Advances in Health Sciences Education 7: 211–221, 2002.© 2002 Kluwer Academic Publishers. Printed in the Netherlands.
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Introducing Professional Educators into AcademicMedicine: Stories of Exemplars
M.A. HITCHco*ckUniversity of Southern California, Keck School of Medicine, U.S.A.
Abstract. This article describes an oral history project aimed at documenting the history and contri-butions of the innovation of hiring professional educators in medical schools to improve the educationof medical students, residents, and fellows. Six professional educators who spent their careers inmedical schools were chosen as Exemplars: Stephen Abrahamson, Ph.D.; Charles Dohner, Ph.D.;Arthur Elstein, Ph.D.; Hilliard Jason, M.D., Ph.D.; Christine McGuire, M.A.; and Frank Stritter,Ph.D. Pairs of senior professional educators currently working in medical schools interviewed thesix Exemplars using a standardized protocol. Articles describing each Exemplar appear consecutivelyin this and subsequent issues of Advances in Health Professions Education. The series culminateswith an article that presents the consensus conclusions of the series authors, based on the five studyquestions that guided the study and interview protocol.
Key words: education: medical, faculty: medical mentors, models: educational, schools: medical
In 1955 an innovative experiment began at the University of Buffalo (now theState University of New York at Buffalo). The Schools of Medicine and Educa-tion collaborated on an intervention to raise the quality of the education receivedby medical students. This collaborative experiment hired the first professional-educators, faculty with advanced training in Education – in a medical school.
Since then, the experiment begun at Buffalo has grown exponentially. Halfof the schools of medicine in the United States now have offices of medicaleducation (Albanese, Dottl et al., 2002). These offices employ professionallytrained educators as faculty to support the medical school’s educational mission.Virtually every medical school and specialty in medicine now employs profes-sional educators to assist with curriculum revision, train faculty to teach, conductstandardized patient programs, or assist with evaluating students and educationalprograms.
The series of articles that begins with the article by Simpson and Bland inthis issue of Advances in Health Sciences Education will document the historyand impact of introducing professional educators into academic medicine in theUnited States by examining the professional and work lives of six leaders duringthe formative years. Six retired professional educators who spent their careers inacademic medicine were chosen as Exemplars. (Because the term exemplar wasused for the six who were interviewed, this project has come to be known inform-
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ally as the Exemplar Project.) Six senior professional educators now working inacademic medicine were recruited to collect and report the Exemplars’ careerstories and their perspectives on a range of issues in medical education. Eachof the Exemplars will be the focus of an article in this series, with one articleappearing per issue. The series will close with an article synthesizing the views ofthe six Exemplars and drawing conclusions about the study questions that guidedthe project.
Why bother with such a series? What is important about documenting thehistory and impact of introducing professional educators into academic medicine?First, this series may inform current deans and faculty members on the effectiveuse of professional educators and their potential as collaborators to improve theteaching and learning of future physicians. Documenting the intervention is alsoimportant because of its uniqueness among the professions. No other professionin the United States has collaborated with professional educators on the scale thatmedicine has. Those of us in academic medicine have an opportunity to informfaculty in other professions about our experience. Finally, this series offers guid-ance to the many professional educators recently hired as faculty in academicmedicine. They may find an understanding of the ongoing experiment that theyhave joined, guidance for their careers from the Exemplars’ stories’ and directionfor their efforts from the Exemplars’ recommendations.
Early History of Professional Educators in Academic Medicine
THE PROJECT IN MEDICAL EDUCATION AT BUFFALO: THE BEGINNING
The first professional educators to work in a medical school collaborated on theProject in Medical Education at the University of Buffalo. Ideas for the Projectoriginated in a conversation between George Miller, M.D., associate professor ofinternal medicine at the School of Medicine, and Robert Fisk, Ph.D., Dean of theSchool of Education. Coming from the world of medicine, where a physician seeksthe aid of a specialist in those situations in which s/he feels such assistance isnecessary, “what could be more logical”, Dr. Miller asked, “than to consult withspecialists in education when problems in instruction and evaluation arise”? Acommittee of professional educators and School of Medicine faculty members metfor a year and a half to plan a project that would raise the quality of educationprovided to medical students. The committee wrestled with the issue of “exactlywhat can the professional in education offer to medical school faculty members?”(Abrahamson, 1960).
The plan conceived was for a limited number of medical school facultymembers to participate in a series of seminars, scheduled across an academic year,designed to give them greater familiarity with fundamental educational principles.Five major topics formed the content base for these seminars: (1) the teaching-learning process, (2) the nature of the medical student (psychosocial), (3) thedevelopment of higher education, with special emphasis on medical education,
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(4) instructional materials and techniques, and (5) evaluation of the effective-ness of instruction. Each seminar was designed and led by a pair of instructors,with a faculty member from the school of medicine paired with a professionaleducator. Funding for the project was awarded by the Commonwealth Fund, andthe first seminars began in September1956. Four faculty members from Buffalo,three visiting faculty members from other medical schools, and one senior medicalstudent from Buffalo completed the inaugural offering of the one-year program.After two offerings of the program in the one-year format, a decision was madeto develop what seemed to be a more practical format, one that would allow moremedical teachers the opportunity to participate. The annual Summer Seminar onMedical Teaching was the result (Miller, 1980).
What was so significant about the Project in Medical Education at Buffalo?The project did not represent the first time attention had been drawn to the needto be concerned with how things are taught in medical school. The distinguishedGerman surgeon Theodore Billroth published “Teaching and Learning of MedicalKnowledge” in 1876; it includes a reference to an order in 1811 by the AustrianImperial Commission on Schools for “the establishment of training schools forfuture professors of medicine and related sciences” (Millroth, 1924). The Buffaloproject was also not the first experiment in medical education or even the firstcollaboration between a school of medicine and a school of education. For abrief time in the 1920s, a sustained dialogue between the faculties of medicineand education occurred at the University of Minnesota. This dialogue grew into acollaborative effort to improve medical instruction (Miller, 1980). Two papers werepublished reporting the outcomes of this experiment, one written by the dean of theCollege of Education and the other by a professor of pharmacology in the schoolof medicine (Haggerty, 1929; Hirschfelder, 1929). Unfortunately, the collaborativeeffort at Minnesota did not survive.
The Project in Medical Education at Buffalo was the first funded, sustainedeffort to improve teaching and learning in medical schools. The reputation ofthe project as a success, established through research and participation of facultyfrom other medical schools, created a role for professional educators as faculty inmedical schools. Furthermore, the project generated a number of the professionaleducators who would be hired into the initial positions created for professionaleducators in other medical schools. Two of the Exemplars chosen for the currentstudy were collaborators on the Project.
COLONIZATION
The 1960s were years of growing interest in improving medical education.Medical schools such as Harvard, Johns Hopkins, the University of California,San Francisco and Case Western Reserve launched curricular revisions to improvethe instruction of medical students. Such revisions were partly in response to theactivism of students, who began demanding improvements in grading fairness andreduction in the stress associated with training. Professional associations, such as
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the Association of American Medical Colleges, organized conferences on researchin medical education to support the rising interest of members and created specialdivisions (e.g., student affairs, admissions, and evaluation) as the field began todiversify into specific interest areas. This growing interest in research in medicaleducation was greatly fueled by the passage of federal legislation that providedfunding for medical education innovations (e.g., Regional Medical Programs;Health Manpower Act of 1968) (Ludmerer, 1999).
It was in this climate of interest in medical education research and innovationthat the first professional educators, the Exemplars of our study, began work inacademic medicine. The curriculum experiments of the time made apparent theneed to devise strategies to evaluate curricula and teaching methods; deans weremore willing to provide funds to support medical education research and innova-tion, and grant programs supported the hiring of professional educators. Most of theprofessional educators were hired by offices of medical education, units created tosupport the educational missions of their respective schools. The first three officesof medical education were created within a few months of each other in 1958–1959.By 1972, 30 medical schools had created offices of medical education (Miller,1980; Rosinski, 1988).
The Study
THE EXEMPLARS
The remaining history of the growth in the use of professional educators inacademic medicine will be reported by the Exemplars through the individualarticles in this series. The Exemplars are introduced below.
Stephen Abrahamson, Ph.D. began his involvement in medical education asa collaborator from the School of Education on the “Project in Medical Educa-tion” at the University of Buffalo. After spending six months understanding theculture and issues specific to medical education, Dr. Abrahamson began teachingmedical school faculty the basic principles and concepts of education and alsoas a part of the Seminar Series that was part of the Buffalo project. After a one-year visiting professorship in the Department of Surgery at Stanford University,Dr. Abrahamson in 1963 founded the Department of Medical Education at theUniversity of Southern California where he stayed until his retirement in 1993.He is respected around the world for his writings on medical education and histeaching of other teachers. He created a Master of Science in Education program incollaboration with the School of Education at the University of Southern Californiathat continues to train physician faculty from around the world.
Charles W. Dohner, Ph.D. established the tenth office of medical education in1967 at the University of Washington, where he served as chair of the departmentuntil he stepped down in 1996. As an early pioneer and leader of the emerging fieldof medical education, he was a passionate spokesman for excellence in medicaleducation and most notably for his role as a mentor of academic leaders, directors
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of medical education, and faculty in medical education. Serving as a consultant tothe American Board of Obstetrics and Gynecology, he helped improve the qualityof certifying examinations and worked with the specialty on faculty development.In his leadership role at the University of Washington, he helped create and evalu-ate the WAMI program (the regional medical education program for the states ofWashington, Alaska, Montana and Idaho).
Arthur Elstein, Ph.D. began his career in medical education in 1968 whenhe accepted Hill Jason’s invitation to join the faculty of the Office of MedicalEducation Research and Development (OMERAD) at Michigan State University.His research focused on examining the skills and strategies used by expert clin-ical diagnosticians. This line of research led to the Medical Inquiry Project, thenow famous study of how physicians make clinical decisions. Dr. Elstein servedas director of OMERAD from 1976 to 1979, then returned to his first loves,teaching and research. In 1984, he returned home to Chicago to become Professorin the Department of Medical Education (DME) in the College of Medicine, andProfessor of Health Resources Management in the School of Public Health, at theUniversity of Illinois, Chicago. He continued his research in decision making andtaught classes in the DME’s Master’s Program in Health Professions Educationuntil he retired in June 2001.
Hilliard Jason, M.D., Ed.D. is the first person known to have pursued bothmedicine and education doctorates. His initial involvement in medical educationwas as a medical student at the University of Buffalo, when he completed thefirst iteration of the Seminar Series conducted by the “Project in Medical Educa-tion”. After completing his residency in psychiatry and his doctorate in education,Dr. Jason devoted his career to improving the quality of teaching in the healthprofessions. He was founding director of the Office of Medical Education andResearch at Michigan State University’s College of Medicine; the Division ofFaculty Development at the Association of American Medical Colleges; and theNational Center for Faculty Development at the University of Miami School ofMedicine. Although officially retired, Dr. Jason is now completing his seventhacademic book on clinical education.
Christine McGuire, M.A. began a long and influential career in medical educa-tion in 1961 as Professor of Medical Education, Associate Director of the newOffice of Research in Medical Education formed by George Miller, M.D. Academicmedicine was a second career for Ms. McGuire, as she spent the prior 20 years asAssociate Professor of Economics and Chief Examiner in the Social Sciences atthe University of Chicago, Ms. McGuire is perhaps best known for innovations inassessment of professional competence, including evaluation of clinical problemsolving with simulated problems in patient management. She authored over 150articles on medical education topics, including:, program evaluation, licensureand certification, assessment of clinical competence, the nature and constraintsof professional practice, and socio-economic contexts of medical practice. (Ms.
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McGuire died 22 November 2001, only a few months after she gave the interviewsfor the Exemplar Project.)
Frank Stritter, Ph.D. completed his Ph.D. in 1968 and took a position withthe Association of American Medical Colleges, where he worked with the firstAAMC curriculum committee and served as liaison with the U. S. House ofRepresentatives to develop legislation to support the funding of medical education.In 1971 he joined and later served as the director of one of the early Offices ofEducation and Research in medical schools at the University of North Carolina(UNC). He conducted early, seminal research on clinical teaching and designedand implemented many faculty development programs. The Teaching Scholar’sprogram now popular at medical schools as a faculty development strategy was hiscreation. In addition to his work in the medical school, Frank also was appointedas faculty member in the College of Education at UNC where he mentored manygraduate students; some are now leaders of offices of education in medical or healthsciences schools and themselves known for significant contributions to medicaleducation.. He has written numerous articles, chapters, and books, particularly onfaculty development.
STUDY METHODS
Criteria for Exemplars. Six (6) Exemplars were chosen to be the focus of this studyusing four criteria. Those considered had to be: (1) retired (but living); (2) possessan advanced degree in Education, (3) someone who focused his/her career onimproving the process of medical education (e.g., faculty development, research),and (4) someone whose contributions changed the way medical education isconducted now. The seven authors of this project nominated eleven professionaleducators for consideration. Four of these eleven were independently nominated byall seven authors and were selected for study without further review. The remainingtwo Exemplars for the study were selected at a meeting of the authors using a peerreview process. Each of the authors of the study presented the curriculum vitae ofone nominee along with a recommendation as to whether she/he should be selectedfor study. A secret ballot of the authors determined the final two Exemplars forstudy.
The Eight Series Authors. The eight authors of the series who nominated andselected the Exemplars, and who later conducted the research and wrote the articlesin the series, are:
Maurice Hitchco*ck, Ed.D. (Principal Investigator)Professor and DirectorDivision of Medical EducationKeck School of MedicineUniversity of Southern California
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William Anderson, Ph.D.Professor and DirectorOffice of Medical Education Research and DevelopmentMichigan State University
Carole Bland, Ph.D.Professor and Vice Chair of Research and Faculty AffairsDepartment of Family Practice and Community HealthUniversity of Minnesota Medical School
Ilene Harris, Ph.D.Professor and DirectorOffice of Educational Development and ResearchUniversity of Minnesota Medical School
David Irby, Ph.D.Vice Dean for EducationUniversity of California at San Francisco
Deborah Simpson, Ph.D.Associate Dean for Educational Support and EvaluationDirector of the Office of Educational ResoursesMedical College of Wisconsin
LuAnn Wilkerson, Ed.D.Senior Associate Dean for Medical EducationUniversity of California at Los Angeles
An eighth person was involved in discussions at all stages of the project and nowserves as Series Editor for the project:
Addeane Calleigh, M.A.President, Science Publishing ServicesFormer editor, Academic Medicine
STUDY DESIGN
This study was designed primarily as an oral history. Each Exemplar was inter-viewed by one of the authors of the study using an established interview protocol.Each interview was also videotaped for later analysis. Authors worked in teamsto analyze the data from each interview, collect other data as appropriate, andwrite the article profiling each Exemplar. Other sources of data on Exemplars wereinterviews of an Exemplar’s colleagues, the Exemplar’s writings, and visits to theschool and unit where an Exemplar worked.
Five questions guided this study.
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1. What were the history and contributions of the Exemplars?2. What have been the most important innovations in medical education to date?3. How have professional educators contributed to the improvement of medical
education?4. What lessons have been learned about introducing professional educators into
academic medicine to guide the future?5. Which issues, problems, questions, and trends should be the focus of profes-
sional educators now working in academic medicine?
Measurement
The interview of each Exemplar was guided by a protocol designed specifically forthis study. Questions for the protocol were constructed using the study questionsabove as major categories. The protocol was designed by Dr. Hitchco*ck, PrincipalInvestigator, who shared a draft of the instrument with the remaining six authors forreview and comment. Suggested revisions were incorporated into the final protocolof the study, which was pilot-tested on two Exemplars. Interview protocols weresent to each Exemplar in advance of their video-taped interview to allow Exemplarsto prepare for the subsequent interview.
Analysis
The interview data from this study were analyzed in two steps. First, pairs ofauthors summarized the comments of each Exemplar, organized according to ourstudy questions, in separate articles that focus on each Exemplar. Second, the prin-cipal investigator conducted a Delphi Study with the Exemplar authors to deriveconsensus conclusions to the questions of the study.
Publication format and schedule
An article profiling each of the Exemplars is scheduled to appear in Advances inHealth Sciences Education. The first one, on Stephen Abrahamson, Ph.D., is in thepresent issue along with this article that introduces the series (Adv Health Sci Educ,2002; 7[3]). The others are scheduled for the next five issues. An article presentingthe consensus conclusions about the study questions will be published along withthe final article.
George E. Miller, M.D., 1918–1998
Any article describing the introduction of professional educators into academicmedicine would not be complete without a tribute to George Miller, M.D., the manmost responsible for the origin of the intervention. Hilliard Jason, M.D., Ed.D.,one of Dr. Miller’s students and an Exemplar in the current study, wrote andpublished the following article on the occasion of the death of his mentor. Thistribute first appeared in “Education for Health: Change in Learning and Practice”,
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George E. Miller
and is reproduced here with the permission of the author and the journal (Jason,1999).
In MemoriamGeorge Edward Miller, an early promoter of the idea that the process of educa-tion in medicine should be a field of study, died of a heart attack at age 79 athis home in Kennett Square, Pennsylvania on 7 November 1998.
As a young internist on the faculty of the University of Buffalo School ofMedicine in the early 1950s, George became impressed that faculty members inthe School of Education and the Department of Sociology and Anthropology onthat campus had much to offer those who were responsible for teaching medicalstudents. He became the leader of an interdisciplinary team that secured anexceptional grant from the Commonwealth Fund of New York, perhaps thefirst foundation funding of what we now call faculty development. The programthat evolved, which was known as “The Project in Medical Education,” became
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one of the seminal undertakings in the formative history of this nascent field.George’s 1956 paper, Adventure in Pedagogy, explaining this project and therationale for medical teachers learning from professional educators and others,was among the early calls for change in the conventional wisdom and practicein medical education (Miller, 1956). It should still be read by anyone concernedwith the history and direction of medical education.
Forecasting the many disputes that would emerge from positions he wouldbe promoting for years to come, this first paper generated a quick and scathingreply from an articulate defender of the status quo (Lyman, 1957). Perhapsrevealing the otherwise well-concealed sense of difficulty George felt in hisadopted role as a pioneer, and adding an important footnote to the history ofinnovation in medication education, he wrote to me about the Lyman article40 years later, saying that it: “. . . won more widespread support at the timethan what I had written (G. miller, personal Correspondence, May 9, 1997). Isuspect it might even today.
The work of the Project in Medical Education and the educational thinkingthat served as the foundation of the experiences offered to participants, werewell captured in the book that George edited and wrote with the other leaders ofthat effort.12 The Project launched George’s fulltime career in medical educa-tion, as it did for Stephen Abrahamson, Edwin Rosinski, and myself. It alsocontributed to the evolution of the careers of many of the medical educatorswho attended the offered sessions. Some of that history is well summarized inGeorge’s reflective book on that set of events and the subsequent evolution ofthe field of medical education (Miller, 1980).
In 1959 George left Buffalo to become the founding Director of the Centerfor Educational Development (CED) [now the Department of Medical Educa-tion (DME)] at the University of Illinois. Under his leadership, CED becameand remains a world-recognized leader in the field and a major contributor tothe educational programs of institutions in many countries.
George enjoyed a distinguished career as a long-time consultant to the WorldHealth Organization and to many other organizations and institutions. Yet, in1979, after more than 20 years as a fulltime medical educator, he left theUniversity of Illinois and the Center he had founded to return to his profes-sional roots. He and his wife Barbara (“Barney”) moved to Clinton, New York,where George again became a practicing physician, serving with the StudentHealth Service of Hamilton College. In thinking about that major career choicethat George made, I am reminded of him as a physician and as a teacher ofmedicine. In addition to my work with George and others on the Project inMedical Education, I had the good fortune of having him as my teacher when Iwas a clinical medical student and an intern. I remember George quite distinctlyas one of a precious few instructors who actually cared about the way I thoughtabout clinical issues, not just about whether I could mouth the correct answersto questions. Clinical supervisory sessions with him were events that promoted
INTRODUCING PROFESSIONAL EDUCATORS 221
personal growth, not the defensiveness and discomfort that I often felt whensupervised by others. Unlike most teachers of that era, he was actually inter-esting, challenging, and enjoyable to learn with and from. I suspect that Georgemay well have found that observation to be among the highest of complimentshe could be given.
George Miller was one of those few people who seemed ageless throughouttheir adult lives. As a young man in his thirties, George carried himself with aquiet dignity and self-assurance that suggested someone of considerably moreyears. When well into his seventies, he seemed hardly different. He was still thesame trim man with an erect posture and a slightly formal but friendly manner.It was easy to imagine that George was destined to remain that way forever.Sadly, and inevitably, such was not to be the case. Yet, his presence will live onfor all of us who are grateful for the many doors that he opened and the roadthat he helped pave, making our path so much easier to pursue than it mightotherwise have been. Thank you, George.
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Billroth T. (1924). The Medical Sciences in Germany. New York: Macmillan.Haggerty, M.E. (1929). The improvement of medical instruction. Bulletin of the Association of
American Medical Colleges [now Academic Medicine] 4: 42–58.Hirschfelder, A.D. (1929). Coordination in the teaching of the fundamental and clinical sciences.
Bulletin of the Association of American Medical Colleges [now Academic Medicine] 4: 6–12.Jason, H. (1999). In memoriam: George E. Miller, MD. Education for Health: Change in Learning
and Practice 12: 145–147.Ludmerer, R. (1999). Time to Heal. New York, NY: Oxford University Press.Lyman, R.A. (1957). Disaster in pedagogy. N Engl J Med 257: 501–507.Miller, G.E. (1980). Educating Medical Teachers. Cambridge, MA: Harvard University Press.Miller, G.E. (1961). In Hillard Jason (ed.), Teaching and Learning in Medical School. Cambridge,
MA: Harvard University Press.Miller, G.E. (1956). Adventure in pedagogy. JAMA 162: 144–150.Rosinski, E.F. (1988). The Society of Directors of Research in Medical Education: A Brief History.
<www.sdrme.org/HistoryTOC.html>. Accessed 5/23/01. Society of Directors of Research inMedical Education, 1988.
