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Keys to Implementation and Sustainability
Key #1: Clear Authorization by Program Leadership
Medical education programs are increasingly expected to educate more trainees with fewer resources. Yet, institutional leadership may worry that teaching non-technical aspects of medicine detracts from the fundamental competence of trainees. The relentless pressure on faculty and trainees to cover service and research duties is such a significant barrier to implementing an RP&L program that often only the leadership of the medical program can signal the importance of an event and allocate the infrastructure (e.g., people and protected time) to start the program, highlight its achievements, and encourage its growth.
One such example of leadership was the inauguration of our fellows’ seminar which the section chief was authorized when he sent a memo to all fellows and faculty – including research mentors – stipulating that participation by first-year fellows in the seminar was mandatory. He requested the cooperation of all faculty to ensure that fellows were given the time to participate. We reiterate this authorization as new faculty join the section.
Key #2: Participation of Seasoned, Highly Regarded Faculty
Leadership of the seminar is a critical factor and participation by role models is key. Faculty who are selected to lead the program must be recognized and respected for their expertise and demonstrate high standards of professionalism. Their convivial nature and/or interest in psycho-social topics should not be a factor in your decision.
Recruiting senior faculty as facilitators can have a positive effect on your RP&L program. It may encourage junior faculty to provide support for seminar logistics while senior faculty address potential program obstacles. Senior faculty bring accumulated wisdom and a professional history that helps them crystalize questions, offer analogous case circumstances, and illuminate implicit data, pragmatic considerations, or potential consequences that may not be apparent to less experienced colleagues.
When recruiting, consider the number and type of faculty. We recommend a minimum of two faculty facilitators in order to ensure that the seminars are not cancelled if one person is unavailable. Having at least two facilitators also allows one faculty member to pay attention to the process (e.g., is the faculty adhering to the method) while the other offers alternative insights into the case discussion. Two facilitators also increases the diversity of role models available for the participants (e.g., gender, ethnicity, academic pathway).
When the infrastructure, logistics and primary faculty have been identified and are performing as expected, other faculty can be recruited for specific purposes (e.g., to represent an “80-20” research pathway). Even, we are now questioning if there is an upper limit to the number of faculty who should participate. On some occasions we have recruited faculty with particular expertise (e.g., ethics of clinical research) to participate in a particular seminar. For the past several years we have successfully balanced a ratio of approximately 2 or 3 faculty to 8 fellows participating in any given seminar.
Key #3: Consistent Use of the Method
Disciplined Reflection and Formulation of a Plan. The seminar teaches participants how to systematically observe and form hypotheses about social situations. What makes an event useful rather than a “gripe session” is working a case through to a plan for strategic action. By requiring such a plan, the faculty offer a way for participants to determine whether they have stayed on, or moved off it. When the group moves off the plan, they are able to explore why and test the effectiveness of RP&L methods to set them on the right course. Thus, these seminars help participants rehearse the sequence of defining a plan, analyzing the patterns of interaction regarding the plan's development, exercising leadership in the group process when the plan goes astray, and assessing the group's results.
Key #4: Prompts
For ongoing events such as the fellows’ seminar we have found it useful to provide minor prompts such as email reminders at the beginning of a week and batch notifications to pagers approximately 30 minutes before the seminar is scheduled to start. Paging has been particularly useful for reminding participants and faculty about the seminar, while giving them time to complete their immediate commitments.
Key #5: Accreditation Matters
RP&L seminars can satisfy requirements for program accreditation initiatives, such as the ACGME Core Competency Project.