The Impact of the Stanford Faculty Development Program on Ambulatory Teaching Behavior


  • The authors have no conflict of interest to declare for this work.This work was presented at the plenary session of the annual Society of General Internal Medicine Meeting, May 2004, Chicago, IL

Address correspondence and requests for reprints to Dr Berbano: Department of Medicine, MCHL-MG, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, DC 20307 (e-mail:


CONTEXT: Faculty development has received considerable investment of resources from medical institutions, though the impact of these efforts has been infrequently studied.

OBJECTIVE: To measure the impact of the Stanford Faculty Development Program in Clinical Teaching on ambulatory teaching behavior.

DESIGN: Pre-post.

SETTING AND PARTICIPANTS: Eight internal medicine faculty participating in local faculty development.

INTERVENTION: Participants received 7 2-hour sessions of faculty development. Each session included didactic, role-play, and videotaped performance evaluation.

MAIN OUTCOME MEASURE: Before and after the intervention, faculty were video-taped during a case presentation from a standardized learner, who had been trained to portray 3 levels of learners: a third-year medical student, an intern, and a senior medical resident. Teacher and learner utterances (i.e, phrases) were blindly and randomly coded, using the Teacher Learner Interaction Analysis System, into categories that capture both the nature and intent of the utterances. We measured change in teaching behavior as detected through analysis of the coded utterances.

RESULTS: Among the 48 videotaped encounters, there were a total of 7,119 utterances, with 3,203 (45%) by the teacher. Examining only the teacher, the total number of questions asked declined (714 vs 426, P=.02) with an increase in the proportion of higher-level, analytic questions (44% vs 55%, P<.0001). The quality of feedback also improved, with less “minimal” feedback (87% vs 76%, P<.0005) and more specific feedback (13% vs 22%) provided.

CONCLUSIONS: Teaching behaviors improved after participation in this faculty development program, specifically in the quality of questions asked and feedback provided.