Teaching, Scholarship & Production: Expectations for Contemporary

Clinical Faculty

Bill Hendricson

Assistant Dean, Education & Faculty Development

UTHSCSA Dental School

Associate Editor, Journal of Dental Education

Academy for Academic Leadership

Clinical ScholarModel

Research

Teaching

Service

Hypothesis:

Dental Schools Desire Clinical Faculty Who Are Fully Engaged With the School

Goal:

Share a Vision of “Scope of

Practice” for Clinical Faculty

Service

We’re Talking about Faculty Who Teach in Labs and Clinics

2500 hrs X 56 schools =

140,000 hrs

Influence on Productionand Clinic Revenue ??

Questions for you to ponder:

Will more frequent use of “teaching best practices” influence students’ speed & patient completion?

What effect will movement to a “clinical scholar” model for faculty have on students’ functioning in the clinic / $$ productivity?

Can clinical faculty function in a more “academic” role within the standard clinical education model of dental school?

Agenda • Academic roles for clinical faculty in dental

schools – historical trends• What makes clinical faculty “happy &

satisfied”?• Clinical scholar model / examples• Scholarship opportunities • Service opportunities • Teaching roles

You ponder “implications”

Competencies for Dental School Faculty

• Clinical Teacher • Clinical Scholar • Research-Intensive Scholar

Hand JS. Identification of competencies for effective dental faculty. J Dent Educ 2006; 70(9):937-47.

ClinicScholar

Clinic Teach

ResearchIntensive

Clinical Teacher• Teaching students in laboratories & clinics

is primary focus.

• Limited classroom teaching.

• May participate in research as a clinician.

• May publish, but not a major expectation.

• Low service expectations.

Clinical Scholar• Expected to participate in teaching, research &

service. “triple threat” faculty • Expected to serve as course director & teach in

the classroom, lab & clinic.• Expected to participate on committees.• Expected to publish in peer-reviewed journals • Not expected to secure NIH-level funding. • Should have capacity to secure seed money

funding for pilot projects from foundations.

Research-Intensive Scholar• Expected to teach with emphasis on graduate

students. • Expected to develop a research “niche” & secure

NIH-level grant funding. • Expected to publish research in highly ranked

journals. • Expected to recruit other researchers & mentor

them.

ClinicalScholar

Clinical Teacher

ResearchIntensive

1945 - 1985

1985 - 2008

2010 - 2030

Fully Engaged Faculty

Historical Trends

Issues: Clinical Teacher• Perception of “isolation” from school

activities & events; i.e., out of the loop

• Disconnect from classroom instruction

• Tensions between clinical scholar faculty & clinical teacher; perceived hierarchy

• Core school functions not being performed often or well – educational planning

• High turn-over at some schools

Haden. Quality of Dental School Faculty Work Life. J Dent Educ. May, 2008

ResearchScholarshi

p

TeachingMentoring

Service For School

2010 - 2030

Clinical Scholar Model

Return to Academic

“Triple Threat” ??

Clinical Faculty More “Fully Engaged” in

School Affairs

What are clinical faculty perceptions of

academic work-life?

The good, the bad & the ugly

Report of 2007 Dental School Faculty

Work Environment Questionnaire

Haden, JDE. May 2008

• Fully engaged faculty are most satisfied with academic career & report best “balance”

• Roger, Wehmeyer, Milliner. Reflections on academic careers by

current dental school faculty. J Dent Educ. 2008; 72 (5)

• Haden. Quality of dental faculty work life. J Dent Educ. 2008; 72 (5).

R

T

S

Clinical Scholar

Scope of Practice: TeachingResearch Service

Gen X Faculty ExpectationsComponent What X’ers

Expect & ValueWhat They Find in

Academia

Curriculum Planning

Openness

Systematic

Vagueness

Ad - hoc

Research Centered around problems / needs

Centered around disciplines

Teaching Trans-disciplinary

Collaboration

Experimentation

Narrow within discipline

Resistance

Academic Decision-Making

Transparent Opaqueness

“Head-scratchers”

Trower CA. (CCI) Making academic dentistry more attractive to new teacher – scholars. Journal of Dental Education. May 2007; pgs 601- 605

What makes clinical faculty “happy & satisfied”?

• Variety of work assignments– Teaching in different settings & levels

– School service: contribute to planning– Scholarship: disseminate educational methods

• Opportunity to be a “player” in school

• Learn new skills / roles

• Create new programs

• Interaction with students

“The best thing about my job is that I can move from project to project, and task to task and never have time to get

bored. No day is ever identical to another which keeps me charged up and learning new things.”

Haden. Quality of dental faculty work life. J Dent Educ. 2008; 72 (5).

ResearchScholarshi

p

T

S

Clinical Scholar Model

Opportunities

Fully Engaged Faculty

Quality of Teacher &

Student Interactions

Factors Teachers Can Control

Teaching Strategies in Classroom & Clinic

Design of Curriculum

Evaluation Methods

Student Variables

Learning Style & Self - Concept

Difficult Behavior

Students’ Expectations& Preferences

Research

Opportunity

What is ER?

• It’s not Thursday 9 pm “Must See TV”

What is Educational Research (ER)?• Exploration of factors, conditions, techniques

and interferences that influence the outcomes of teaching and learning processes,

• including personal traits and habits of teachers, students and the overall environment of the school and it’s community.

John Dewey

Human Nature & Conduct (1927)

Dewey & Eisenhower

Beginning of Educational Research

Types of ERPrediction studies: admissions, GPA, boards Influences on student achievement (emotional

intelligence, personality factors, academic variables)Students’ perceptions of education & issuesTraits of teachers, students & school environment Students’ study habits & learning stylesWhat is appropriate curriculum content?Organizational development / change strategies Proof of concept studies - assessmentProof of concept studies - teaching methodologyHot issues / best practices – Critical Thinking

Examples: ER Papers in JDE

• Evaluation of Clinical Mock Boards & Their Influence on Qualifying Exam Success. J Dent Educ. 2002

• What is the Impact of Case-based Seminars on Student Self-Assessment of Orthodontic Skills?

J Dent Educ 1994; 58• What is the Agreement Between Clinicians & A

Computer-Based Decision Support System for Planning Dental Treatment? J Dent Educ. 2002; 66

2008 ADEA Competencies for the New General DentistADEA Council of Sections Task Force on Competencies & Foundation Knowledge

Major Change in Emphasis: Critical Thinking

How do you assess your students’ capacity to:

Recognize, analyze & describe problems

Gather & assess relevant information, weigh it against existing knowledge, to better understand the problem

Interpret information & arrive at well-reasoned conclusions

Explain rationales for decisions & answer questions

Communicate effectively with others while exploring problems

What if a CODA site visit team asked these questions at the next review?

Tremendous Research Opportunities

How do dental students develop critical thinking?

Novice Expert

♦

@

♦

@

Vertical – compartmentalized Horizontal – networked

Data Knowledge

Hendricson, ADEA CCI. Educational Strategies Associated with Development of Critical Thinking and Self-Directed Learning. J Dent Educ. 2006; 70(9): 925-936.

Assessment of Critical Thinking Capacity

• Fresno Test• Health Science Reasoning Test

(HSRT)• California Critical Thinking

Disposition Inventory

It All Starts With Questions

• It's easy to find answers. The hard part is finding good questions.

Thomas Edison

• It’s far better to get an approximate answer to the right question than an exact answer to the wrong question.

John Tukey

A Quick Trip Through Research Questions

Hot Research Questions in the 13th Century

• How many angels can dance on the point of a fine needle without jostling each other?

• Can angels pass from one place to another without going through the middle? Can angels move from point A to point C without passing point B?

• Is there excrement in paradise? • Why are angels more logical in thought when it is

warm & sunny versus when it is cold & wet?

Royal. St Thomas Aquinas: The Person and his Work. 1996.

W – H – I –F QuestionsWhat Would Happen If?

Hendricson. It All Starts with Questions JDE, Sept, 2004

What would happen to student attrition if we [ fill in the blank ]?

What would happen to board scores if we [ fill in the blank ] ? Why do students have difficulty learning [ fill in the blank ] ?

What would happen to clinic performance if we [ fill in the blank ] ?

Based on the literature, what are best practices for [ blank ] ?

What are barriers to implementing [ fill in the blank ] ?

What would happen if we stopped [ blank ] & started [ blank ] ?

ER Question Generator

WHIFs from My CareerWhat would happen if we…

• Provided feedback to faculty on their lecture skills? Hendricson, Hawkins, Hudepohl, Littlefield. Effects of Providing Feedback to Lecturers via Videotape Recordings &

Observer Critiques. Am J of Pharm Educ. 1983.

• Changed eval forms to focus on 4 global skills versus 13 component tasks?

del Rio, Dale, Hendricson: A Method for Training Endodontic Evaluators. JDE. 1983.

• Compared clinical errors among students who learned endodontics by 4 methods?

Hendricson, Sandoval, Dale: A Comparison of 4 Instructional Methods for Reviewing Clinical Endodontics. JDE. 1987.

Compared dental students’ performance on “work alone” competency exams and daily grades.

Berrong, Dale, Hendricson, JDE 1983.

Write A WHIF for a Potential Educational Research Project at

Your School

• What Would Happen If we …. ????

Case 1Fully Engaged Faculty

4 Years at Dental School

Dr. Tom TransitionReturning Boomer

Fully Engaged Clinical Faculty

Teaching Course Director Fr

Lab instructor Soph

Clinic: 5 sessions Jrs

2 Electives Srs

2 teacher training programs

Course Drs Group

Class Advisor

Research One ER study each yr

ER study group

2 ER pubs; 4 abstracts

3 invited presentations

Clinician on grant

Student research mentor

Piloting new method

Service Clinical niche – “the expert” at school

Chair – Curr Comm

Strat Plan Comm

Mentor for new faculty

One new project each year

in each area:

TeachingResearchService

R

T

Service For School

Clinical Scholar Model

Opportunities for Service in Curriculum

Fully Engaged Faculty

Persistently Advocated Reforms in Dental Education

Kassebaum, Hendricson, Hayden, Taft. J Dent Educ. Sept 2004; 68(9): 914 – 931

Eliminate “smokestack” (silo)approach to curriculum

Dental Students Spend More Time in Lecture than Clinic

0%

10%

20%

30%

40%

50%

60%

Lecture Lab Clinic

Dental

Medical

Nursing

Alternative Teaching / Learning

Are We Getting it Right?Avoiding False Positives & False

Negatives When Evaluating Students’ Performance in Labs and Clinics

Dental Education Has Not Adopted New

Assessment Methods Used In Other H

PE

Albino, Young, Hendricson. D

ecember 2008; J Dent Educ.

What we evaluate, we do it the right way.. But I’m not sure we’re right in what we choose to evaluate.

ADEA CCI Competency Assessment Survey, 2008

Focus of Assessment in Dental Education?

Curriculum Revision MethodsStrategy Characteristics

Mount Olympus This is what we’re going to do!

Sneak Attack “Oh, by the way, we now have a new clinical ...”

Atilla the Hun Mandated across-the-board cuts

Fire-fighting Temporary “pothole-filling”

Department review “Fox guarding the chicken coop”

Interdis peer review Plastic surgery (nip & tuck)

CQI Model Parallels scientific decision - making process

Abrahamson. Diseases of the Curriculum J Med Educ 1978

Continuous Program MonitoringSystematic Process

CAAMP 2008

Curriculum Quality

Case 2Fully Engaged Faculty

4 Years at Dental School

Dr. Ima New30-Something Clinician

Fully Engaged Clinical Faculty

Teaching Lecture Course Fr

Course Dir Soph

Support Lab Soph

Clinic Faculty Jrs

Teaching Methods

Course - HSC

National Teaching

Course

Research 2 studies – motor skill

6 abstracts

3 invited presentations

Institutional grant

Co-I foundation grant

Team for NIH grant

Service IPE Curriculum TF

Med-Dent HomelessEvening Clinic

Alternate Track Comm

Student org advisor

ADEA CCI

WFA at HSC

Goals:

Predoc Educ Director for Department

Clinical Education Director for Dental

School

R

Teaching

S

Clinical Scholar Role

Fully Engaged Faculty

Faculty Perception of Role in Clinic

Checker

Cover

Coach

Clinician / Fireman

Irby. Acad Med. 1995

Linn. Rev Educ Research. 1991

Glance and Grade

Research on Clinical Teaching• Chambers. Association among factors thought to be

important by instructors in dental education and perceived effectiveness of these instructors by students. Eur J Dental Education. 2004;8:147-51.

• Manogue. Clinical assessment of dental students: values and practices of teachers in restorative dentistry. Med Educ. 2001;35:364-70

• McGrath. Development and Evaluation of a Questionnaire to Evaluate Clinical Dental Teachers. Br Dent J. 2005;198:45-8.

• Victoroff. Students’ perceptions of effective learning experiences in dental school: A qualitative study using a critical incident technique. J Dent Educ 2006; 70:124-132.

• Henzi. North American dental students’ perspectives about their clinical education. J Dent Educ 2006; 70: 361-377.

• Schonwetter. Students’ perceptions of effective classroom & clinical teaching in dental & dental hygiene education. J Dent Educ. 2006; 70: 624-635

7 Microskills of Clinical Teaching• Set expectations, assess learner’s level & needs• Coach students through patient care

– Guide assessment & planning with questions & pearls – Provide tips during patient care– Debrief: what went right & wrong? how to handle next time?

• Ask questions to stimulate thinking • Give constructive “how to improve” feedback• Explain “why, how, where, when” (prescriptions) • Provide personal support & encouragement• Model professional behavior & valuesNeher. Microskills Model of Clinical Teaching. J Am Board Fam Pract. 1993; 6: 86-87 Irby. Teaching & learning in ambulatory care: thematic review of literature. Acad Med.

1995; 70(10): 898-931

Exemplary Clinical Faculty Use a Bookends Teaching

Orient students before patient encounter• Ask “assessment & planning” questions - What do you plan to do & why? - How & why did you rule-out alternatives?• Priming & anticipatory guidance questions

Debrief students after patient encounter• Ask reflection & self-assessment questions

- What is the most important thing you learned today?- What could we do differently next time?- Review specific trouble spots

Irby. Teaching in Ambulatory Care Setting: Thematic Review of Literature. Acad Med.

Chambers. Association Among Factors Thought Important by Instructors & Perceived Effectiveness

of These Instructors by Students. Eur J Dent Educ. 2004:8:147-51.

Exemplary Clinical Scholars

“Check” is just one part of

overall mentoring process

See themselves as students’ professional

mentor

• “A poor surgeon hurts 1 person at a time.”

• “A poor teacher hurts 130."

Dr. Ernest Boyer– Former President , Carnegie Foundation– United States Commissioner of Education

Renewed Sense that Quality Teaching is Really Important

Influence of enhanced focus on coaching versus checking on clinical operations?

ResearchScholarshi

p

TeachingMentoring

Service For School

Clinical Scholar Model

Goal:

Future “Scope of Practice” for Clinical Faculty

Effect on Clinic Production: Operations

OrganizationsIncome

Thank You!