Introduction

The number of medical students and residents training in rural and underresourced sites is growing.^1-3 However, little is known about how to engage busy community-based physicians toward developing their skills as educators. We studied the feasibility of implementing a 25-minute “bite-sized” continuing medication education (CME) credit-eligible program for educators in residency training programs located in underserved areas in Oregon and California to address barriers to participating in professional development. This program was developed as part of the American Medical Association Reimaging Residency Initiative, California Oregon Partnership to Address Disparities in Rural Education and Health (COMPADRE). COMPADRE’s overarching aim was to reduce health disparities by transforming the physician workforce to be better prepared, more equitably distributed, and more deeply connected to underresourced communities in Oregon and northern California.⁴ An important component of COMPADRE was to develop residency program directors, educators, and community preceptors.

Methods

Results

Over the 25-month period, 20 bite-sized sessions were offered, and 91 educators registered to participate (Table 1). Of the educators, 75.8% (69 of 91) were physicians while 17.6% (16 of 91) were other program educators.

Table 1 Demographic and Clinical Training Characteristics of Enrolled COMPADRE Educators

View Fullscreen

Two to 14 learners viewed each session, either synchronously or asynchronously. A total of 3805 minutes (approximately 63.4 hours) of viewing time occurred among all attendees, including asynchronous sessions. Feasibility, as assessed by user interface connections (eg, desktop, mobile app, the web, or recording), was found to be 50% or greater by desktop app connection for all except one session. Sixteen of 20 (80%) sessions received comments in response to the question, “What new information did you learn that you intend to apply in teaching practice?” Table 2 contains direct quotes and select themes from the qualitative analysis. The themes revealed that participants learned new clinical teaching strategies, identified tools and approaches to support educator development, and recognized that they can participate in education scholarship (Table 2). Only 23.1% (21 of 91) of the participants requested CME credit.

Table 2 Emergent Themes From Open Ended Responses Regarding New Information to Apply in Teaching Practice

View Fullscreen

Discussion

Findings from this exploratory study indicate that it is feasible to provide interactive web-based faculty development in resource-limited settings and that a virtual program offering 25-minute development opportunities has utility for participants. Most participants took part in real time and utilized a desktop device, which suggests they could access the sessions in their clinic offices, precepting rooms, or at home. We did find that mobile connections were also used, suggesting that participants may login from several locations, depending on connectivity.

Based on the wide-ranging comments received about the sessions, it appears they held educational value for many participants. Notable examples include that participants felt like the instruction on feedback helped them better understand how to provide actionable feedback and that reflective learning provided an opportunity for stimulated recall of what participants already knew but had not been applying in their clinical practice.

This study makes important contributions to the literature by providing an understanding of the feasibility and utilization of implementing distance learning for educators in underresourced settings. Distance learning has been studied in other countries, such as Canada and India, where large medical schools depend on various community-based settings to train physicians in rural physician shortage areas.^8-10 The 2003 Canadian study by Curran¹⁰ is most like the study we conducted, though it is now 20 years old. The investigators conducted 31 one-hour audioconferences, each of which was attended by approximately 14 educators. They found that 67% (12 of 18) accessed the program either at work or from home and that the presentation materials and ability to submit evaluations online were beneficial. Similar research using the same method of continuous professional development has not been conducted in the United States, where distributed medical education is becoming increasingly common.¹¹

Because we have demonstrated feasibility and utility, there is value in continuing to evolve this important work. Areas for future development include conducting more in-depth needs assessments that include current faculty knowledge of and comfort with teaching, and assessing what impediments exist to attending in real time or in reviewing the recordings. Additionally, identifying more rural clinicians who may be naïve to teaching students and residents and more rigorously evaluating the quality and educational value of sessions offered will be important for future studies. Plans are for the network of COMPADRE residency programs to sustain this program after the funding period is complete; however, administrative and faculty coordinator support will continue in-kind.

Limitations include a small sample size, which limits generalizability to other programs and settings. Furthermore, participants were asked to self-report what they learned and intend to apply to their teaching practice. Conducting an additional assessment of whether participants applied what they learned in actual teaching practice will strengthen future studies. Finally, data collection on the reliability of mobile connectivity could give insight into additional options to access virtual content.

Conclusions

Brief, web-based educator development sessions are feasible to implement in residency training sites located in remote and underresourced communities. Participants self-reported their intention to apply what they learned in their work with trainees.