UCSF Program Aims to Improve Medical Teaching

The Haile T. Debas Academy of Medical Educators is receiving rave reviews for its innovative program designed to improve teaching in the UCSF School of Medicine.

The program is called TIP-TOP, an acronym that stands for Teaching Improvement Program and Teaching Observation Program. Developed by faculty members Sophia Vinogradov, MD, professor in residence in the Department of Psychiatry, and Maria Wamsley, MD, associate clinical professor of medicine, TIP-TOP was inaugurated early in 2005.

Since then, the program has quickly become one of the academy's high-profile activities with the goal of enhancing teaching effectiveness in any setting, from the classroom to clinics and hospital wards.

Faculty participate in the teaching improvement program at UCSF.

The academy itself was the brainchild of a faculty committee, which recommended establishing a cadre of dedicated teachers and outstanding medical educators who would inspire and help junior teachers. In March 1999, then School of Medicine Dean Haile Debas, MD, announced that he would provide support for the Academy of Medical Educators through its formative stages. In the summer of 2001, the first group of academy members was selected through a rigorous process, and the first class was inducted in September 2001. A new class of members has been inducted each September. Today, the academy consists of 68 active members. All medical school faculty, whether academy members or not, are eligible to participate in TIP-TOP. TIP is based on strategic observation of a master teacher in action. TOP involves being observed during a teaching session - giving a lecture, facilitating a discussion group or directing rounds - and then receiving feedback from a trained observer, with the opportunity to brainstorm together ways for further improvement of teaching techniques. To launch this ambitious project, academy members were trained to be observers, and then signed up to observe or be observed in real teaching situations. The fall 2005 first-year medical student course, prologue, was the first block to develop the expectation that all lectures would be "TOPped." While lecturers were allowed to opt out, only two did. The metabolism and nutrition course followed suit, and many other blocks are now planning to make "TOPping" a standard element of teaching in the course. A Learning Experience Even some of the best teachers benefit from the experience of being observed. Marieke Kruidering-Hall, PhD, who was recently named by the Academic Senate for her distinction in teaching, serves as block director of prologue and is an assistant adjunct professor in the Department of Cellular and Molecular Pharmacology. She was "TOPped" at one of her lectures last year. "It was fantastic to have another perspective on the lecture, and it helped me reorganize the material for the next year," Kruidering-Hall said. "You never know how your lecture is perceived; a 'TOPper' really helps you clarify your concepts when they ask you what you meant by this or that slide or point. The process helped me streamline my concepts further and think about new ways to get my points across." Dana Rohde, PhD, associate adjunct professor in the departments of anatomy and physiology, has experienced both sides of TOP. "As an observee, I learned about a few subtle points that had completely escaped me - particularly how students might react to something I said. This was very useful." And in the other role, observer of a small group, she reported, "It made me think about some things that I do as a small-group leader, and I think it helped me in teaching small groups. I also believe that I gave some good input to help the observee." Daniel Dohan, PhD, assistant adjunct professor in the Institute for Health Policy Studies and the Department of Anthropology, History and Social Medicine, and Lowell Tong, MD, clinical professor in the Department of Psychiatry, were observed jointly as co-facilitators of a small group. Both professors found the TOP experience invaluable. "Having an observer in the classroom provided important confirmation that some of the initiatives we had undertaken to improve classroom dynamics seemed to be having positive effects," Tong said. "Having a third person - who had observed us in action, then probed us immediately afterwards with questions - was particularly valuable and productive. We came out of the process with new insights and directions to guide our teaching, both in this specific classroom situation and for teaching in general. "As both observer and observee multiple times now, this whole process really is helping to build a real community of faculty at a different level. I've known some of my colleagues only in their administrative roles, but this is getting us to observe each other and discuss our teaching styles in starkly candid, yet supportive ways." Community of Teachers Vinogradov and Wamsley developed TIP-TOP as co-chairs of the academy's Faculty Development Committee. The TIP-TOP idea stems from several sources. It is part of the academy's commitment to fulfill its mission of promoting faculty development to all faculty, not just academy members; it furthers the goal of improving the quality of teaching; and helps develop a community and culture of communication about teaching. Early ideas of a standardized approach to evaluating teaching methods were discarded because of the acknowledgment that there isn't a single best way to teach. The focus switched to teaching effectiveness, recognizing there are many right ways to be effective. Vinogradov and Wamsley also wanted to develop a culture of reflection and dialogue on teaching - paralleling modern educational philosophy on learning. By the end of 2005, about 75 TIP-TOP sessions were requested and completed. "The next step for TIP-TOP is to have all academy members sign up to be observed," said Vinogradov. "While the prospect of being observed can sound scary, this program is set up so that the faculty member requesting the observation gets to choose in advance the focus of the feedback. To experience TIP-TOP and personally realize its value will help this process of openness to feedback become widespread and part of the expected process of teaching at UCSF." Asked what she was most proud of about TIP-TOP, Wamsley said, "So many academy members stepped up to the plate and volunteered enthusiastically to observe others lecture and then provide feedback. This enthusiasm for active participation is really amazing. We were the catalysts, and everyone else stepped up to the plate. I've been a little surprised and very gratified." For more information on TIP-TOP, please visit website. Source: The Haile T. Debas Academy of Medical Educators Links: The Haile T. Debas Academy of Medical Educators