Abstract Title | Faculty development strategy for undergraduate medical teachers to enhance clinical teaching skills and to change clinical practice: A case study of a new approach to mechanical back pain


  1. Jean Hudson
  2. Jana Bajcar
  3. Hamilton Hall


3JJ Staff development


Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Trillium Health Partners, Mississauga, Ontario, Canada


The University of Toronto Faculty of Medicine has a four year undergraduate medical program (two years pre-clerkship and two years clerkship) with class sizes of 259 students dispersed across a large geographic area. There is extensive clinical skills education and training in pre-clerkship in two courses called Art and Science of Clinical Medicine (ASCM).

The approach to assessment of patients with mechanical back pain is taught to both pre-clerkship and clerkship students.

When a new approach to clinical practice is introduced into medical teaching, the faculty must have confidence in that approach, understand it thoroughly and be willing to incorporate it into their own practice to provide an aligned and authentic learning experience.

The Ontario government introduced a new provincial strategy for the management of patients with mechanical back pain which was added to the University of Toronto undergraduate curriculum.

Although the majority of clinical skills teachers see patients with back pain, most had never used, much less taught, this new clinical approach. Also many of the tutors never had to teach assessment of patients with mechanical back pain before.

Our purpose was to support faculty in teaching undergraduate medical students a new innovative clinical method for assessing patients with mechanical back pain. Given that for many of the faculty the clinical approach was new both in terms of teaching and in terms of their clinical practice, we set out to develop an approach that would make most efficient use of tutor’s time; “two for one strategy” supporting tutors to “learn to do” as they “learn to teach”.

Summary of Work

1. We used a collaborative and systematic instructional design approach to analyze, design, develop, implement and evaluate the faculty development strategy (See Figure 1). The design and development team included the content expert (Hamilton Hall), ASCM Course Director (Jean Hudson), Faculty Development Director (Jana Bajcar), and early in the process we obtained additional input from an Educational Developer (Cleo Boyd) who also has expertise in Rhetoric, as we needed to be sensitive how we integrate multiple perspectives into the design.   

Figure 1: Instructional Design Model (Morrison, Ross, and Kemp 2004)


2. Provided the basic content on the new clinical approach, which uses four patterns of symptoms and signs to classify mechanical back pain, via a PowerPoint voice over.

3. Designed e-learning teaching materials- 3 videos. Developed an instructional video demonstrating a mock teaching scenario with the student as an active participant within the teaching. This illustrated both the application to clinical practice and provided a role-modeled approach to teaching.

4. Designed the face-to-face faculty development teaching delivered by content and teaching experts.

5. Used the same instructional materials for students and for faculty and embedded it in "teaching to teach" role modelling.

6. Offered the faculty development session for pre-clerkship and clerkship teachers.

7. Evaluated the teacher’s experience and perception of the faculty development session.

Summary of Results

Development of a Model to Design the Approach

This case study illustrates how a course director, content expert, and faculty developer, collaborated to design, implement and evaluate a complex faculty development intervention to ensure alignment between teaching and new best clinical practice. Through this experience, we developed a conceptual model that we call the 2 for 1 Model of Faculty Development for Clinical Skills Teaching (see figure 2).

Figure 2: The University of Toronto 2 for 1 Model of Faculty Development for Clinical Skills Teaching


Development of the Faculty Development Strategy and Instructional Materials that included:

a) Instructional videos on how to use/do and teach the framework, history and physical exam


b) An interactive face-to-face teaching session

c) The Ontario Government Practice Change toolkit



Total: 104 faculty participated in six sessions

  • 51 attended four pre-clerkship sessions
  • 53 attended two clerkship sessions

Figure 3: Session Attendance


Evaluation of Pre-Clerkship Teachers: Prepared to Teach and Change own Clinical Practice

  • 100% of the pre-clerkship teachers felt the faculty development session prepared them to teach the new approach to mechanical back pain.
  • 81% of those teachers felt that what they learned resulted in a change in their practice.

Figures 4-7: Three months post faculty development session for pre-clerkship teachers (response rate 21/51 attendees)


Evaluation of Clerkship Teachers: Self-Rated Confidence to Teach

The overall average confidence to teach for clerkship teachers increased from 2.9 to 4.2 on a 5 point Likert scale.

Figure 8: Teaching Confidence Pre- and Post-Session


Figure 9: Sample of Confidence Scale


Figures 10-14: Change in Confidence to Teach Four Key Areas of the Back Pain Exam by Clerkship Teachers


Description of Faculty Experiences: Theme 2 for 1

  • “Great session. Not only as faculty development to aid our teaching but changed my practice as well”
  • “Practical questions and exam skills to transition into clinical work as well as teaching”
  • “It is very helpful to know current approaches and be prepared for teaching the students. Serves as a refresher for practice and enhances teaching skills at the same time- two for one”

Lessons Learned

  1. It is critical to foster collaborative relationships and create conducive environments in which faculty development, curriculum design and clinical practice can align and to implement best practices in each of these three domains. This integrated approach can open unexpected windows of opportunity and create timely and efficient solutions.
  2. It is important to create faculty engagement in faculty development by selecting common practice problems and making the topic and approach meaningful to both their clinical practice and their teaching.
  3. Acknowledge that the need for practice change can be uncomfortable for both novice and expert teachers. Housing the need for practice change within a “teaching to teach” model may make it less threatening. Communities of practice can emerge more naturally in a familiar environment.
  4. Instructional video based on a triad of teacher, student, and patient can provide a multipurpose resource instructing teachers and students how to practice and teachers how to teach. All purposes are aligned in one video (3 for 1).
  5. The 2 for 1 faculty development approach requires, a “2 for 1” instructor who is a master practitioner and master teacher. This enhances knowledge translation into practice by creating the key expert clinical credibility.
  6. “Teaching to teach” a new clinical practice is a critical element to create a sustained practice change. It promotes:
  • adopting new best practices earlier than might naturally occur
  • more rapid uptake and supports change
  • motivation and sustainability
  • a change in physician behavior with the goal of changing practice
Take-home Messages
  • Given the challenges to implement clinical practice change, a 2 for 1 Faculty Development strategy can be an effective means to support development of specific clinical teaching skills and stimulate a corresponding change in clinical practice.
  • Next step – it would be ideal to assess this faculty development approach more formally by measuring actual clinical change in practice. The challenge will be to isolate and detect the effect of faculty development since clinical practice is impacted by many different factors. This is a work in progress.
  • Hall H, McIntosh G, Boyle C: Effectiveness of a Low Back Pain Classification System. The Spine Journal 2009; 9: 648-57.
  • Fourney DR, Dettori JR, Hall H, Hartl R, McGirt MJ, Daubs MD: A Systemic Review of Clinical Pathways for Lower Back Pain and Introduction  of the Saskatchewan Spine Pathway.  Spine 2011; 36(21S): 164-171.
  • Hall H: Effective Spine Triage: Patterns of Pain. The Ochsner Journal 2014; 14(1): 88-95.

We would like to thank Prof Cleo Boyd, Educational Developer, Robert Gillespie Academic Skills Centre, University of Toronto at Mississauga for her expertise and facilitation of our collaborative design meeting.

Note: This project has been exempt from Research Ethics Review at the University of Toronto and any conclusions or learnings were not gained through research (for wide external application) but through a QI/QA project carried out in the local context.

Summary of Work
Summary of Results
Take-home Messages
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