year on faculty.
Program Development Principles
We began by conducting a literature review to draw on the successes and lessons learned from existing FD programs, particularly in large departments, academic centers, and the hospitalist field.1115 We focused our program development on a set of FD principles, which included instructional improvement, organizational development, the development of professional academic skills, and the teaching of specific content.11 Furthermore, whereas many FD programs traditionally focus on mentoring or a longitudinal set of seminars, we believed a multifaceted approach could help shift our culture towards one that prioritized FD and generated a sense of community. We hoped this cultural shift would create an environment that increased faculty satisfaction with their work, with their colleagues, and in our division.
This context drove us to build programmatic activities that not only targeted new faculty, the initial focus of our planning efforts, but also the division more broadly. We wanted to adopt known strategies (eg, mentoring relationships, teaching methods for FD, and grand rounds) but also weave in new ones that targeted AHM and our Division. It was clear that successful programs used a variety of instructional methods, and often combined methods, to create active and engaged faculty. We similarly wanted to create venues for didactic and small‐group learning, but also opportunities for peer learning and facilitated discussions around important topics. Allowing new faculty to learn from each other, and having them observe more senior faculty do the same, would be an important and explicit programmatic element.
Program Description and Implementation
All new faculty meet with Divisional leadership (RMW/BAS), administrative staff (they receive an orientation binder that highlights frequently asked questions and provides service‐specific orientation documents), and the Director of FD (NLS). The latter introduces the DHM FD Program and provides the road map for their first year (Supporting Information). The checklist serves to orient, guide, and emphasize the various programmatic goals, expectations, and logistics. Discussion focuses on the activities targeted to new faculty followed by wider divisional offerings. New faculty activities include:
Coaching Program
Rather than having new faculty independently seek out an appropriate mentor, we explicitly paired each with a more senior hospitalist (eg, 3 years on faculty). We provided explicit goals and expectations for the faculty coach and used a similar road map to guide their role (Supporting Information). We chose to call them coaches rather than mentors because in the first year, we felt a new faculty member needed nuts and bolts support from a big sibling more than they needed formal academic mentoring. We placed the burden of organizing the coaching sessions on the faculty coach and provided them with periodic reminders and suggestions for topics to discuss over the course the year, including supporting the junior faculty's performance against their scholarly benchmarks. Finally, we also organized a peer mentoring session for new facultydesigned to create additional peer support and shared learnings, and establish the importance of these relationships moving forward.
Core Seminars
We created a 12‐hour curriculum to cover a broad range of relevant AHM topics (Table 1). The choice of topics was informed by our needs assessment, suggestions of the FD Steering Committee, and the new faculty themselves. The sessions included a few didactic presentations, but they were largely interactive in a workshop‐style format to allow new faculty to engage the content. For instance, a session on quality improvement asked new faculty to bring a project idea and then work through creating a project plan. We coupled three half‐day sessions with a divisional social activity and made every attempt to ensure new faculty were not distracted by clinical responsibilities (eg, not on a clinical service or coverage was provided).
|
| Core Seminars |
| Being an academic hospitalist: The nuts & bolts |
| Tools for the master clinician |
| Documentation pearls & practices: Clinical, billing, and medico‐legal issues |
| Preparing your first talk: From topic selection to power point presentation |
| Choosing a case and writing it up for a clinical vignette abstract submission |
| Searching for clinical answers: An interactive computer‐lab workshop |
| Introduction to quality improvement |
| Leadership 101: Self‐awareness, your Myers‐Briggs, and leading change |
| Project Management: An exercise in team building |
| Thinking about systems and creating a culture of safety |
| Lunch Seminars |
| Managing and updating your academic CV |
| What to do when a patient on your service dies? |
| Evaluating students & housestaffAnd giving feedback |
| Being an effective ward attending |
| Medical‐legal consultative work & being an expert witness |
| Getting involved in professional societies |
| Understanding the promotion tracks: Practical tips and career preparation |
| Getting involved in hospital committee work |
| Caring for sick family members & navigating the healthcare system as a physician |
| Retirement planning 101: Life after UCSF |
| Time management & creating scholarly work |
| Teaching medical students on the wards |
| Clinical resources: What do you use to find answers? |
Teaching Course
One of our faculty (BAS) delivered the Stanford Faculty Development Clinical Teaching program16 (a train the trainer model designed to teach faculty how to become more effective teachers) to all new faculty. The program consisted of 14 hours of highly interactive curricula, video review, and role plays. The course was offered after hours (4 PM or 5 PM) and with input from the new faculty to ensure availability and participation.
Feedback and Observation
Each new faculty received directed feedback about their teaching and supervision on the housestaff service following their first rotation. Feedback was based on housestaff evaluations and direct observation of the new faculty during patient care and teaching rounds. One of our faculty (BAS) observed each new faculty member during rounds, and met with them individually to provide feedback and generate a discussion about teaching style and improvement opportunities.
Scholarly Expectations
We developed a set of scholarly expectations for new faculty. These helped inform the coach‐new faculty meetings and our selection of content for the Core Seminars. We initially had concerns that these expectations could overwhelm new faculty, but those junior faculty (years 2‐4) on the FD steering committee urged this practice, wishing they had similar guidance in their first year.
From the divisional perspective, we also added a number of new structures.
Grand Rounds
We established a monthly continuing medical education (CME) credit‐granting DHM Grand Rounds that combined a 10‐minute Hospital Medicine Update with a 45‐minute didactic presentation. The updates were presented by new faculty in order to provide them with an opportunity to receive feedback on their teaching and presentation skills (eg, how to give a talk, make PowerPoint slides, etc.). Didactic presentations were given by senior DHM faculty as well as subspecialty colleagues or ones from other departments (eg, dermatology or neurology), disciplines (eg, risk management), or campuses.
FD Lunch Seminar Series
Our division traditionally meets each Monday over the lunch hour to talk about service or academic issues. With a growing division, we believed there was an opportunity to better organize the content of these meetings. Once monthly, we dedicated a lunch session to a Faculty Development Seminar with topics that spanned a variety of interest areas, were driven by faculty suggestions, and were focused on being facilitated discussions rather than didactics. Table 1 provides examples of these seminar topics.
| Survey Statements Reporting Level of Comfort With(% responding somewhat agree or agree) | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| Identifying important resources within the School of Medicine | 64 | 83 |
| Identifying important resources within the Department of Medicine | 63 | 100 |
| Identifying important resources within the Division of Hospital Medicine | 90 | 100 |
| Identifying important resources within UCSF Medical Center | 72 | 67 |
| Having a system to effectively manage my email | 64 | 67 |
| Having a system to keep my CV updated | 64 | 84 |
| Using my non‐clinical time for academic success | 54 | 67 |
| Best practices for clinical/medico‐legal documentation | 54 | 67 |
| Best practices for billing documentation | 62 | 84 |
| Being an effective supervising ward attending | 90 | 84 |
| Being an effective teacher | 90 | 84 |
| Evaluating students and housestaff performance | 90 | 83 |
| Providing feedback to students and housestaff | 90 | 100 |
| Getting involved in professional societies | 27 | 100 |
| Understanding the difference between promotion pathways | 36 | 67 |
| Getting involved in hospital committee work | 54 | 84 |
| Choosing a good case for a clinical vignette submission to a regional/national meeting | 54 | 83 |
| Creating a poster for presentation at a regional/national meeting | 36 | 84 |
| Giving a lecture to students or residents | 64 | 84 |
| Developing a PowerPoint presentation for a lecture | 45 | 100 |
| Describing my personality type and how it relates to my work | 45 | 100 |
| Understanding important aspects of being a leader | 54 | 100 |
| Explaining the basic principles of quality improvement | 45 | 84 |
| Participating and contributing to a quality improvement project | 54 | 67 |
| Explaining the basic principles of patient safety | 45 | 67 |
| Understanding the factors that contribute to medical errors | 36 | 84 |
| Creating scholarly products from my work | 27 | 50 |
| Identifying what kind of mentors I need for the future | 45 | 100 |
| Category (% completed during first year) | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| Medical student teaching | 90 | 100 |
| Talk for trainees | 45 | 100 |
| Hospital committee involvement | 63 | 100 |
| Participation in a quality or safety project | 33 | 67 |
| Abstract submission | 27 | 50 |
| Identified mentor for year 2 | 63 | 83 |
Quality and Safety Lunch Seminars
In addition to our FD seminars, we also used one lunch session each month to provide updates on performance measures, ongoing quality or safety improvement initiatives, or a broader quality or safety topic. Speakers were either divisional or outside experts, depending on the topic, and organized by our director for quality and safety.
Incubator Sessions
Our director of research (AA) organized a weekly works in progress meeting, to which faculty and fellows brought ideas, grant applications, early manuscript drafts, or other potential scholarship products to obtain feedback and further group mentorship.
Divisional Retreats
We began alternating annual full‐day and mini half‐day retreats as a method to bring the division together, build camaraderie, set strategic priorities, identify divisional goals, and assess needs. These helped guide the creation of additional FD opportunities as well as our overall division's strategy to achieve our academic mission. The outcomes of these retreats led to many significant initiatives and policies, such as changes in compensation models, new scheduling processes, and decisions to spend resources on areas such as quality improvement.
Program Evaluation
Our evaluation focused on measuring the FD program's impact on our new faculty. We tracked their success in completing the stated scholarly expectations and surveyed them about their satisfaction with the programmatic activities, their first year on faculty, and their preparation for year 2. Prior to implementing the program, we surveyed the previous 2 years of new faculty to provide a comparison.
Results
Seven faculty participated in the inaugural program. We compared their scholarly output and experiences (6 faculty completed the survey; 87% response rate) with that of 11 more senior faculty who completed the comparison survey. Of note, the response rate of the comparison group was 69% (5 faculty who departed from our division during the previous 2 years were not surveyed). New faculty were surveyed at the start of the academic year with the follow‐up survey completed the following June. The more senior faculty completed the survey once at the same time as the baseline survey for the new faculty. All new faculty participated in each of the Core Seminars, the Teaching Course, the required number of Coaching sessions, and the observed teaching activity. We did not track their attendance at Divisional activities such as Grand Rounds or the Lunch Seminars.
Overall, the FD programmatic offerings were rated highly by new faculty (on a scale of 1 [lowest] to 5 [highest] for a global rating of each FD activity): Core Seminars 4.83 0.41, Coaching Program 4.5 0.84, Teaching Course 4.5 0.55, Grand Rounds 4.83 0.41, and Lunch Seminars 4.5 0.84. Table 2, which compares responses to a series of end of the year statements posed to new faculty, highlights notable differences in their level of comfort with specific skills and resource awareness. Given the small sample size, statistical significance was not calculated. Table 3 illustrates similar comparisons focused on academic output, which demonstrate that new faculty gave more talks to trainees, had greater involvement in hospital committees, more actively participated in quality and safety projects, and submitted more abstracts to regional or national meetings. New faculty also responded differently to which part of the FD program was most influential with 1 suggesting the Coaching Program, 2 the Core Seminars, 2 the entire program efforts, and 1 did not specify.
Table 4 illustrates comparison responses to a series of directed statements. New faculty all reported greater degrees of satisfaction overall, measured by the above responses, compared to previous faculty.
| Categories | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| ||
| Success: To what degree do you feel successful as an academic hospitalist at the end of your first year? (% responding successful or very successful) | 27 | 67 |
| Prepared: To what degree do you feel prepared for academic success moving into your second year on faculty? (% responding prepared or very prepared) | 27 | 100 |
| Part of DHM: I felt like an integral part of our division after my first year on faculty (% responding somewhat agree or agree) | 45 | 84 |
| Expectations: My first year on faculty exceeded my expectations (% responding somewhat agree or agree) | 27 | 84 |
Discussion
We implemented an FD program to foster the academic development of new faculty, and to mitigate the effects of growing clinical demands and a rapid group expansion on our academic mission. The impact of the program was measured by increased work satisfaction and academic output in first year faculty, greater self‐reported comfort in a variety of skills and knowledge of resources, and an improvement in our sense of purpose behind our academic mission. Though the program is only in its second year, we believe the model is of value for other AHM groups, and perhaps even nonacademic groups, all of whom may use such an investment in their hospitalists as a method to improve recruitment, job satisfaction, and retention.
Reviewing our program's first year suggests there were at least 3 keys to our success. First, we benefited tremendously from the time spent crafting a vision for the program and relying heavily on input from the target audience of junior faculty. Moreover, we made every effort to leverage existing resources (eg, using faculty who already taught about a given topic) and time commitments (eg, reshaping our existing Monday lunch meeting). Finally, we increasingly used our FD venues to connect and build networks with colleagues outside our division and within the hospital. This was a deliberate effort to create opportunities for individual faculty to be exposed to and collaborate with nonhospitalists for academic output.
Our research has some limitations, most notably the small sample size in evaluating the program for statistical significance, and the incomplete survey return rates. However, the results were quite consistent and the nonresponses of departed faculty would tend to bias our results toward the null. We also acknowledge the possibility of other confounding factors (eg, changes in clinical compensation models) that may have played a role, although compensation changes were relatively minor during the period studied and faculty did attribute many of the benefits in job satisfaction and skill building to the FD program itself.
Hospital medicine is an unusual field in that there is low barrier to entry and exit. Providers can change jobs without having to say goodbye to a large panel of patients, and in the continued mismatch between available positions and hospitalists, alternative positions can easily and quickly be found if they are dissatisfied.17 In the academic arena, even as hospitalists are hired to fill clinical gaps, they still have to perform under more traditional academic rules in order to be promoted and receive the support and kudos of colleagues and trainees. For both these reasons, early nurturing and socialization is critical to retention and academic success. While some opportunities for FD will be offered by national organizations,18 groups also have local responsibilities to support, mentor, and develop their junior faculty. Not only is such support crucial for the junior faculty themselves, but in our young field, the mentored very quickly become the mentors. Our decision to invest in both mentees and mentors reinforced the importance of mentorship for academic success and retention while planting the seeds for continued success and growth.1923 A recent study suggested that the environment for mentoring may be as important as the mentoring itself, a finding we did not specifically measure, but would support based our anecdotal experiences.24 This orientation toward future needs and creating the right milieu is crucial because demands for continued hospitalist growth are likely to remain.
Moving into year 2 of our FD program and reflecting on the lessons learned from year 1, we've adopted the same multifaceted approach with only minor adjustments to the curriculum, greater expansion of faculty involved in teaching and coaching, and a continued focus on building a sense of community around our academic mission. For the Core Seminars, we moved away from the 3 half‐day sessions and chose to host 2‐hour sessions every other month. This allowed for the same curriculum to be delivered but was much easier to logistically orchestrate. It also had the intended effect of bringing the new faculty together more regularly. In addition, we created dedicated sessions in preparation for our national meeting to allow faculty to bring abstract submissions for review and later, posters and oral presentations for feedback. These added sessions came partly as a suggestion from new faculty in our first year program, and seemed to further energize junior faculty around converting their projects into scholarship. Finally, we continue to further develop coaching and mentoring relationships in our division, partly a result of successful new facultycoach pairings.
In conclusion, our FD program had a noted impact on our new faculty and had a meaningful impact on our division in terms of camaraderie and cohesion, a shared commitment to an academic mission, and a mechanism for recruitment and retention. We hope our practical description for development and implementation of an FD program, including our specific tools, are useful to other groups considering such an initiative.
Acknowledgements
The authors thank Katherine Li for her invaluable assistance in coordinating the DHM FD program. They are also indebted to their faculty colleagues for their time and roles in teaching and mentoring within the program. Dr. Sehgal partly developed this program as part of a project during his California Healthcare Foundation Leadership Fellowship. Dr. Sharpe delivered the teaching workshops at UCSF after completing the Stanford Faculty Development Teaching Program.
- ,,,.The status of Hospital Medicine Groups in the United States.J Hosp Med.2006;1(2):75–80.
- Accreditation Council for Graduate Medical Education: information related to the ACGME's effort to address resident duty hours and other relevant resource materials. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_index.asp. Accessed August 2010.
- ,,, et al.Effects of work hour reduction on residents' lives: a systematic review.JAMA.2005;294(9):1088–1100.
- ,,,,.Non‐housestaff medicine services in academic centers: models and challenges.J Hosp Med.2008;3(3):247–255.
- ,.Surgical comanagement: a natural evolution of hospitalist practice.J Hosp Med.2008;3(5):394–397.
- ,.The expanding role of hospitalists in the United States.Swiss Med Wkly.2006;136(37–38):591–596.
- 2007–08 Hospital Medicine Survey. Society of Hospital Medicine. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Survey19(4):392–393.
- ,,, et al.Challenges and opportunities in Academic Hospital Medicine: report from the Academic Hospital Medicine Summit.J Hosp Med.2009;4(4):240–246.
- .Palliative care and hospitalists: a partnership for hope.J Hosp Med.2006;1(1):5–6.
- ,.Faculty development: principles and practices.J Vet Med Educ.2006;33(3):317–324.
- ,,, et al.A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8.Med Teach.2006;28(6):497–526.
- ,.A successful approach to faculty development at an independent academic medical center.Med Teach.2008;30:e10–e14.
- ,,,.An innovative approach to supporting hospitalist physicians towards academic success.J Hosp Med.2008;3(4):314–318.
- ,,, et al.The curriculum for the Hospitalized Aging Medical Patient program: a collaborative faculty development program for hospitalists, general internists, and geriatricians.J Hosp Med.2008;3(5):384–393.
- Stanford Faculty Development Clinical Teaching Program. Available at: http://www.stanford.edu/group/SFDP. Accessed August 2010.
- ,,, et al.Trends in market demand for internal medicine 1999–2004: an analysis of physician job advertisements.J Gen Intern Med.2006;21(10):1079–1085.
- The Academic Hospitalist Academy. Available at: http://www.sgim.org/index.cfm?pageId=815. Accessed August 2010.
- ,,.Mentoring in academic medicine: a systematic review.JAMA.2006;296(9):1103–1115.
- ,,.Facilitating faculty success: outcomes and cost benefit of the UCSD National Center of Leadership in Academic Medicine.Acad Med.2004;79(10 Suppl):S9–S11.
- ,,, et al.Retention of junior faculty in academic medicine at the University of California, San Diego.Acad Med.2009;84(1):37–41.
- ,,,.Helping medical school faculty realize their dreams: an innovative, collaborative mentoring program.Acad Med.2002;77:377–384.
- ,,, et al.Physicians' perceptions of institutional and leadership factors influencing their job satisfaction at one academic medical center.Acad Med.2002;77:1235–1240.
- ,,.A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine.J Gen Intern Med.2010;25(1);72–78.
The growth of hospitalists nationally continues at an unprecedented pace.1 In academic medical centers, the development of hospital medicine groups either as independent divisions or as part of divisions of general internal medicine (DGIM) reflects this trend. Drivers for growth in the academic setting include housestaff work hour restrictions, increased need for oversight on teaching services, development of nonhousestaff services, surgical comanagement, and greater emphasis on efficiency, quality, and safety.26 These drivers have created tremendous opportunities for hospitalists, but the rapid growth has also created challenges to achieving traditional academic success.7, 8
While hospitalists feel the traditional academic pressures to produce new knowledge and teach, the extraordinary need to expand clinical services has resulted in a young hospitalist workforce, with most lacking fellowship training. At the same time, there are few senior mentors available. Taken together, many academic hospital medicine (AHM) programs find themselves populated by large cadres of junior faculty without the support, training, and mentoring they need to succeed in a faculty career.9 For hospital medicine groups, the risk to faculty recruitment, retention, productivity, and morale is high.
In this article, we describe the development and implementation of a multifaceted Faculty Development (FD) program whose goal was to provide our faculty with clinical, educational, leadership, and scholarly skills that would promote academic output and foster work satisfaction.
Methods
Problem Identification
The University of California, San Francisco (UCSF) Medical Center operates nearly 800 beds across 2 hospitals (Parnassus and Mount Zion campuses). The UCSF Division of Hospital Medicine (DHM) provides care on the teaching service (90% of all ward months covered by a hospitalist faculty), a nonhousestaff medical service based at Mount Zion,4 a palliative care service,10 a medical consultation service, a neurosurgical comanagement service, a procedure service, and comanagement on advanced heart failure and cancer services. Like many AHM groups, ours has experienced explosive growth, more than doubling in faculty size in 3 years (50+ faculty by July 2010).
In addition, many of our new faculty joined the division directly after residency training whereas our early hospitalists were mostly former chief residents and/or fellowship‐trained. During a 2‐year period, our division lost several faculty to burnout from clinically heavy positions or because they felt their ultimate academic success was in doubt. During a 2008 divisional retreat, the single greatest need identified was to invest in the development of our first‐year faculty who were felt to be at greatest risk for burnout, dissatisfaction, and failing to integrate into the divisional mission. Based on this result, we set out to develop a program to meet this pressing need.
Needs Assessment
We formed a FD steering committee comprised of faculty from all ranks and career paths in our division (eg, educator, administrator, and investigator), with overrepresentation of recent hires to ascertain how best to meet their needs. Information from the division retreat provided the basis for the program and its priorities. The FD steering committee then outlined ideas that guided program development, which included:
New faculty should be required to meet regularly with assigned faculty mentors during their first year, and expectations for that relationship should be outlined for both parties
New faculty should be required to attend dedicated sessions that build their teaching skills
New faculty should receive a specially designed first year curriculum to provide learnings focused on high‐yield and relevant topics
New faculty should receive a set of goals, or scholarly expectations, for their first year that would foster a partnership between individual faculty and the division to meet those goals
The division should create new structures for FD that promote collaboration, sharing of personal and professional growth and challenges, and a culture of continuous learning
All of the activities that comprise our new FD program must be aligned with our stated mission: to provide the highest quality clinical care, education, system improvements, and research that benefit our patients and trainees by developing successful academic hospitalist faculty.
Program Goals and Objectives
Our DHM FD program established the goal to provide our new faculty with clinical, educational, leadership, and scholarly skills that would promote academic output and foster work satisfaction. From a broader divisional standpoint, the goal was simply to create new FD structures that fostered the division's commitment to the program. The primary objectives of the program were for new faculty to:
Increase their knowledge, skills, and attitudes about key academic hospitalist domains following participation in the program;
Demonstrate successful production of scholarly output, participation in a hospital committee, and participation in a quality or safety improvement initiative by the end of their first year;
Report high levels of satisfaction with the FD program and their first year on faculty.
Program Development Principles
We began by conducting a literature review to draw on the successes and lessons learned from existing FD programs, particularly in large departments, academic centers, and the hospitalist field.1115 We focused our program development on a set of FD principles, which included instructional improvement, organizational development, the development of professional academic skills, and the teaching of specific content.11 Furthermore, whereas many FD programs traditionally focus on mentoring or a longitudinal set of seminars, we believed a multifaceted approach could help shift our culture towards one that prioritized FD and generated a sense of community. We hoped this cultural shift would create an environment that increased faculty satisfaction with their work, with their colleagues, and in our division.
This context drove us to build programmatic activities that not only targeted new faculty, the initial focus of our planning efforts, but also the division more broadly. We wanted to adopt known strategies (eg, mentoring relationships, teaching methods for FD, and grand rounds) but also weave in new ones that targeted AHM and our Division. It was clear that successful programs used a variety of instructional methods, and often combined methods, to create active and engaged faculty. We similarly wanted to create venues for didactic and small‐group learning, but also opportunities for peer learning and facilitated discussions around important topics. Allowing new faculty to learn from each other, and having them observe more senior faculty do the same, would be an important and explicit programmatic element.
Program Description and Implementation
All new faculty meet with Divisional leadership (RMW/BAS), administrative staff (they receive an orientation binder that highlights frequently asked questions and provides service‐specific orientation documents), and the Director of FD (NLS). The latter introduces the DHM FD Program and provides the road map for their first year (Supporting Information). The checklist serves to orient, guide, and emphasize the various programmatic goals, expectations, and logistics. Discussion focuses on the activities targeted to new faculty followed by wider divisional offerings. New faculty activities include:
Coaching Program
Rather than having new faculty independently seek out an appropriate mentor, we explicitly paired each with a more senior hospitalist (eg, 3 years on faculty). We provided explicit goals and expectations for the faculty coach and used a similar road map to guide their role (Supporting Information). We chose to call them coaches rather than mentors because in the first year, we felt a new faculty member needed nuts and bolts support from a big sibling more than they needed formal academic mentoring. We placed the burden of organizing the coaching sessions on the faculty coach and provided them with periodic reminders and suggestions for topics to discuss over the course the year, including supporting the junior faculty's performance against their scholarly benchmarks. Finally, we also organized a peer mentoring session for new facultydesigned to create additional peer support and shared learnings, and establish the importance of these relationships moving forward.
Core Seminars
We created a 12‐hour curriculum to cover a broad range of relevant AHM topics (Table 1). The choice of topics was informed by our needs assessment, suggestions of the FD Steering Committee, and the new faculty themselves. The sessions included a few didactic presentations, but they were largely interactive in a workshop‐style format to allow new faculty to engage the content. For instance, a session on quality improvement asked new faculty to bring a project idea and then work through creating a project plan. We coupled three half‐day sessions with a divisional social activity and made every attempt to ensure new faculty were not distracted by clinical responsibilities (eg, not on a clinical service or coverage was provided).
|
| Core Seminars |
| Being an academic hospitalist: The nuts & bolts |
| Tools for the master clinician |
| Documentation pearls & practices: Clinical, billing, and medico‐legal issues |
| Preparing your first talk: From topic selection to power point presentation |
| Choosing a case and writing it up for a clinical vignette abstract submission |
| Searching for clinical answers: An interactive computer‐lab workshop |
| Introduction to quality improvement |
| Leadership 101: Self‐awareness, your Myers‐Briggs, and leading change |
| Project Management: An exercise in team building |
| Thinking about systems and creating a culture of safety |
| Lunch Seminars |
| Managing and updating your academic CV |
| What to do when a patient on your service dies? |
| Evaluating students & housestaffAnd giving feedback |
| Being an effective ward attending |
| Medical‐legal consultative work & being an expert witness |
| Getting involved in professional societies |
| Understanding the promotion tracks: Practical tips and career preparation |
| Getting involved in hospital committee work |
| Caring for sick family members & navigating the healthcare system as a physician |
| Retirement planning 101: Life after UCSF |
| Time management & creating scholarly work |
| Teaching medical students on the wards |
| Clinical resources: What do you use to find answers? |
Teaching Course
One of our faculty (BAS) delivered the Stanford Faculty Development Clinical Teaching program16 (a train the trainer model designed to teach faculty how to become more effective teachers) to all new faculty. The program consisted of 14 hours of highly interactive curricula, video review, and role plays. The course was offered after hours (4 PM or 5 PM) and with input from the new faculty to ensure availability and participation.
Feedback and Observation
Each new faculty received directed feedback about their teaching and supervision on the housestaff service following their first rotation. Feedback was based on housestaff evaluations and direct observation of the new faculty during patient care and teaching rounds. One of our faculty (BAS) observed each new faculty member during rounds, and met with them individually to provide feedback and generate a discussion about teaching style and improvement opportunities.
Scholarly Expectations
We developed a set of scholarly expectations for new faculty. These helped inform the coach‐new faculty meetings and our selection of content for the Core Seminars. We initially had concerns that these expectations could overwhelm new faculty, but those junior faculty (years 2‐4) on the FD steering committee urged this practice, wishing they had similar guidance in their first year.
From the divisional perspective, we also added a number of new structures.
Grand Rounds
We established a monthly continuing medical education (CME) credit‐granting DHM Grand Rounds that combined a 10‐minute Hospital Medicine Update with a 45‐minute didactic presentation. The updates were presented by new faculty in order to provide them with an opportunity to receive feedback on their teaching and presentation skills (eg, how to give a talk, make PowerPoint slides, etc.). Didactic presentations were given by senior DHM faculty as well as subspecialty colleagues or ones from other departments (eg, dermatology or neurology), disciplines (eg, risk management), or campuses.
FD Lunch Seminar Series
Our division traditionally meets each Monday over the lunch hour to talk about service or academic issues. With a growing division, we believed there was an opportunity to better organize the content of these meetings. Once monthly, we dedicated a lunch session to a Faculty Development Seminar with topics that spanned a variety of interest areas, were driven by faculty suggestions, and were focused on being facilitated discussions rather than didactics. Table 1 provides examples of these seminar topics.
| Survey Statements Reporting Level of Comfort With(% responding somewhat agree or agree) | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| Identifying important resources within the School of Medicine | 64 | 83 |
| Identifying important resources within the Department of Medicine | 63 | 100 |
| Identifying important resources within the Division of Hospital Medicine | 90 | 100 |
| Identifying important resources within UCSF Medical Center | 72 | 67 |
| Having a system to effectively manage my email | 64 | 67 |
| Having a system to keep my CV updated | 64 | 84 |
| Using my non‐clinical time for academic success | 54 | 67 |
| Best practices for clinical/medico‐legal documentation | 54 | 67 |
| Best practices for billing documentation | 62 | 84 |
| Being an effective supervising ward attending | 90 | 84 |
| Being an effective teacher | 90 | 84 |
| Evaluating students and housestaff performance | 90 | 83 |
| Providing feedback to students and housestaff | 90 | 100 |
| Getting involved in professional societies | 27 | 100 |
| Understanding the difference between promotion pathways | 36 | 67 |
| Getting involved in hospital committee work | 54 | 84 |
| Choosing a good case for a clinical vignette submission to a regional/national meeting | 54 | 83 |
| Creating a poster for presentation at a regional/national meeting | 36 | 84 |
| Giving a lecture to students or residents | 64 | 84 |
| Developing a PowerPoint presentation for a lecture | 45 | 100 |
| Describing my personality type and how it relates to my work | 45 | 100 |
| Understanding important aspects of being a leader | 54 | 100 |
| Explaining the basic principles of quality improvement | 45 | 84 |
| Participating and contributing to a quality improvement project | 54 | 67 |
| Explaining the basic principles of patient safety | 45 | 67 |
| Understanding the factors that contribute to medical errors | 36 | 84 |
| Creating scholarly products from my work | 27 | 50 |
| Identifying what kind of mentors I need for the future | 45 | 100 |
| Category (% completed during first year) | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| Medical student teaching | 90 | 100 |
| Talk for trainees | 45 | 100 |
| Hospital committee involvement | 63 | 100 |
| Participation in a quality or safety project | 33 | 67 |
| Abstract submission | 27 | 50 |
| Identified mentor for year 2 | 63 | 83 |
Quality and Safety Lunch Seminars
In addition to our FD seminars, we also used one lunch session each month to provide updates on performance measures, ongoing quality or safety improvement initiatives, or a broader quality or safety topic. Speakers were either divisional or outside experts, depending on the topic, and organized by our director for quality and safety.
Incubator Sessions
Our director of research (AA) organized a weekly works in progress meeting, to which faculty and fellows brought ideas, grant applications, early manuscript drafts, or other potential scholarship products to obtain feedback and further group mentorship.
Divisional Retreats
We began alternating annual full‐day and mini half‐day retreats as a method to bring the division together, build camaraderie, set strategic priorities, identify divisional goals, and assess needs. These helped guide the creation of additional FD opportunities as well as our overall division's strategy to achieve our academic mission. The outcomes of these retreats led to many significant initiatives and policies, such as changes in compensation models, new scheduling processes, and decisions to spend resources on areas such as quality improvement.
Program Evaluation
Our evaluation focused on measuring the FD program's impact on our new faculty. We tracked their success in completing the stated scholarly expectations and surveyed them about their satisfaction with the programmatic activities, their first year on faculty, and their preparation for year 2. Prior to implementing the program, we surveyed the previous 2 years of new faculty to provide a comparison.
Results
Seven faculty participated in the inaugural program. We compared their scholarly output and experiences (6 faculty completed the survey; 87% response rate) with that of 11 more senior faculty who completed the comparison survey. Of note, the response rate of the comparison group was 69% (5 faculty who departed from our division during the previous 2 years were not surveyed). New faculty were surveyed at the start of the academic year with the follow‐up survey completed the following June. The more senior faculty completed the survey once at the same time as the baseline survey for the new faculty. All new faculty participated in each of the Core Seminars, the Teaching Course, the required number of Coaching sessions, and the observed teaching activity. We did not track their attendance at Divisional activities such as Grand Rounds or the Lunch Seminars.
Overall, the FD programmatic offerings were rated highly by new faculty (on a scale of 1 [lowest] to 5 [highest] for a global rating of each FD activity): Core Seminars 4.83 0.41, Coaching Program 4.5 0.84, Teaching Course 4.5 0.55, Grand Rounds 4.83 0.41, and Lunch Seminars 4.5 0.84. Table 2, which compares responses to a series of end of the year statements posed to new faculty, highlights notable differences in their level of comfort with specific skills and resource awareness. Given the small sample size, statistical significance was not calculated. Table 3 illustrates similar comparisons focused on academic output, which demonstrate that new faculty gave more talks to trainees, had greater involvement in hospital committees, more actively participated in quality and safety projects, and submitted more abstracts to regional or national meetings. New faculty also responded differently to which part of the FD program was most influential with 1 suggesting the Coaching Program, 2 the Core Seminars, 2 the entire program efforts, and 1 did not specify.
Table 4 illustrates comparison responses to a series of directed statements. New faculty all reported greater degrees of satisfaction overall, measured by the above responses, compared to previous faculty.
| Categories | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| ||
| Success: To what degree do you feel successful as an academic hospitalist at the end of your first year? (% responding successful or very successful) | 27 | 67 |
| Prepared: To what degree do you feel prepared for academic success moving into your second year on faculty? (% responding prepared or very prepared) | 27 | 100 |
| Part of DHM: I felt like an integral part of our division after my first year on faculty (% responding somewhat agree or agree) | 45 | 84 |
| Expectations: My first year on faculty exceeded my expectations (% responding somewhat agree or agree) | 27 | 84 |
Discussion
We implemented an FD program to foster the academic development of new faculty, and to mitigate the effects of growing clinical demands and a rapid group expansion on our academic mission. The impact of the program was measured by increased work satisfaction and academic output in first year faculty, greater self‐reported comfort in a variety of skills and knowledge of resources, and an improvement in our sense of purpose behind our academic mission. Though the program is only in its second year, we believe the model is of value for other AHM groups, and perhaps even nonacademic groups, all of whom may use such an investment in their hospitalists as a method to improve recruitment, job satisfaction, and retention.
Reviewing our program's first year suggests there were at least 3 keys to our success. First, we benefited tremendously from the time spent crafting a vision for the program and relying heavily on input from the target audience of junior faculty. Moreover, we made every effort to leverage existing resources (eg, using faculty who already taught about a given topic) and time commitments (eg, reshaping our existing Monday lunch meeting). Finally, we increasingly used our FD venues to connect and build networks with colleagues outside our division and within the hospital. This was a deliberate effort to create opportunities for individual faculty to be exposed to and collaborate with nonhospitalists for academic output.
Our research has some limitations, most notably the small sample size in evaluating the program for statistical significance, and the incomplete survey return rates. However, the results were quite consistent and the nonresponses of departed faculty would tend to bias our results toward the null. We also acknowledge the possibility of other confounding factors (eg, changes in clinical compensation models) that may have played a role, although compensation changes were relatively minor during the period studied and faculty did attribute many of the benefits in job satisfaction and skill building to the FD program itself.
Hospital medicine is an unusual field in that there is low barrier to entry and exit. Providers can change jobs without having to say goodbye to a large panel of patients, and in the continued mismatch between available positions and hospitalists, alternative positions can easily and quickly be found if they are dissatisfied.17 In the academic arena, even as hospitalists are hired to fill clinical gaps, they still have to perform under more traditional academic rules in order to be promoted and receive the support and kudos of colleagues and trainees. For both these reasons, early nurturing and socialization is critical to retention and academic success. While some opportunities for FD will be offered by national organizations,18 groups also have local responsibilities to support, mentor, and develop their junior faculty. Not only is such support crucial for the junior faculty themselves, but in our young field, the mentored very quickly become the mentors. Our decision to invest in both mentees and mentors reinforced the importance of mentorship for academic success and retention while planting the seeds for continued success and growth.1923 A recent study suggested that the environment for mentoring may be as important as the mentoring itself, a finding we did not specifically measure, but would support based our anecdotal experiences.24 This orientation toward future needs and creating the right milieu is crucial because demands for continued hospitalist growth are likely to remain.
Moving into year 2 of our FD program and reflecting on the lessons learned from year 1, we've adopted the same multifaceted approach with only minor adjustments to the curriculum, greater expansion of faculty involved in teaching and coaching, and a continued focus on building a sense of community around our academic mission. For the Core Seminars, we moved away from the 3 half‐day sessions and chose to host 2‐hour sessions every other month. This allowed for the same curriculum to be delivered but was much easier to logistically orchestrate. It also had the intended effect of bringing the new faculty together more regularly. In addition, we created dedicated sessions in preparation for our national meeting to allow faculty to bring abstract submissions for review and later, posters and oral presentations for feedback. These added sessions came partly as a suggestion from new faculty in our first year program, and seemed to further energize junior faculty around converting their projects into scholarship. Finally, we continue to further develop coaching and mentoring relationships in our division, partly a result of successful new facultycoach pairings.
In conclusion, our FD program had a noted impact on our new faculty and had a meaningful impact on our division in terms of camaraderie and cohesion, a shared commitment to an academic mission, and a mechanism for recruitment and retention. We hope our practical description for development and implementation of an FD program, including our specific tools, are useful to other groups considering such an initiative.
Acknowledgements
The authors thank Katherine Li for her invaluable assistance in coordinating the DHM FD program. They are also indebted to their faculty colleagues for their time and roles in teaching and mentoring within the program. Dr. Sehgal partly developed this program as part of a project during his California Healthcare Foundation Leadership Fellowship. Dr. Sharpe delivered the teaching workshops at UCSF after completing the Stanford Faculty Development Teaching Program.
The growth of hospitalists nationally continues at an unprecedented pace.1 In academic medical centers, the development of hospital medicine groups either as independent divisions or as part of divisions of general internal medicine (DGIM) reflects this trend. Drivers for growth in the academic setting include housestaff work hour restrictions, increased need for oversight on teaching services, development of nonhousestaff services, surgical comanagement, and greater emphasis on efficiency, quality, and safety.26 These drivers have created tremendous opportunities for hospitalists, but the rapid growth has also created challenges to achieving traditional academic success.7, 8
While hospitalists feel the traditional academic pressures to produce new knowledge and teach, the extraordinary need to expand clinical services has resulted in a young hospitalist workforce, with most lacking fellowship training. At the same time, there are few senior mentors available. Taken together, many academic hospital medicine (AHM) programs find themselves populated by large cadres of junior faculty without the support, training, and mentoring they need to succeed in a faculty career.9 For hospital medicine groups, the risk to faculty recruitment, retention, productivity, and morale is high.
In this article, we describe the development and implementation of a multifaceted Faculty Development (FD) program whose goal was to provide our faculty with clinical, educational, leadership, and scholarly skills that would promote academic output and foster work satisfaction.
Methods
Problem Identification
The University of California, San Francisco (UCSF) Medical Center operates nearly 800 beds across 2 hospitals (Parnassus and Mount Zion campuses). The UCSF Division of Hospital Medicine (DHM) provides care on the teaching service (90% of all ward months covered by a hospitalist faculty), a nonhousestaff medical service based at Mount Zion,4 a palliative care service,10 a medical consultation service, a neurosurgical comanagement service, a procedure service, and comanagement on advanced heart failure and cancer services. Like many AHM groups, ours has experienced explosive growth, more than doubling in faculty size in 3 years (50+ faculty by July 2010).
In addition, many of our new faculty joined the division directly after residency training whereas our early hospitalists were mostly former chief residents and/or fellowship‐trained. During a 2‐year period, our division lost several faculty to burnout from clinically heavy positions or because they felt their ultimate academic success was in doubt. During a 2008 divisional retreat, the single greatest need identified was to invest in the development of our first‐year faculty who were felt to be at greatest risk for burnout, dissatisfaction, and failing to integrate into the divisional mission. Based on this result, we set out to develop a program to meet this pressing need.
Needs Assessment
We formed a FD steering committee comprised of faculty from all ranks and career paths in our division (eg, educator, administrator, and investigator), with overrepresentation of recent hires to ascertain how best to meet their needs. Information from the division retreat provided the basis for the program and its priorities. The FD steering committee then outlined ideas that guided program development, which included:
New faculty should be required to meet regularly with assigned faculty mentors during their first year, and expectations for that relationship should be outlined for both parties
New faculty should be required to attend dedicated sessions that build their teaching skills
New faculty should receive a specially designed first year curriculum to provide learnings focused on high‐yield and relevant topics
New faculty should receive a set of goals, or scholarly expectations, for their first year that would foster a partnership between individual faculty and the division to meet those goals
The division should create new structures for FD that promote collaboration, sharing of personal and professional growth and challenges, and a culture of continuous learning
All of the activities that comprise our new FD program must be aligned with our stated mission: to provide the highest quality clinical care, education, system improvements, and research that benefit our patients and trainees by developing successful academic hospitalist faculty.
Program Goals and Objectives
Our DHM FD program established the goal to provide our new faculty with clinical, educational, leadership, and scholarly skills that would promote academic output and foster work satisfaction. From a broader divisional standpoint, the goal was simply to create new FD structures that fostered the division's commitment to the program. The primary objectives of the program were for new faculty to:
Increase their knowledge, skills, and attitudes about key academic hospitalist domains following participation in the program;
Demonstrate successful production of scholarly output, participation in a hospital committee, and participation in a quality or safety improvement initiative by the end of their first year;
Report high levels of satisfaction with the FD program and their first year on faculty.
Program Development Principles
We began by conducting a literature review to draw on the successes and lessons learned from existing FD programs, particularly in large departments, academic centers, and the hospitalist field.1115 We focused our program development on a set of FD principles, which included instructional improvement, organizational development, the development of professional academic skills, and the teaching of specific content.11 Furthermore, whereas many FD programs traditionally focus on mentoring or a longitudinal set of seminars, we believed a multifaceted approach could help shift our culture towards one that prioritized FD and generated a sense of community. We hoped this cultural shift would create an environment that increased faculty satisfaction with their work, with their colleagues, and in our division.
This context drove us to build programmatic activities that not only targeted new faculty, the initial focus of our planning efforts, but also the division more broadly. We wanted to adopt known strategies (eg, mentoring relationships, teaching methods for FD, and grand rounds) but also weave in new ones that targeted AHM and our Division. It was clear that successful programs used a variety of instructional methods, and often combined methods, to create active and engaged faculty. We similarly wanted to create venues for didactic and small‐group learning, but also opportunities for peer learning and facilitated discussions around important topics. Allowing new faculty to learn from each other, and having them observe more senior faculty do the same, would be an important and explicit programmatic element.
Program Description and Implementation
All new faculty meet with Divisional leadership (RMW/BAS), administrative staff (they receive an orientation binder that highlights frequently asked questions and provides service‐specific orientation documents), and the Director of FD (NLS). The latter introduces the DHM FD Program and provides the road map for their first year (Supporting Information). The checklist serves to orient, guide, and emphasize the various programmatic goals, expectations, and logistics. Discussion focuses on the activities targeted to new faculty followed by wider divisional offerings. New faculty activities include:
Coaching Program
Rather than having new faculty independently seek out an appropriate mentor, we explicitly paired each with a more senior hospitalist (eg, 3 years on faculty). We provided explicit goals and expectations for the faculty coach and used a similar road map to guide their role (Supporting Information). We chose to call them coaches rather than mentors because in the first year, we felt a new faculty member needed nuts and bolts support from a big sibling more than they needed formal academic mentoring. We placed the burden of organizing the coaching sessions on the faculty coach and provided them with periodic reminders and suggestions for topics to discuss over the course the year, including supporting the junior faculty's performance against their scholarly benchmarks. Finally, we also organized a peer mentoring session for new facultydesigned to create additional peer support and shared learnings, and establish the importance of these relationships moving forward.
Core Seminars
We created a 12‐hour curriculum to cover a broad range of relevant AHM topics (Table 1). The choice of topics was informed by our needs assessment, suggestions of the FD Steering Committee, and the new faculty themselves. The sessions included a few didactic presentations, but they were largely interactive in a workshop‐style format to allow new faculty to engage the content. For instance, a session on quality improvement asked new faculty to bring a project idea and then work through creating a project plan. We coupled three half‐day sessions with a divisional social activity and made every attempt to ensure new faculty were not distracted by clinical responsibilities (eg, not on a clinical service or coverage was provided).
|
| Core Seminars |
| Being an academic hospitalist: The nuts & bolts |
| Tools for the master clinician |
| Documentation pearls & practices: Clinical, billing, and medico‐legal issues |
| Preparing your first talk: From topic selection to power point presentation |
| Choosing a case and writing it up for a clinical vignette abstract submission |
| Searching for clinical answers: An interactive computer‐lab workshop |
| Introduction to quality improvement |
| Leadership 101: Self‐awareness, your Myers‐Briggs, and leading change |
| Project Management: An exercise in team building |
| Thinking about systems and creating a culture of safety |
| Lunch Seminars |
| Managing and updating your academic CV |
| What to do when a patient on your service dies? |
| Evaluating students & housestaffAnd giving feedback |
| Being an effective ward attending |
| Medical‐legal consultative work & being an expert witness |
| Getting involved in professional societies |
| Understanding the promotion tracks: Practical tips and career preparation |
| Getting involved in hospital committee work |
| Caring for sick family members & navigating the healthcare system as a physician |
| Retirement planning 101: Life after UCSF |
| Time management & creating scholarly work |
| Teaching medical students on the wards |
| Clinical resources: What do you use to find answers? |
Teaching Course
One of our faculty (BAS) delivered the Stanford Faculty Development Clinical Teaching program16 (a train the trainer model designed to teach faculty how to become more effective teachers) to all new faculty. The program consisted of 14 hours of highly interactive curricula, video review, and role plays. The course was offered after hours (4 PM or 5 PM) and with input from the new faculty to ensure availability and participation.
Feedback and Observation
Each new faculty received directed feedback about their teaching and supervision on the housestaff service following their first rotation. Feedback was based on housestaff evaluations and direct observation of the new faculty during patient care and teaching rounds. One of our faculty (BAS) observed each new faculty member during rounds, and met with them individually to provide feedback and generate a discussion about teaching style and improvement opportunities.
Scholarly Expectations
We developed a set of scholarly expectations for new faculty. These helped inform the coach‐new faculty meetings and our selection of content for the Core Seminars. We initially had concerns that these expectations could overwhelm new faculty, but those junior faculty (years 2‐4) on the FD steering committee urged this practice, wishing they had similar guidance in their first year.
From the divisional perspective, we also added a number of new structures.
Grand Rounds
We established a monthly continuing medical education (CME) credit‐granting DHM Grand Rounds that combined a 10‐minute Hospital Medicine Update with a 45‐minute didactic presentation. The updates were presented by new faculty in order to provide them with an opportunity to receive feedback on their teaching and presentation skills (eg, how to give a talk, make PowerPoint slides, etc.). Didactic presentations were given by senior DHM faculty as well as subspecialty colleagues or ones from other departments (eg, dermatology or neurology), disciplines (eg, risk management), or campuses.
FD Lunch Seminar Series
Our division traditionally meets each Monday over the lunch hour to talk about service or academic issues. With a growing division, we believed there was an opportunity to better organize the content of these meetings. Once monthly, we dedicated a lunch session to a Faculty Development Seminar with topics that spanned a variety of interest areas, were driven by faculty suggestions, and were focused on being facilitated discussions rather than didactics. Table 1 provides examples of these seminar topics.
| Survey Statements Reporting Level of Comfort With(% responding somewhat agree or agree) | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| Identifying important resources within the School of Medicine | 64 | 83 |
| Identifying important resources within the Department of Medicine | 63 | 100 |
| Identifying important resources within the Division of Hospital Medicine | 90 | 100 |
| Identifying important resources within UCSF Medical Center | 72 | 67 |
| Having a system to effectively manage my email | 64 | 67 |
| Having a system to keep my CV updated | 64 | 84 |
| Using my non‐clinical time for academic success | 54 | 67 |
| Best practices for clinical/medico‐legal documentation | 54 | 67 |
| Best practices for billing documentation | 62 | 84 |
| Being an effective supervising ward attending | 90 | 84 |
| Being an effective teacher | 90 | 84 |
| Evaluating students and housestaff performance | 90 | 83 |
| Providing feedback to students and housestaff | 90 | 100 |
| Getting involved in professional societies | 27 | 100 |
| Understanding the difference between promotion pathways | 36 | 67 |
| Getting involved in hospital committee work | 54 | 84 |
| Choosing a good case for a clinical vignette submission to a regional/national meeting | 54 | 83 |
| Creating a poster for presentation at a regional/national meeting | 36 | 84 |
| Giving a lecture to students or residents | 64 | 84 |
| Developing a PowerPoint presentation for a lecture | 45 | 100 |
| Describing my personality type and how it relates to my work | 45 | 100 |
| Understanding important aspects of being a leader | 54 | 100 |
| Explaining the basic principles of quality improvement | 45 | 84 |
| Participating and contributing to a quality improvement project | 54 | 67 |
| Explaining the basic principles of patient safety | 45 | 67 |
| Understanding the factors that contribute to medical errors | 36 | 84 |
| Creating scholarly products from my work | 27 | 50 |
| Identifying what kind of mentors I need for the future | 45 | 100 |
| Category (% completed during first year) | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| Medical student teaching | 90 | 100 |
| Talk for trainees | 45 | 100 |
| Hospital committee involvement | 63 | 100 |
| Participation in a quality or safety project | 33 | 67 |
| Abstract submission | 27 | 50 |
| Identified mentor for year 2 | 63 | 83 |
Quality and Safety Lunch Seminars
In addition to our FD seminars, we also used one lunch session each month to provide updates on performance measures, ongoing quality or safety improvement initiatives, or a broader quality or safety topic. Speakers were either divisional or outside experts, depending on the topic, and organized by our director for quality and safety.
Incubator Sessions
Our director of research (AA) organized a weekly works in progress meeting, to which faculty and fellows brought ideas, grant applications, early manuscript drafts, or other potential scholarship products to obtain feedback and further group mentorship.
Divisional Retreats
We began alternating annual full‐day and mini half‐day retreats as a method to bring the division together, build camaraderie, set strategic priorities, identify divisional goals, and assess needs. These helped guide the creation of additional FD opportunities as well as our overall division's strategy to achieve our academic mission. The outcomes of these retreats led to many significant initiatives and policies, such as changes in compensation models, new scheduling processes, and decisions to spend resources on areas such as quality improvement.
Program Evaluation
Our evaluation focused on measuring the FD program's impact on our new faculty. We tracked their success in completing the stated scholarly expectations and surveyed them about their satisfaction with the programmatic activities, their first year on faculty, and their preparation for year 2. Prior to implementing the program, we surveyed the previous 2 years of new faculty to provide a comparison.
Results
Seven faculty participated in the inaugural program. We compared their scholarly output and experiences (6 faculty completed the survey; 87% response rate) with that of 11 more senior faculty who completed the comparison survey. Of note, the response rate of the comparison group was 69% (5 faculty who departed from our division during the previous 2 years were not surveyed). New faculty were surveyed at the start of the academic year with the follow‐up survey completed the following June. The more senior faculty completed the survey once at the same time as the baseline survey for the new faculty. All new faculty participated in each of the Core Seminars, the Teaching Course, the required number of Coaching sessions, and the observed teaching activity. We did not track their attendance at Divisional activities such as Grand Rounds or the Lunch Seminars.
Overall, the FD programmatic offerings were rated highly by new faculty (on a scale of 1 [lowest] to 5 [highest] for a global rating of each FD activity): Core Seminars 4.83 0.41, Coaching Program 4.5 0.84, Teaching Course 4.5 0.55, Grand Rounds 4.83 0.41, and Lunch Seminars 4.5 0.84. Table 2, which compares responses to a series of end of the year statements posed to new faculty, highlights notable differences in their level of comfort with specific skills and resource awareness. Given the small sample size, statistical significance was not calculated. Table 3 illustrates similar comparisons focused on academic output, which demonstrate that new faculty gave more talks to trainees, had greater involvement in hospital committees, more actively participated in quality and safety projects, and submitted more abstracts to regional or national meetings. New faculty also responded differently to which part of the FD program was most influential with 1 suggesting the Coaching Program, 2 the Core Seminars, 2 the entire program efforts, and 1 did not specify.
Table 4 illustrates comparison responses to a series of directed statements. New faculty all reported greater degrees of satisfaction overall, measured by the above responses, compared to previous faculty.
| Categories | Previous Faculty, % (n = 11) | New Faculty, % (n = 6) |
|---|---|---|
| ||
| Success: To what degree do you feel successful as an academic hospitalist at the end of your first year? (% responding successful or very successful) | 27 | 67 |
| Prepared: To what degree do you feel prepared for academic success moving into your second year on faculty? (% responding prepared or very prepared) | 27 | 100 |
| Part of DHM: I felt like an integral part of our division after my first year on faculty (% responding somewhat agree or agree) | 45 | 84 |
| Expectations: My first year on faculty exceeded my expectations (% responding somewhat agree or agree) | 27 | 84 |
Discussion
We implemented an FD program to foster the academic development of new faculty, and to mitigate the effects of growing clinical demands and a rapid group expansion on our academic mission. The impact of the program was measured by increased work satisfaction and academic output in first year faculty, greater self‐reported comfort in a variety of skills and knowledge of resources, and an improvement in our sense of purpose behind our academic mission. Though the program is only in its second year, we believe the model is of value for other AHM groups, and perhaps even nonacademic groups, all of whom may use such an investment in their hospitalists as a method to improve recruitment, job satisfaction, and retention.
Reviewing our program's first year suggests there were at least 3 keys to our success. First, we benefited tremendously from the time spent crafting a vision for the program and relying heavily on input from the target audience of junior faculty. Moreover, we made every effort to leverage existing resources (eg, using faculty who already taught about a given topic) and time commitments (eg, reshaping our existing Monday lunch meeting). Finally, we increasingly used our FD venues to connect and build networks with colleagues outside our division and within the hospital. This was a deliberate effort to create opportunities for individual faculty to be exposed to and collaborate with nonhospitalists for academic output.
Our research has some limitations, most notably the small sample size in evaluating the program for statistical significance, and the incomplete survey return rates. However, the results were quite consistent and the nonresponses of departed faculty would tend to bias our results toward the null. We also acknowledge the possibility of other confounding factors (eg, changes in clinical compensation models) that may have played a role, although compensation changes were relatively minor during the period studied and faculty did attribute many of the benefits in job satisfaction and skill building to the FD program itself.
Hospital medicine is an unusual field in that there is low barrier to entry and exit. Providers can change jobs without having to say goodbye to a large panel of patients, and in the continued mismatch between available positions and hospitalists, alternative positions can easily and quickly be found if they are dissatisfied.17 In the academic arena, even as hospitalists are hired to fill clinical gaps, they still have to perform under more traditional academic rules in order to be promoted and receive the support and kudos of colleagues and trainees. For both these reasons, early nurturing and socialization is critical to retention and academic success. While some opportunities for FD will be offered by national organizations,18 groups also have local responsibilities to support, mentor, and develop their junior faculty. Not only is such support crucial for the junior faculty themselves, but in our young field, the mentored very quickly become the mentors. Our decision to invest in both mentees and mentors reinforced the importance of mentorship for academic success and retention while planting the seeds for continued success and growth.1923 A recent study suggested that the environment for mentoring may be as important as the mentoring itself, a finding we did not specifically measure, but would support based our anecdotal experiences.24 This orientation toward future needs and creating the right milieu is crucial because demands for continued hospitalist growth are likely to remain.
Moving into year 2 of our FD program and reflecting on the lessons learned from year 1, we've adopted the same multifaceted approach with only minor adjustments to the curriculum, greater expansion of faculty involved in teaching and coaching, and a continued focus on building a sense of community around our academic mission. For the Core Seminars, we moved away from the 3 half‐day sessions and chose to host 2‐hour sessions every other month. This allowed for the same curriculum to be delivered but was much easier to logistically orchestrate. It also had the intended effect of bringing the new faculty together more regularly. In addition, we created dedicated sessions in preparation for our national meeting to allow faculty to bring abstract submissions for review and later, posters and oral presentations for feedback. These added sessions came partly as a suggestion from new faculty in our first year program, and seemed to further energize junior faculty around converting their projects into scholarship. Finally, we continue to further develop coaching and mentoring relationships in our division, partly a result of successful new facultycoach pairings.
In conclusion, our FD program had a noted impact on our new faculty and had a meaningful impact on our division in terms of camaraderie and cohesion, a shared commitment to an academic mission, and a mechanism for recruitment and retention. We hope our practical description for development and implementation of an FD program, including our specific tools, are useful to other groups considering such an initiative.
Acknowledgements
The authors thank Katherine Li for her invaluable assistance in coordinating the DHM FD program. They are also indebted to their faculty colleagues for their time and roles in teaching and mentoring within the program. Dr. Sehgal partly developed this program as part of a project during his California Healthcare Foundation Leadership Fellowship. Dr. Sharpe delivered the teaching workshops at UCSF after completing the Stanford Faculty Development Teaching Program.
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- Accreditation Council for Graduate Medical Education: information related to the ACGME's effort to address resident duty hours and other relevant resource materials. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_index.asp. Accessed August 2010.
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- ,.The expanding role of hospitalists in the United States.Swiss Med Wkly.2006;136(37–38):591–596.
- 2007–08 Hospital Medicine Survey. Society of Hospital Medicine. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Survey19(4):392–393.
- ,,, et al.Challenges and opportunities in Academic Hospital Medicine: report from the Academic Hospital Medicine Summit.J Hosp Med.2009;4(4):240–246.
- .Palliative care and hospitalists: a partnership for hope.J Hosp Med.2006;1(1):5–6.
- ,.Faculty development: principles and practices.J Vet Med Educ.2006;33(3):317–324.
- ,,, et al.A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8.Med Teach.2006;28(6):497–526.
- ,.A successful approach to faculty development at an independent academic medical center.Med Teach.2008;30:e10–e14.
- ,,,.An innovative approach to supporting hospitalist physicians towards academic success.J Hosp Med.2008;3(4):314–318.
- ,,, et al.The curriculum for the Hospitalized Aging Medical Patient program: a collaborative faculty development program for hospitalists, general internists, and geriatricians.J Hosp Med.2008;3(5):384–393.
- Stanford Faculty Development Clinical Teaching Program. Available at: http://www.stanford.edu/group/SFDP. Accessed August 2010.
- ,,, et al.Trends in market demand for internal medicine 1999–2004: an analysis of physician job advertisements.J Gen Intern Med.2006;21(10):1079–1085.
- The Academic Hospitalist Academy. Available at: http://www.sgim.org/index.cfm?pageId=815. Accessed August 2010.
- ,,.Mentoring in academic medicine: a systematic review.JAMA.2006;296(9):1103–1115.
- ,,.Facilitating faculty success: outcomes and cost benefit of the UCSD National Center of Leadership in Academic Medicine.Acad Med.2004;79(10 Suppl):S9–S11.
- ,,, et al.Retention of junior faculty in academic medicine at the University of California, San Diego.Acad Med.2009;84(1):37–41.
- ,,,.Helping medical school faculty realize their dreams: an innovative, collaborative mentoring program.Acad Med.2002;77:377–384.
- ,,, et al.Physicians' perceptions of institutional and leadership factors influencing their job satisfaction at one academic medical center.Acad Med.2002;77:1235–1240.
- ,,.A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine.J Gen Intern Med.2010;25(1);72–78.
- ,,,.The status of Hospital Medicine Groups in the United States.J Hosp Med.2006;1(2):75–80.
- Accreditation Council for Graduate Medical Education: information related to the ACGME's effort to address resident duty hours and other relevant resource materials. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_index.asp. Accessed August 2010.
- ,,, et al.Effects of work hour reduction on residents' lives: a systematic review.JAMA.2005;294(9):1088–1100.
- ,,,,.Non‐housestaff medicine services in academic centers: models and challenges.J Hosp Med.2008;3(3):247–255.
- ,.Surgical comanagement: a natural evolution of hospitalist practice.J Hosp Med.2008;3(5):394–397.
- ,.The expanding role of hospitalists in the United States.Swiss Med Wkly.2006;136(37–38):591–596.
- 2007–08 Hospital Medicine Survey. Society of Hospital Medicine. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Survey19(4):392–393.
- ,,, et al.Challenges and opportunities in Academic Hospital Medicine: report from the Academic Hospital Medicine Summit.J Hosp Med.2009;4(4):240–246.
- .Palliative care and hospitalists: a partnership for hope.J Hosp Med.2006;1(1):5–6.
- ,.Faculty development: principles and practices.J Vet Med Educ.2006;33(3):317–324.
- ,,, et al.A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8.Med Teach.2006;28(6):497–526.
- ,.A successful approach to faculty development at an independent academic medical center.Med Teach.2008;30:e10–e14.
- ,,,.An innovative approach to supporting hospitalist physicians towards academic success.J Hosp Med.2008;3(4):314–318.
- ,,, et al.The curriculum for the Hospitalized Aging Medical Patient program: a collaborative faculty development program for hospitalists, general internists, and geriatricians.J Hosp Med.2008;3(5):384–393.
- Stanford Faculty Development Clinical Teaching Program. Available at: http://www.stanford.edu/group/SFDP. Accessed August 2010.
- ,,, et al.Trends in market demand for internal medicine 1999–2004: an analysis of physician job advertisements.J Gen Intern Med.2006;21(10):1079–1085.
- The Academic Hospitalist Academy. Available at: http://www.sgim.org/index.cfm?pageId=815. Accessed August 2010.
- ,,.Mentoring in academic medicine: a systematic review.JAMA.2006;296(9):1103–1115.
- ,,.Facilitating faculty success: outcomes and cost benefit of the UCSD National Center of Leadership in Academic Medicine.Acad Med.2004;79(10 Suppl):S9–S11.
- ,,, et al.Retention of junior faculty in academic medicine at the University of California, San Diego.Acad Med.2009;84(1):37–41.
- ,,,.Helping medical school faculty realize their dreams: an innovative, collaborative mentoring program.Acad Med.2002;77:377–384.
- ,,, et al.Physicians' perceptions of institutional and leadership factors influencing their job satisfaction at one academic medical center.Acad Med.2002;77:1235–1240.
- ,,.A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine.J Gen Intern Med.2010;25(1);72–78.
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