Design and Implementation of a Program Development Practicum for Faculty Education and Advancement of Clinical Programs

Round 1

Reviewer 1 Report

This is an interesting model.  You've described the sessions and the self-reported knowledge improvement.  For me, the more important finding was that the project proposals led to hospital investment of money.  I would consider adding some details about that as it is rather vague what investment looked like.  It was a also a bit unclear which of the 5 final projects were expansions of prior programs versus entirely new programs.  I would consider being more explicit

I think it would be important to include the size of the division--how many faculty were involved.  It appears 100% participated but did all attend every session?  Also, I found myself really wondering about how to implement the program given that twice a month 4 hours were blocked to be completely patient-free.  Who covered?  Then in lines 153-155 the authors drop that there was no impact on clinical productivity.  If the entire service shut down for 24 hours over the course of 3 months, how can this be true if faculty weren't instead asked to "make up" time.  I think readers will need more information to believe this statement.  

The second through fourth paragraphs of the discussion (line 169-193) provide some important new information about why you created the intervention.  I think a good portion of this information would be important to include earlier on in the paper, rather than presenting it new in the discussion.  No discussion about engaging faculty to reduce burnout was presented as rationale previously.  

Author Response

This is an interesting model.  You've described the sessions and the self-reported knowledge improvement.  For me, the more important finding was that the project proposals led to hospital investment of money.  I would consider adding some details about that as it is rather vague what investment looked like.  It was a also a bit unclear which of the 5 final projects were expansions of prior programs versus entirely new programs.  I would consider being more explicit.

• Of the five programs identified for the PDP, two were existing programs (Inflammatory Bowel Disease and Endoscopic Procedures) and 3 were new programs (Celiac Disease, transition of Care, and Integrative Health Clinic). [Page 3, Paragraph 1]
• The exciting consequence of the PDP was institutional investment in the Division as a whole to support these clinical programs. This investment included both personnel and material resources which the Division worked with the program leaders to best determine how to allocate this resource investment. We have included this information in the discussion session. [Page 4, Paragraph 1]

I think it would be important to include the size of the division--how many faculty were involved.  It appears 100% participated but did all attend every session?  Also, I found myself really wondering about how to implement the program given that twice a month 4 hours were blocked to be completely patient-free.  Who covered?  Then in lines 153-155 the authors drop that there was no impact on clinical productivity.  If the entire service shut down for 24 hours over the course of 3 months, how can this be true if faculty weren't instead asked to "make up" time.  I think readers will need more information to believe this statement.  

• Our Division has 9 physicians and 1 clinical psychologist who are on faculty. All faculty participated in the PDP. The PDP workshops were strategically designed to minimize impact on clinical service and scheduled on days with less ambulatory clinics with an average of 2-3 clinics that were cancelled for each session.  The inpatient service was covered by the Division Head.  It is not fully clear how clinical productivity was not impacted as faculty were not asked to make up time. A speculation is that faculty are responsible and found ways to see any patients needed via overbooking patients.

The second through fourth paragraphs of the discussion (line 169-193) provide some important new information about why you created the intervention.  I think a good portion of this information would be important to include earlier on in the paper, rather than presenting it new in the discussion.  No discussion about engaging faculty to reduce burnout was presented as rationale previously.  

• Thank you for this feedback. We have included some initial information in the introduction. [Page 2, Paragraph 1]

Reviewer 2 Report

The authors provide an account of their experience with the design, evaluation, implementation and success of program to train physicians in the development of interdisciplinary clinical programs. They accurately identified a general gap in physician training and experience, in that physicians are not traditionally trained to develop relevant leadership skills, and other more “business” skills such as finance and marketing.  They implemented a program to develop clinical programs and the training addressed these deficits in experience.  The strengths include the use of well defined theoretical framework for education.  The programs were developed within the context of the institutional needs.  Objectives and desired outcomes were well defined and pre- and post- training knowledge was assessed in a standardized fashion. 

A few considerations for inclusion in the paper:

1)      It is good that participation was mandatory and time was carved out of clinical obligations for the program.  I would recommend indicating how many faculty participated.  What was their rank? What was the rank of those selected to for completion in part 4, compared to those not selected?  Were there any barriers to full participation in the program or any faculty that did not complete?

2)      Five programs were identified for inclusion.  How many programs were excluded and why (systems issues, program training issues, funding, interdisciplinary resources…)?  Is there a plan to further develop the excluded programs in future endeavors?

3)      Program design and implementation pitfalls was mentioned in line 57 and 89.  What where the pitfalls?

4)      For those programs that were chosen and successful, apart from faculty training in the process, what institutional resources were essential to success?

5)      What is the feasibility and sustainability for future ongoing training for new hires?

6)      Figure 1: I don’t see a label for post workshop on the bar graph.

7)      Discuss applicability across other departments and institutions. 

Author Response

1. It is good that participation was mandatory and time was carved out of clinical obligations for the program.  I would recommend indicating how many faculty participated.  What was their rank? What was the rank of those selected to for completion in part 4, compared to those not selected?  Were there any barriers to full participation in the program or any faculty that did not complete?

• Our Division has 9 physicians and 1 clinical psychologist who are on faculty and range in range from full professor to assistant professor. All faculty participated in the PDP.  We eliminated barriers to participate by blocking of any conflicting clinic time and providing time to complete some of the work during the PDP workshop session.  We have included some clarification in the results section. [Page 3, Paragraph 3]

2. Five programs were identified for inclusion.  How many programs were excluded and why (systems issues, program training issues, funding, interdisciplinary resources…)?  Is there a plan to further develop the excluded programs in future endeavors?

• The programs identified for further development was based on faculty discussion and assessment of maturation of program idea or readiness for further development. Our plan is to provide faculty with an opportunity to revisit their clinical ideas any time but also host a mini-PDP workshop every few years to further allow for program development.  We have included this in the manuscript. [Page 5, Paragraph 4]

3. Program design and implementation pitfalls was mentioned in line 57 and 89.  What where the pitfalls?

• Some of the program pitfalls as shared by the PDP faculty include scope of project as some goals are too broad or aspirational, or the goals are inadequately scoped for administrators to understand the direct impact on hospital goals.

4. For those programs that were chosen and successful, apart from faculty training in the process, what institutional resources were essential to success?

• As a consequence of the PDP, we received investment of personnel and equipment for the Division’s clinical programs. We have included this information in the discussion session. [Page 4, Paragraph 1]

5. What is the feasibility and sustainability for future ongoing training for new hires?

• This is a great point. Our plan is to host a mini-PDP workshop every few years to further allow for program development.  We have included this in the manuscript. [Page 5, Paragraph 4]

6. Figure 1: I don’t see a label for post workshop on the bar graph.

• Thank you for catching this. We have updated the Figure. [Page 3]

7. Discuss applicability across other departments and institutions. 

• The curriculum content of the PDP should be relevant to faculty in academic institutions, especially those who do not have this type of training before. As such, in theory, the PDP should be applicable across institutions and we have shared the PDP model with other groups at our institution. [Page 5, Paragraph 3]

Round 2

Reviewer 2 Report

Revisions are acceptable.