Thirty Years of Teaching Teachers

Georgette Stratos, PhD and Kelley Skeff, MD, PhD

Picture this: You are walking into your building and you see a close colleague you realize you haven’t spoken to in more than a month walking toward you. You stop and say, “Hey, I haven’t seen you in awhile. What have you been up to?”

He responds: “I was at Stanford for the past 4 weeks going through the Stanford Faculty Development Center Clinical Teaching Facilitator Training program.  A mouthful you say?  You don't know the half of it!  What was it like? Well, you could call it a cross between a boot camp and summer camp.  It was an intense training experience, diving right into the depths of educational literature, with so much to learn about how it applies to clinical teaching.  It was also a tremendous relational experience, being able to work with and learn alongside like-minded individuals from all over the US and Canada, all under the tutelage and mentorship of wonderfully bright and nurturing mentors, Kelley Skeff and Georgette Stratos.  Was it a sacrifice? Being away from family always is.  But I like to think of it as an investment, with rich dividends in terms of knowledge gained and relationships formed, with more to come!!”  Joshua LaBrin, MD, University of Utah

Or this: "I've been taking the Clinical Teacher Facilitator Course, offered by the Stanford Faculty Development Center.  It provides teachers with an educational framework which can be applied across a wide variety of clinical settings. The month has proven to be so much more.  It has been a month of reflection on one's own biases, strengths, and weaknesses as a person, teacher, and clinician.  I will not look at teaching the same way again. It has been a transformative journey, one that oozes inspiration to be better." Josee Paradis, MD, MSc, London, Ontario

Or this: “It was a privilege to spend an entire month at Stanford University away from my routine to really think about teaching. The experience was even more incredible than I could have imagined. Kelley Skeff and Georgette Stratos made the six of us feel like part of a new family not only for that month but for always. They designed the month-long course with each I dotted and T crossed. They changed the way I think about teaching and inspired me to remember the opportunity that I have to make a difference not only in my educational interactions but really in every conversation I have.” Reena Hemrajani, MD, Virginia Commonwealth University

Intrigued, you ask your colleague to join you for a cup of coffee so you can hear more. And this is what you learn.

Back in 1977, Kelley Skeff, MD, PhD (professor, General Medical Disciplines) was in his first year of a fellowship in general internal medicine at Stanford when his interest in education became very clear. Together with then chief of the division, Harold Sox, Jr., MD, and Chairman of Medicine, Daniel Federman, MD, he decided to go to the Stanford School of Education and get a PhD, which he accomplished in 1981.

Kelley M. Skeff

By 1985 he was co-director with his colleague, Georgette Stratos, PhD (senior research scholar, General Internal Medicine), of the Stanford Faculty Development Center teaching physician-teachers how to teach better and, importantly, how to train their colleagues back home to do the same. To date, nine countries have participated in this teaching improvement program.  30 years later Skeff and Stratos continue as co-directors, bringing one to two classes of six faculty from around the world to Stanford for a full month of facilitator training each year. 

In addition, the Center trains 200 Stanford medical teachers each year, including faculty, fellows, chief residents, residents, teaching assistants, and post-doctoral scholars.  “What we do,” says Skeff, “is assist medical teachers to be more effective by enhancing their knowledge, skills, and attitudes related to teaching.”  

There are likely many keys to the success of this program, but one of the most interesting is the desire of Skeff and Stratos to work with teachers wherever they are in their teaching practice and provide them additional approaches to consider.

Skeff explains: “We teach about concepts and behaviors and then allow the teachers to decide how to incorporate them into whatever teaching philosophy and methods they use.  We designed the course to apply across settings, including one-on-one teaching, small group discussions, and lecturing.  It leaves the teachers in the power position of making the decisions about what they are going to do in their teaching.”

Stratos continues: “What we offer is a non-prescriptive approach to teaching, which means that whether participants assume a more teacher-centered, content-centered, or learner-centered approach, they can find useful material in this course.”

One critical aspect of the facilitator-training course is that the trained faculty are expected to return to their home institutions and train their colleagues to be better teachers.  “Many former facilitators have been doing so for years,” Skeff explains, “with some, for example the group at Mayo Clinic, training hundreds of teachers.”

Although this course is celebrating its 30th anniversary, and by any measure is a grand success, it continues to evolve. Skeff explains several recent changes: “For the first few decades (1985-2005), the focus was on clinical teachers, but in the last ten years we have moved from training clinical teachers to also training basic science teachers. We intentionally follow the same methods developed for clinical teachers, and have found that they are equally useful for those in the basic sciences, including postdoctoral scholars.”

Is the course effective in cultures different from ours in the United States? Both Stratos and Skeff point out that it has been well received across many regions, including Asia, Europe, the Middle East, and South America.  Workshop participants have highlighted changes they made when they returned home.  For example, one Taiwanese participant explained to Stratos that he had adopted more direct methods of giving feedback, in contrast to his previously used indirect strategies, saying, “I went back as a revolutionary!”

Georgette A. Stratos

A Taiwanese surgeon reported to Skeff that he changed his teaching completely. “He now talks during surgery,” Skeff says, “whereas his prior approach to teaching a technical procedural skill had been to rely on learner observation. The surgeon discovered the utility of explaining what he was doing with his hands during the procedure.”

In an age of Internet everything, one wonders if the Stanford Faculty Development Center teacher training program will ever be available online. Neither of the co-directors sees that happening in the near future, but neither says it will never happen. “Sometimes faculty come with resistances or doubts about teaching improvement courses,” Skeff says. “So we had to build methods that were powerful enough to convince even the greatest skeptics.  And the methods we have found to be most effective are conducted face-to-face.”

Stratos believes moving online could fundamentally change the atmosphere that the in-person course creates: “I believe the emotional current that can help induce and support change comes from the excitement and trust that group members share as they go on the journey together.”

We’ll check back on that in another 30 years.