Setting and Participants

The hour-long video review session was embedded in a preestablished, weekly, academic half-day faculty development series in the University of Pittsburgh's Division of General Medicine. The longitudinal series included a journal club, research seminar, academy of master educator's lectureship, and faculty development series rotating on a weekly basis. The target audience included clinician educators, research faculty, and fellows. Participation was voluntary, yet strongly encouraged; protected time was granted to facilitate attendance. Forty-three clinician-educator faculty attended at least 1 of 6 pilot sessions delivered monthly between February and August 2016. On average, 20 to 25 faculty members attended each video discussion session.

Program Description

The curriculum followed 4 steps (figure). Using a smartphone, participants recorded teaching encounters and were instructed to focus video footage on the teacher, with the goal of capturing verbal and nonverbal teaching behaviors. Videos were stored on a secure, cloud-based platform. Faculty predominately chose to video small group, conference room–based, inpatient teaching sessions with both medical students and residents, although ambulatory and classroom videos were also represented. No videos of teaching on rounds were made to avoid including patient-identifiable data. Faculty obtained verbal consent from all learners prior to recording sessions. Faculty members reviewed their videos, reflected on the teaching encounter, and selected a 5-minute clip to show during the large group review session with a specific question for group feedback. Two faculty video clips were reviewed during each hour-long, large group session, held monthly over 6 months. Faculty in attendance were encouraged to observe the videos (looking for stimulus-response teaching behaviors). The session leader guided the group to give global feedback on exemplary skills, before providing comments relevant to the presenter's self-identified focus.²⁰ Observations were translated into skills-based teaching points (eg, learners were asked to take 2 minutes and write their answer to increase participation and engagement and to set high standards for learners by rewarding complete answers, not partially correct ones). Sessions concluded with participants committing to try a new teaching strategy, with the goal of consolidating and applying learning.²¹ The primary author (S.B.M.) was available to address technical questions regarding obtaining, editing, and uploading video footage. Otherwise, the authors did not have a role in curricular implementation.

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Program Evaluation

We used a qualitative approach to better understand participants' perceived motivators and barriers to participation, and the impact of the intervention on individual reflective practice and incorporation of new teaching behaviors. A qualitative approach is well suited for exploratory, descriptive research and affords a deeper understanding of efficacy and acceptability.^22,23 We conducted 1-on-1 telephone interviews with a semistructured script (provided as online supplemental material) to encourage respondents to reveal their perspectives candidly and in greater depth. When interviewees provided more general responses, interviewers used “probes,” or follow-up questions, designed to encourage participants to give specific examples or more detailed responses.²⁴ At the beginning of the interview, participants answered questions about faculty rank, sex, and frequency of attendance.

All participating faculty were invited to interview, and 24 responded. To ensure we captured responses from faculty across a spectrum of rank, experience, and degree of curricular participation, we used stratified purposeful sampling to recruit a final sample of 20 participants.²⁵ Participation was not compensated.

Data Collection

In October 2016, an experienced interviewer not affiliated with the creation or implementation of the curriculum conducted confidential, 20-minute interviews. All conversations were audio-recorded, deidentified, and transcribed verbatim.

This project was designated exempt by the University of Pittsburgh Institutional Review Board.

Analysis

Using established qualitative methods,²⁶ the primary author (S.B.M.) inductively developed a codebook, as the authors did not have preexisting notions of how physicians would respond to interview questions.²⁷ Two authors (S.B.M. and B.S.) independently compared coding on 6 of 20 transcripts (30%) in 3 rounds, using ATLAS.ti software (Scientific Software Development GmbH, Berlin, Germany). After each round, coders resolved discrepancies through discussion. Codes were further refined using the constant comparative method.²⁸ Triangulation (coding of the data by more than 1 investigator) was employed to ensure consistency of interpretation.^22,25 Although “thematic saturation” was achieved by the 12th interview, we interviewed all 20 physicians who communicated interest to respect their time and willingness to participate. Final codes were grouped into themes and sorted within 2 main categories: (1) advantages of, and barriers to, participation, and (2) effect of the curriculum on teaching and reflective practices. To establish the credibility of the results, we performed member checking in real time; the interviewer frequently restated and clarified participants' responses to ensure correct interpretation. We also performed synthesized member checking after all interview data had been analyzed, and provided ability for comments.²⁹ This did not identify any need for further analysis or revision. To ensure reflexivity in data collection and analysis, authors discussed different reactions to, and interpretations of, the data during research meetings.

Advantages of, and Barriers to, Participation

All respondents stated that they would continue to attend faculty development sessions and would recommend participating to others. Regarding helpful curricular aspects, participant responses revealed 5 central themes: exposure to new teaching strategies, direct feedback, safe environment, community of practice, and growth mind-set.³⁰ Exemplar quotations are included in table 2.

Table 2 Themes Related to Perceived Advantages and Barriers of a Video Review Faculty Development Program

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Effect on Teaching Practice

Twelve participants reported they increased their reflection on teaching after the program. One noted, “I've already started thinking about what strategies I'm going to implement to keep my learners engaged.” Another identified the framework as a facilitator for individual reflection: “It's like you carry the group around in your head, and say, ‘What would the rest of the group say about that teaching session?'” Thirteen participants reported an increased ability to change teaching behavior after faculty development. At the time of the interview, 12 participants had implemented a learning point taken from a session and an additional 6 planned to do so in the future. The most frequently cited learning points included strategies to increase participation, promote self-directed learning, maximize efficacy of teaching tools (eg, handouts, articles), and effectively use nonverbal teaching cues. Participants reported that concrete examples of observed behaviors facilitated learning: “Instead of an abstract discussion … we could talk very specifically about certain wording that was used, about certain things done to set the learning climate, about positioning in the room.” All who reported no change in reflection or teaching behavior ascribed this to the impact of prior training (eg, postresidency teaching programs that incorporated 1-on-1 observation of teaching).