J Dent Educ. 68(8): 845-850 2004
© 2004 American Dental Education Association
Milieu in Dental Schools and Practice |
Academy: Strengthening the Educational Mission in Academic Health Centers
Thomas H. Howell, D.D.S.;
Nadeem Y. Karimbux, D.M.D., M.M.Sc.
Key words: faculty development, dental education
Submitted for publication 04/20/04;
accepted 05/06/04
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Abstract
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A dental school in the modern academic health center often finds that its traditional mission of educating dentists has become more complex as a result of the increased emphasis placed on research and patient care. Although health care education clearly benefits from a rich environment including research and patient care, faculty often find themselves conflicted about their roles in the complex mix of activities in the health center. In order to support faculty in their educational activities, several schools have formed organizational structures with the specific purpose of providing financial and developmental assistance. This article describes a model for an organizational structure within the Harvard School of Dental Medicine designed to promote educational excellence and then describes two academies dedicated to promoting teaching quality at Harvard Medical School and at the University of California at San Francisco.
The last five decades have seen significant shifts in priorities for dental and medical academic institutions as they try to balance their educational, research, patient care, and community agendas. Although health care education and society have benefited from the increased investment in research and patient care by academic health centers, in some instances these enterprises have overshadowed education as the primary mission and have led to a perception of a precipitous decline in the quality of teaching and learning. Recent publications including the U.S. surgeon general’s report on "Oral Health Care in the United States," the Commonwealth Fund’s Task Force on Academic Health Centers, and the Institute of Medicine’s Committee on the Roles of Academic Health Centers in the 21st Century have highlighted the importance of reinvigorating and supporting education as the primary role of academic health centers in light of the increased role played by research and patient care.1–3 For many years, the essential activities of a thriving academic health center were seen as synergistic. However, at a time when there is increased activity in research and the demands of patient care are greater and more financially rewarding, faculty, in the absence of evident support and rewards for teaching, find less time to sustain consistent educational activity. Therefore, a discord has developed between the various missions of the health center.
Schools, departments, and faculty have become dependent on the revenue and prestige that research and patient care bring to their operations. As research has become more complex, multidisciplinary, and collaborative, it also has become more competitive. Because of the genetic, cellular, and molecular nature of today’s basic science, research faculty do not always find it easy to translate the latest information from the laboratories into the educational context of novice learners who primarily need to learn fundamental biomedical concepts that can serve as a foundation for subsequent phases of their educational development. Even the most well-intentioned faculty member is prevented from teaching when grant deadlines, management of research activities, and publication pressures begin to mount. Although many schools recognize teaching, clinical activity, and service for academic advancement, the promotion policy at most schools is based primarily on research productivity (i.e., publications and grants), leading faculty to focus their attention on research activities rather than on educational methodology or teaching. The majority of clinical faculty are involved in patient care either within school- or hospital-based clinics or in private practice, taking significant time away from educational activities. Clinical departments at many health science centers are more and more relying on revenue streams from clinical services to provide funds for basic operating budgets, which has increased "time in clinic" for many health professions educators. Thus, the increasing time and talent needed to successfully compete in research and patient care demand that faculty members focus exclusively on one or two of the core activities of the academic health center (research, education, or patient care/community service). Education often is assigned the lowest priority, in part because it is not perceived to have a lucrative revenue stream, although administrators forget that tuition is usually the largest revenue stream at any academic health center. However, to produce practitioners who are ready for contemporary health care, our academic programs need committed individuals and innovative methods to provide educational experiences that ensure the inclusion of new science content as well as learning experiences that are relevant to the changing paradigm of clinical practice.
In order to swing the pendulum back toward education, several health education institutions have established a core teaching faculty and a core administrative structure for curriculum to refocus attention on the educational mission, to provide incentives and opportunities for educational innovation, to enhance the visibility and prominence of educators, and to address the erosion of high quality education for their students. In 1992, for example, the Harvard School of Dental Medicine (HSDM) was preparing to launch a multidisciplinary, comprehensive curriculum based on a hybrid form of problem-based learning. We realized that the traditional method of curricular administration based strictly on a departmental structure was not optimal for the operation of this new curriculum because the discipline-based nature of the departments can run counter to schoolwide educational goals that seek to provide integrated, multidisciplinary approaches to learning. Historically, departments have been reluctant to allocate sufficient time or support for teaching activities that are interdisciplinary in nature. At the HSDM, we concluded that the central administration of the school must play a key role in making multidisciplinary education a reality. We created the Office of Dental Education4,5 to ensure the quality of dental students’ education in this multidisciplinary learning environment. The office was charged with faculty development, the formation and operation of the multidisciplinary curriculum, the evaluation of outcomes and progressive change of course content, and faculty evaluation. This organizational change provided an office that works in collaboration with the departments on the educational agenda, freeing them for their mission of pursuing dynamic research agendas, recruiting and retaining the best and brightest faculty, providing laboratories and clinical settings for learning, and providing teachers for meeting the school’s educational mission in both the predoctoral and advanced graduate education programs. The result of this organizational shift has produced a dynamic curriculum based on critical thinking, evaluation, and change. Through a series of faculty development programs, we have seen an improvement in teaching and evaluative methods, faculty scholarship, leadership skills, and institutional awareness. Faculty promotions also have occurred at a higher rate and with greater success.
Recently, two medical schools have taken further steps to energize and support the educational missions of their faculty by establishing academies dedicated to teaching excellence. The University of California at San Francisco (UCSF) and the Harvard Medical School (HMS) each formed an "Academy" comprised of a community of faculty interested in teaching and innovative educational methodology. To enlarge the scope of this project, these institutions have formed the Academies Collaborative. In the future, additional medical schools from across the country will be added to the collaborative to share information on educational infrastructure and knowledge about teaching methodology, stimulate research and assessment, support innovative models in education, and advocate for medical faculty interested in educational issues. The next section of this article will describe the academies at HMS and UCSF and discuss their outcomes to date.
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Academy at Harvard Medical School
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In September 2000, Dr. Joseph Martin, Dean, and Dr. Daniel Lowenstein, Dean for Medical Education, convened a task force at Harvard Medical School (HMS) to determine the feasibility of establishing an "Academy" (based on a similar entity recently formed at the University of California, San Francisco) for the support of the most accomplished HMS/HSDM teachers who had made the greatest impact on the school’s educational mission.6 The goals of the Academy, in cooperation with the departments, were to provide greater recognition for teaching efforts, increase support of innovative educational activities, and enhance skills development for the entire community of teachers at HMS/HSDM by providing resources (including salary support) and advocacy for promotions to outstanding teachers both in the hospitals and at the medical and dental schools. Following its deliberations, the task force recommended the formation of an academy with the intent of creating a community of talented and committed scholars who had demonstrated leadership in medical education. The formation of the Academy was based on restructuring the traditional manner in which departments supported their most effective teachers. In the traditional system, the departmental structure, because of its multiple agendas, often limits the extent to which the school can advance quality and innovation in the education of medical students. The Academy, therefore, has the aim of supporting the efforts of the most gifted, innovative teachers and improving the professional satisfaction and standing of the entire teaching faculty by facilitating excellence and innovation in teaching, fostering the choice of a career with teaching as a major component, promoting educational scholarship, improving pedagogy, providing a forum for the exchange of ideas about teaching, and establishing a platform for enhanced interactions among basic, social, and clinical scientists. Additionally, members of the Academy recognize the need for acquiring new resources to support teaching. These aims are incorporated into the mission statement of the Academy (Table 1
).
In February 2001, fourteen individuals were appointed as founding members, and in September 2001 an administrative organization was put in place, consisting of a director, a full-time deputy director, and a program manager. The director consults a ten-member executive committee that meets monthly and oversees the academic plans and initiatives. The executive committee consists of the director of the Academy, the dean of Harvard Medical School, the dean for medical education, the dean for alumni, and selected senior faculty. Additionally, a steering committee meets quarterly to advise the director on strategic issues and overall direction. All faculty members are eligible to apply for membership. Applications are reviewed by an internal selection committee and by outside reviewers. Final selection is ratified by the Academy’s executive committee. The Academy’s operating budget is supported by funds from Harvard Medical School as well as a onetime, five-year $5,000,000 commitment from Harvard University. Eventually, the Academy expects to provide at least another $3,000,000 per year from endowment funds to support faculty teaching activity. The Academy anticipates establishing its own endowment to support both operational needs and endowed professorships. Subcommittees review applications for educational projects, faculty development, educational innovation, and membership. Both dental and medical faculty are members of these various committees. At present, three members of the School of Dental Medicine are appointed as scholars, and the dean for dental education serves on the steering committee.
Membership is based on strict criteria. All members of the Harvard Faculty of Medicine, which includes both medicine and dentistry, are eligible. Members of the Academy must be active teachers and mentors who are recognized for their excellence by teaching awards, student evaluations, and recommendations by colleagues. In addition, members must be significant contributors in one or more of the following areas: curriculum development, educational leadership/administration, faculty development and mentorship, and educational scholarship. Academy membership includes medical and dental faculty members at all stages of their careers who make a commitment to improve the educational environment and teaching at HMS/HSDM and its affiliates (Table 2). Members attend regular meetings and an annual retreat and participate in colloquia and workshops sponsored by the Academy. They serve as advocates in their departments for teaching, educational reform, and promotion in the academic ranks, as mentors for trainees, and as catalysts for educational innovation. The members are divided into categories based on individual accomplishments and goals (Table 3).
Each year, the Academy holds a retreat during which organizational operations are reviewed and evaluated. Members also identify projects that will contribute to educational reform during the next academic year. These projects may be in the areas of curricular innovation or faculty development or may take the form of an Academy-initiated faculty task force. The Academy also hosts an annual Medical Education Day featuring a plenary session where selected faculty papers are presented followed by a keynote address. Also during Education Day, faculty are invited to present posters of educational projects, and faculty development workshops are held. Dental faculty have been active participants in all of these activities. Interdisciplinary links are encouraged with hospitals, other Harvard schools, and other medical schools. Of particular importance is the continuing collaboration with the Academy at the University of California, San Francisco.
The Academy also sponsors several programs aimed at curricular and faculty development. The first is the Academy fellowship program. This one-year fellowship provides a $25,000 stipend targeting all junior faculty who work on specific educational projects and participate in the Harvard-Macy Program for Physician Educators. Five of these fellowships have been awarded for each of the last two years. Examples of educational projects in this program include development and integration of a cross-cultural curriculum, geriatrics curriculum theme integration, creating future leaders to care for people with disabilities, breastfeeding education, and palliative care. A second program aimed at providing support for protected time for scholarship in clinical areas has also seen many successful curricular innovations. Up to $10,000 per project is provided. These innovative pilot projects are evaluated on the basis of 1) innovation and creativity, 2) feasibility of implementation, 3) positive impact on medical student education at HMS, and 4) feasibility of time commitment by applicant. These programs have been sponsored by the Academy’s operating budget and endowed gifts.
Two of the more important Academy activities have been faculty development and advocacy in the academic promotion process. Support for improvement of teaching skills and educational scholarship is provided by a series of faculty development programs (Table 4). Additionally, the Academy fostered a review of the teacher/clinician promotion track for all faculty and is currently working with other divisions of the institution to incorporate changes into the system. Because of these efforts, during the first two years of the Academy, eighteen members have been promoted: three to professor, nine to associate professor, and six to assistant professor. These promotions were achieved at about twice the rate of success of non-Academy members. Two individuals from HSDM, both members of the Academy, were promoted to associate professor in part because of these Academy initiatives.
The overall outcomes for the first two years of operation confirm the success of the Academy in meeting its goals. Some of the outcomes include the previously described Medical Education Days, induction of ten new members as fellows (see Table 3
), and the promotion of eighteen members to higher academic rank. In addition, fifty-eight Academy-sponsored educational projects involving over one hundred faculty are in progress or have been completed. With stipends of up to $10,000 for each project, a total of $800,000 has been invested in these innovative educational proposals. These projects cover a range of topics including basic science (viewing human disease from the standpoint of immunology and genomics), clinical curriculum (proposal to plan and pilot an integrated core clerkship at an affiliated teaching hospital), faculty development (the art of medical education: a course on teaching for medical school faculty), and humanism/professionalism (end-of-life communication and care program within the core medicine clerkship or a new elective course in literature, arts, and healing). In the first round of funding, two dental school projects concerning the use of information technology and the restructuring of a first-year course were funded.
When the members were asked to evaluate their experiences in the Academy, most felt that it had met or exceeded its mission and provided validation for their roles as clinician teachers, a connection with other faculty, working collaborations, and inspiration to continue improving medical education as a life’s work. Additionally, members remarked that the experience had made them more aware of the continuum among medical school, graduate medical education, and postgraduate education. Many expressed a rejuvenation of their interests in education and recognized the support of the Academy for promotion and recognition within departments for the importance of the teaching mission.
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Academy of Medical Educators at the University of California, San Francisco Medical School
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One year prior to the introduction of the HMS/HSDM Academy, the University of California, San Francisco Medical School established an Academy of Medical Educators with a similar mission to create an environment to enrich the status of teachers, promote and reward teaching excellence, foster curricular innovation, and advance scholarship in education.7 Concern over the viability of a teacher-clinician promotional track led to the establishment of a group of dedicated teachers who would mentor junior faculty and encourage innovation in medical education.
With a similar governing body and an expected membership of 85 by 2009, the UCSF Academy had fifty-two members for 2003–04. These individuals represent basic science and clinical departments as well as affiliated institutions. Membership is based on excellence in one of five categories: teaching, instructional development and curricular design, advising and mentoring, educational administration and leadership, and educational research. Candidates for membership prepare a portfolio demonstrating strength in one or more of the above categories. This portfolio is reviewed by a panel of nationally recognized experts in medical education and faculty development. Although members currently focus their activities for the benefit of the M.D. program, a separate group with emphasis on the graduate medical educational programs is being considered. Each member is appointed for a five-year term and must complete an annual report of activities and productivity. Membership is expected to be broadly based and inclusive of individuals from medicine, dentistry, education, and public health.
Members do not receive direct salary support but benefit in two ways. First, the recognition of their status as outstanding educators marks the member as a resource for all faculty in matters of education. Second, members are more likely to be promoted due to increased scholarly activity and intense mentoring. Twenty-seven percent of Academy members were promoted during the first two years in comparison with 5 percent in the overall faculty.
Through an internal grant process, Academy members and other faculty also are eligible for funds for innovative programs and assessment instruments, faculty development offerings, and pedagogical comparisons. Approximately $450,000 was spent in the first two years for the support of this grant program with grants ranging from $7,000 to $50,000. To date, thirty-six projects have been funded. Topics range from an assessment of interviewing skills to the impact of hand-held computing on medical education. Increased scholarship by the faculty is also supported by quarterly education scholarship clinics where mentoring and advice on projects, presentation, and publications is offered. Outcomes of scholarship and education innovation are showcased during Medical Education Day, an annual event. Since the quality of teaching is also of great importance to members, a program of peer teaching observation and feedback has been planned. Innovative methods of funding professorships and projects are a continuing principal function of the UCSF Academy. Startup and continuing funds were made available by the Office of the Dean.
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Summary
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In these examples, institutional infrastructure (administrative and financial) has been created and dedicated to the support of educational innovation and faculty development. It is clear that their purpose to improve the stature and quality of teaching, to increase camaraderie among faculty, to improve the financial and professional support for teaching faculty and educational programs, and to provide consistent mentoring for junior members of the teaching staff has been met and exceeded. In response to a questionnaire from HMS Academy leadership, the members stated that they felt validated, connected, inspired, supported, recognized, and rejuvenated in their professional lives as a result of their activities within the Academy. Similar outcomes are desirable and imperative for dentistry to maintain the high-quality faculty, students, and educational programs that have propelled U.S. dentistry to being the best in the world. The Institute of Medicine’s report on dental education8 listed twenty-two recommendations for change, several of which dealt with education. Specifically, recommendations 4, 5, and 9 call for innovations in course design, reduction of redundant material, collaboration with other schools within the academic health center and university, and the expansion of research and scholarship in dental education. The implementation of these proposed initiatives could benefit from the formation of an Academy model in dental education to foster leadership in education and to support faculty development and curricular innovation, design, and evaluation.
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Acknowledgments
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The authors would like to thank Molly Cooke, Daniel Kilpatrick, Jane Neill, and George Thibault for their generosity, vision, and contributions to the content and accuracy of this article.
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Footnotes
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Dr. Howell is Professor of Oral Medicine, Infection, and Immunity and Dean for Dental Education, and Dr. Karimbux is Associate Professor of Oral Medicine, Infection, and Immunity and Assistant Dean for Dental Education—both at the Harvard School of Dental Medicine. Direct correspondence to Dr. Thomas H. Howell, Dean for Dental Education, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115; 617-432-1447 phone; 617-432-3881 fax; howard_howell{at}hsdm.harvard.edu. Reprints will not be available.
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REFERENCES
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- Oral health in America: a report of the surgeon general: executive summary. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.
- Training tomorrow’s doctors. New York: The Commonwealth Fund Task Force on Academic Health Centers, 2002.
- Institute of Medicine. Academic health centers: leading change in the 21st century. Washington, DC: National Academy Press, 2003.
- Howell TH, Matlin K. Damn the torpedoes, innovations for the future: the new curriculum at the Harvard School of Dental Medicine. J Dent Educ 1995;59(9):893–9.[Medline]
- Matlin KS, Libert E, McArdle P, Howell TH. Implementing the problem-based curriculum at Harvard School of Dental Medicine. J Dent Educ 1998;62(9):693–708.[Medline]
- Thibault GE, Neill J, Lowenstein D. The Academy at Harvard Medical School: nurturing teaching and stimulating innovation. Acad Med 2003;78(7):673–81.[Medline]
- Cooke M, Irby DM, Debas HT. The UCSF Academy of Medical Educators. Acad Med 2003;78(7):666–72.[Medline]
- Institute of Medicine. Dental education at the crossroads: challenges and change. Washington, DC: National Academy Press, 1995.
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Academy at harvard medical...
