A Scalable Advising Model for Part-Time, Distant Learners in Graduate Health Professions Education Programs

Abstract

Problem

There is a need within graduate health professions education (HPE) programs to align advising practices to support an increasing number of working adult learners, especially those studying part-time and from remote locations. Despite the recognized importance of the advisor–advisee relationship in graduate learner success, many advisors lack formal training and have to manage multiple completing priorities. Furthermore, a lack of established evidence-based practices for graduate HPE advising has left each program navigating advising independently.

Approach

The Department of Health Professions Education, Uniformed Services University, established a small cadre of faculty to serve as academic advisors (n = 7) in August 2018. This cadre uses an advising model based on 5 advising practices, called TOTAL Advising—train the advisors, onboard the learners, touch base frequently, annually review learners, and learner review. These advising practices are meant to provide a wrap-around support system to ensure learners feel empowered to fully engage in the program while managing the demands of their personal and professional lives. TOTAL Advising provides the framework needed to achieve 3 guiding beliefs: each learner is capable of completing the program, fostering community, and providing clear communication.

Outcomes

Between May 2020–May 2024, learners who completed a degree (n = 21) were interviewed about their advising experiences by a program evaluator after they graduated. The themes observed from these reflect the program’s 3 guiding beliefs. Additionally, from May 2018–May 2024, of the 574 learners who enrolled in the program, 568 (99%) graduated with a certificate or degree, only 6 (1%) were disenrolled.

Next Steps

The next steps for TOTAL Advising involve a comprehensive evaluation of the effectiveness of the training program for advisors and collaborating with other graduate HPE programs to share best practices in advising, discuss emerging challenges, and shape advising practices in the broader HPE community.

Problem

Graduate health professions education (HPE) programs have increasingly welcomed working adults, adapting their programs to accommodate part-time and remote learners with only 11% of programs left offering only a face-to-face format.¹ This shift to distance learning has boosted accessibility, flexibility, interactivity, and self-directed learning.² This shift has also meant that HPE programs have had to prioritize advising programs. In 2021, 48 out of 110 graduate HPE programs reported a dedicated faculty role for advising,³ highlighting the value of advising. The higher education literature supports this prioritization, finding the relationship between graduate learners and advisors is the most important factor in graduate learner success.⁴ Furthermore, advising has been an accreditation requirement for years, as represented by the Middle States Commission on Higher Education accreditation Standard IV 1c, which states that “orientation, advisement, and counseling programs to enhance retention and guide learners throughout their educational experience”⁵ should be provided. Meanwhile, the scholarly conversation around advising within graduate HPE has only recently begun.³ Despite the recognized importance of the advisor–advisee relationship in graduate learner success, many advisors lack formal training and have to manage multiple completing priorities.^6,7 Furthermore, a lack of established evidence-based practices for graduate HPE advising has left each program navigating advising independently.

In this article, we present part of our work to address the need for dynamic and engaged advising in the evolving landscape of graduate HPE programs, where an increasing number of working adults opt for part-time and remote learning. That is, this report describes the advising model and beliefs of one graduate HPE program tailored to part-time, distant learners.

Approach

In August 2018, the Department of Health Professions Education at the Uniformed Services University established a small cadre of faculty to serve as academic advisors (n = 3–5 from 2019 to 2023). These advisors support each learner (n = 233 from 2019 to 2023) through the completion of a certificate program or until the learner transitions to research advising if they are in a degree program. Without this group, these learners would be equally distributed across all faculty members in the department (n = 24), resulting in each faculty member advising 9–10 learners and needing continual training to ensure accurate and consistent advising. Our program offers multiple certificates and degrees; Supplemental Digital Appendix 1 (at http://links.lww.com/ACADMED/B623) shows the relationship between these various certificates and degrees.

In August 2018, we established an advising model for this cadre of academic advisors based on 5 advising practices (see below), represented using the acronym TOTAL Advising (Table 1). We believe this is a fitting name as our advising practices are meant to provide a wrap-around support system to ensure learners feel empowered to fully engage in the program, while managing the demands of their personal and professional lives. Supplemental Digital Appendix 2 (at http://links.lww.com/ACADMED/B623) provides a detailed overview of the advising process over the course of an academic year.

Table 1.

Activities Related to and Purpose of Advising Practices, TOTAL Advising Model, Department of Health Professions Education, Uniformed Services University

TOTAL advising practice	Activities	Purpose
Train the advisor	- New faculty members selected to be advisors attend a 1- to 2-hour in-person orientation session on advising procedures and requirements - New advisors shadow (e.g., copied on all emails, attend all advisor–advisee meetings) the current advisor for 6 months - All advisors reference an advising guide to learn how to advise - All advisors meet quarterly to share advising strategies and challenges	- Ensure new and current advisors receive the necessary training - Create a scalable advising system that can train new advisors and adapt to program changes - Develop community among advisors - Ensure consistent advising practices - Adapt advising practices to accommodate changes in the program
Onboard the learner	- Send introductory email to welcome the learner to the program and provide next steps - Advisors onboard learners to the program after matriculation via a series of activities including online introduction forms and synchronous sessions with program leaders - Cocreate with the learner a personalized program of study to map out coursework and program requirements - Communicate timelines and onboarding requirements (e.g., pre-coursework surveys and trainings) - Set up a one-on-one video call with each new learner (about 30 minutes)	- Ensure learners are set up for success in their first courses - Collect program data needed for evaluation purposes - Foster community - Provide clear communication and serve as a point of contact
Touch base frequently	- At least once a quarter, advisors reach out to each learner via email to share program updates, confirm upcoming courses, and review the learner’s progress - Advisors meet with learners via phone and video conference calls, as necessary	- Provide learners with up-to-date program information - Generate a sense of belonging as advisors reach out frequently - Provide clear communication
Annually review learners	- Each spring, the advisor hosts a video call with each learner to discuss their progress for the year - Learners complete program evaluations and reflect on their own learning before the call - A memo is signed by both advisor and learner to confirm progress and establish a remediation plan if needed after the call	- Document learner progress through required program benchmarks - Ensure clear communication around learner progress and establish a plan for remediation, if needed - Document learner progress for program leadership
Learner review	- Each quarter, advisors meet with program directors via a video call to review the status of each learner - Advisors raise programmatic concerns learners may be having or issues occurring in the program	- Ensure learner’s successful completion of the program - Communicate learner progress to leadership - Advocate for resource and/or policy changes for learners

TOTAL Advising is based on the following advising practices:

1. Train the advisor,

2. Onboard the learner,

3. Touch base frequently,

4. Annually review learners, and

5. Learner review.

TOTAL Advising provides the framework needed to achieve our 3 advising beliefs:

1. We believe each learner is capable of completing the program,

2. We believe in fostering community, and

3. We believe in providing clear communication.

Advising belief 1: Each learner is capable of completing the program

We aim to empower learners, give them agency, and support their goals. To do this, we embrace flexibility and responsiveness because adult distant, part-time learners may need to change their desired program or pace to balance personal and/or professional needs. Advisors help determine the certificate or degree that best meets the learners’ goals and map out the corresponding program requirements. This level of personalization requires broad and current knowledge of each program, which makes the advising process a better fit for a small subset of faculty members versus keeping all faculty trained. Learners successfully completing the program also hinges on advisors maintaining flexibility throughout the process.

Advising belief 2: Fostering community

Advisors emphasize that learners are part of a larger HPE community and that they can receive support through advising and from their HPE peers. An initial onboarding meeting provides advisors the opportunity to share the culture of the program through things as simple as using first names and helping the learner understand program expectations and requirements. Learners also have a chance to experience the community through 2 group synchronous orientation sessions: one on learning in an online space and another with the director of the program on our mission, strategic plan, and values. Throughout the academic year, advisors conduct individual meetings at regularly scheduled points of time (either in person or online).

Advising belief 3: Providing clear communication

Clear communication is a central part of our advising program’s philosophy. We aim to ensure all learners receive consistent messages around policy changes or program developments. This means we establish set times per year when advisors communicate changes to learners and when advisors meet with program leadership. During meetings with program leadership, advisors share updates on learners’ progress and the implementation of policy changes. These meetings provide opportunities for clear communication around how program policies are impacting learners and how leadership can support learners’ needs.

Scalability

We needed our advising model to be scalable, so that it could expand from a handful of learners in the first year of the program (2016–2017) to over 200 learners as of 2023–2024, while keeping to 20% (n = 7) of department faculty members being engaged as academic advisors. The need for a scalable advising model became apparent as our program rapidly grew in number of learners and in the variety of certificates and degrees offered, and as the global geographic diversity of our learners increased from 2017 to 2024. In Table 2, we provide a breakdown of the enrollment numbers for our different certificate and degree programs from 2019 to 2023.

Table 2.

Enrollment Numbers, TOTAL Advising Model, Department of Health Professions Education, Uniformed Services University, 2019–2023

Health professions education certificate or degree program	No. of learners
Certificate
Introduction to Foundations in Health Professions Education (I-FHPE)	80
Foundations in Health Professions Education (FHPE)	69
Degree
Masters of Education in Health Professions Education (MEd-HPE)	28
Masters of Health Professions Education (MHPE)	47
Doctor of Philosophy in Health Professions Education (PhD in HPE)	9
Total	233

The Uniformed Services University Human Research Protections Program reviewed the program and determined it did not meet the definition of research in accordance with 32 CFR 219.102(1).

Outcomes

The 3 advising beliefs (see above) formed the pillars of our advising approach and informed our TOTAL Advising model (see Table 1). As part of our model, every graduating learner (n = 321) was surveyed about their experience right before they exited the program between May 2020 and May 2024. During the same time period, those learners who completed a degree (n = 21) were also interviewed about their advising experiences by a program evaluator after they graduated; those who completed a certificate were not interviewed due to limited resources.

To protect learner’s identities, qualitative data were deidentified, and learners’ feedback was paraphrased by the evaluator in submitted reports. H.M. and P.C.M. reviewed all of the feedback from degree learners’ exit interviews and iteratively analyzed the data for themes related to their experiences with the program’s advising practices. To cross-check observed themes, we also included other data, including graduation rates, frequency of meetings, progress reports, and learner handbooks, in our analysis. The themes observed from the data reflect the program’s 3 guiding beliefs as summarized below.

The interviews were conducted by our manager of program evaluation (Elizabeth King), who is trained in evaluation strategies, including interviewing techniques, via on-the-job training. To practice reflexivity throughout the study, the team reflected and shared their own experiences with advising. Analysis was primarily conducted by H.M. and P.C.M., and circulated to the authorship team for feedback. H.M. is an academic advisor and team lead. She serves on the programs’ leadership team as a vice chair of student affairs. Her research training includes extensive studies using qualitative research methods. P.C.M. is an academic adviser, teacher educator, and qualitative researcher who studies how pedagogical philosophies and practices affect learners’ educational experiences. The other authors (A.W., J.M., S.J.D.) have all served as academic advisors within the program for at least 2 years and/or have PhDs focusing on qualitative research methods. S.J.D. is also an MD and PhD and serves as the chair of the department.

Scalability

Scalability was an important factor for the model. In 2019, our ratio of graduates to advisors was 5:1. Over the course of the next 4 years, our ratio rose to an advisor–graduate ratio of between 15:1 and 19:1 as seen in Table 3. The model’s scalability has afforded us the opportunity to expand via partnerships with other programs. For example, since our start, we have collaborated with numerous learner groups, including adding a certificate track for medical students (about 70 students annually, or about 1/3 of the graduating class of medical students).

Table 3.

Ratio of Advisors to Graduates, TOTAL Advising Model, Department of Health Professions Education, Uniformed Services University, 2019–2023

Learner’s graduation year	No. of advisors	No. of graduates	Ratio
2019	3	14	5:1
2020	4	41	10:1
2021	4	59	15:1
2022	5	94	19:1
2023	5	73	15:1

Outcomes of advising belief 1: Each learner is capable of completing the program

From May 2018 to May 2024, of the 574 learners enrolled in the program, 568 (99%) graduated with a certificate or degree, only 6 (1%) were disenrolled. Data indicate learners felt academic advising helped ensure the completion of their respective programs. Of 321 learners that completed the exit survey between May 2020 and May 2024, a large majority of learners (248, 77%) responded that academic advising was at least moderately helpful in completing the HPE program with 100 (31%), 100 (31%), and 48 (15%) marking it extremely, quite, and moderately helpful, respectively. Many learners attributed successful completion of their program to their advising experience. Some learners especially appreciated how their advisors mapped out their program of study such that it was “very doable.” For example, learners noted that with regard to course scheduling, advisors were able to tailor program experiences to meet their unique needs. One learner noted that this was particularly helpful to her because of her “struggle with time commitment.” Many learners faced challenges with time commitments as the majority of them also worked as clinicians, residents, program directors, etc.; however, they noted that advisors were responsive and helped them overcome obstacles, preventing potential setbacks. Learners shared that advisors were flexible and tailored their support to the learner’s individual needs, ensuring learners were able to navigate the program successfully. Flexibility manifested in a variety of formats, including initiating the process of a leave of absence, adjusting learners’ course schedules in the middle of an academic term, or operating as a liaison between learners and instructors. Some learners attributed the successful completion of the program to how advising helped keep them accountable (e.g., kept them on task). Others indicated advising helped them make programmatic decisions, such as selecting their courses, which made sure that learners were not “[set] up for failure.” Indeed, one learner indicated that had it not been for her advisers’ support and flexibility, she would not have been able to finish the program.

Outcomes of advising belief 2: Fostering community

One learner expressed that she never felt like she was isolated despite participating remotely in her studies. Some learners indicated that they faced self-doubt over going back to school; for example, as our evaluator noted of one learner, “She did not realize that becoming a learner would put her in a vulnerable space, as a person with an established reputation.” In those instances, learners communicated the importance of advisors in helping them feel like they belonged and that they were able to get the support they needed when they needed it. Another learner conveyed in the exit interview that “the biggest value of HPE is the people that then become resources for you.”

Outcomes of advising belief 3: Providing clear communication

Communication strategies, such as the learner handbook, personalized program of study documents, and standardized email communication templates, contributed to consistent communication messages. In exit interviews, a key part of providing clear communication was the timeliness of advisors’ responses. When advisors were not readily available to communicate, learners noticed, as was the case with the one learner who reported an issue around problems with “availability and delays.” Otherwise, when learners did bring up communication, they mostly spoke of their advisors’ communication efforts as very responsive, engaged, and flexible. For some learners, conveying “reasonable timelines and expectations” were particularly important, and for others, it was the ability to be “good at giving constructive feedback” and communicating “expectations [that] were very clear” to make sure learners were getting the most out of their program. Providing learners with clear communication sometimes overlapped with other important advisor roles, such as communication that helped learners feel like they were part of a larger community or that helped ensure learners’ successful completion of their programs.

Next Steps

To address the challenges of advising part-time and distant learners, we developed a scalable advising model based on 3 guiding beliefs: that each learner is capable of completing the program, fostering community, and providing clear communication. These 3 beliefs are reflected in each of the TOTAL Advising practices: train the advisor, onboard the learners, touch base frequently, annually review learners, and learner review.

Our advising beliefs and model are aligned with Schroeder and Terras’s 5 identified themes of good graduate advising: (1) programmatic guidance, (2) trust, (3) individual, (4) important, and (5) immediate/electronic communication.⁸ Our advising belief 1 supports empowering learners to complete the program best suited to their personal needs. This aligns with Schroeder and Terras’s work that states learners need good advising to guide them through their program. Good advisors see learners as individuals and provide individualized advising.⁸ Advising belief 2 focused on fostering community. Building community helps the advisor–advisee dyad form trust, another of Schroeder and Terras’s 5 identified themes of good graduate advising.⁸ These meaningful connections can lead to mutual respect, which is a facilitator of good graduate advising relationships.⁹ Lastly, providing clear communication aligns with the last of Schroeder and Terras’s 5 identified themes: good advisors are readily available and immediate in response, such that advising is timely.⁸ It also aligns with another facilitator of good advising relationships—open communication—and fits in with graduate learners’ expectations of proactive, timely, and knowledgeable advising.^9,10

The next steps for the TOTAL Advising program involve a comprehensive evaluation of the effectiveness of the training program for advisors, emphasizing their satisfaction and overall effectiveness in supporting learners. Special attention will be given to the professional development and well-being of advisors. Additionally, we envision collaborating with other graduate HPE programs to share best practices in advising, to engage in dialogue around emerging challenges, and to shape advising practices in the broader HPE community. By addressing these recommended next steps, the program can enhance its advising model, proactively address new challenges, and ensure continued success in supporting learners in the evolving landscape of HPE.

The TOTAL Advising model can be adapted to a variety of settings, including in-person programs, such as fellowships and postdoctoral programs. This model could be particularly beneficial to deans, undergraduate medical education leaders, and graduate medical education leaders, such as program directors, as it provides valuable insights into effective methods for online advising in HPE programs. Given the global expansion of HPE programs and the ongoing adaptation to online formats, this report can help translate best practices into actionable strategies for improving faculty–learner interactions and advising systems.

This innovative advising model is unique in its scalability for supporting part-time distant learners and adaptable for use in tenure and promotion processes, academic planning, and career development for both learners and faculty. By providing structured yet flexible guidance, this model could serve as a pathway for other HPE programs, allowing them to similarly enhance learner outcomes through consistent and scalable advising practices. To expand its utility, future collaboration with other graduate programs could help refine the model for broader academic and professional applications.

In our graduate HPE program, we have implemented a unique approach to advising that aims to foster a sense of belonging and ensure program completion for our learners. This model is ideal for online, part-time programs and emphasizes the importance of creating a supportive environment with personalized advising practices. Our model is scalable and adaptable to multiple settings. We hope that sharing our advising model will allow other HPE or graduate medical education programs to adopt it for their own purposes.