Teaching and Learning in Medicine, 25(S1), S57–S61 C 2013, Taylor & Francis Group, LLC Copyright ISSN: 1040-1334 print / 1532-8015 online DOI: 10.1080/10401334.2013.842913
Future Focus for Professional Development Nicole K. Roberts Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois, USA
Lisa D. Coplit Associate Dean for Assessment and Faculty, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
Professional development has evolved from individually focused sabbaticals and professional leaves to institutionally focused programs with an interest in developing faculty members’ ability to teach in various environments as well as to succeed in the many endeavors they undertake. We address various issues related to professional development in the medical school arena. Professional development in medical school takes place in a context where faculty are stretched to engage in research and service not only for their own sake but also to financially support their institutions. This obligates professional developers to acknowledge and address the environments in which teaching faculty work, and to use approaches to professional development that honor the time and efforts of teaching faculty. These approaches may be brief interventions that make use of principles of education, and may include online offerings. Professional development will be most effective when professional developers acknowledge that most faculty members aspire to excellence in teaching, but they do so in an environment that pushes them to address competing concerns. Offering professional development opportunities that fit within the workplace environment, take little time, and build upon faculty’s existing knowledge will assist in enhancing faculty success. Keywords
professional development, special issue
INTRODUCTION Professional development in higher education has evolved from a focus on individual sabbatical leaves and professional development seminars off site to a current focus on in-house and external programs that support institutional quality and change.1 Faculty in medical education are adapting to several major directional shifts including changes in educational approaches and technologies,1 changes in medical care and accreditation requirements,2 and the ever-increasing focus on teaching patientcentered clinical care and communication.3 Likewise, professional development in medical education continues to evolve to embrace the changing needs of its faculty. In 2010, the Carnegie
Correspondence may be sent to Nicole K. Roberts, PO Box 19681, Southern Illinois University School of Medicine, Springfield, IL 627949681, USA. E-mail: [email protected]
Foundation for the Advancement of Teaching put out its second call for reforms to improve the preparation of physicians, the first being the Flexner Report in 1910 (see the lead article of this issue of Teaching and Learning in Medicine for a detailed discussion.) They based their recommendations on site visits of 11 medical schools and three teaching hospitals and came up with the four I’s: 1. Standardization and Individualization—standardization of learning outcomes and individualization of the learning process 2. Habits of Inquiry and Improvement—of both their own practice and improvement of systems 3. Identity Formation—around the professional and ethical roles of being a physician 4. Integration—of basic, clinical, and social sciences; of their varying roles as a physician; and of patient care teams (interprofessional education)4 To achieve these goals for medical students, the authors describe the need for faculty training in mentorship, curriculum design, competency-based learner assessment, feedback, learning climate, and the hidden curriculum. ENVIRONMENTAL PRESSURES ON FACULTY DEVELOPMENT As professional developers work to create valuable programs for teaching faculty, one imperative they must recognize are the financial tensions inherent in clinical and basic science faculty roles. It is clear that states are supplying less and less funding for higher education, tuition is quickly reaching maximum capacity, national grant funding is diminishing and more people are competing for it, and donors have many causes within academic medical centers needing their support. Clinical faculty are thus under pressure to produce clinical revenues to support the educational enterprise, and basic science faculty are under pressure to acquire and maintain grants, also used to help support the educational enterprise. In this milieu, the professional developer faces the challenges of making education skills
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training feasible while allowing clinical and basic science faculty to be successful, thus ensuring faculty are able to maintain enough productivity to allow the entire enterprise to exist. In 2010, a position statement forecasting the needs for expert clinical teachers was published by the Alliance for Academic Internal Medicine (AAIM), the Report on Master Teachers and Clinician Educators. Responding to the competing demands of research and patient care, they describe the need for full time “master teachers.” These faculty would develop a broad range of expertise within medical education, spend most of their time teaching in patient care settings, engage in educational scholarship, serve as clinical administrative leaders, and mentor the next generations of master teachers. One of the articles in the report focuses on the critical role of professional development in shaping their vision of the master teacher’s expertise. They recommend extensive training ranging from learning theory, curriculum design, and learner assessment to leadership, mentoring, and educational research. Although the breadth and depth of the master teacher’s expertise, as described in the AAIM publication, pushes the limits of what is currently feasible, it is also relevant only for a small proportion of clinical teachers. If this model were adopted, professional development would be targeted toward a select few at each institution, and would be intensive, similar to obtaining an advanced degree in education. What we face now is the need to reach several hundred teaching faculty at each institution and focus on highly relevant and efficient educator skills training.5 Several articles in the professional development literature published in the last 10 years support the idea that programs focused on professional development are generally beneficial.6,7 Steinert et al.’s systematic review of faculty development initiatives for teaching effectiveness confirms that learning theories supporting the pedagogical choices for medical student training are important for effective faculty programs. They found programs that promote effectiveness include the use of experiential learning, the provision of feedback, effective peer and colleague relationships, the use of diverse educational methods, and a curriculum based on principles of teaching and learning.8
CONTENT OF PROFESSIONAL DEVELOPMENT Numerous authors have proposed possible content for professional development in medical school. Most frequently they focus on approaches to teaching, including models for teaching, and helping participants understand how learning occurs. An exciting addition to the content has been information about the neurobiology of learning. But authors have also advocated for teaching biomedical informatics,9 appropriate and educationally supported uses for instructional technology10 patient-centered care,11 a multitude of suggestions for professional developers to consider. However, professional development that focuses on teaching and learning, regardless of where that teaching and learning occurs, should focus on some fundamentals about the nature
of learning, and assist teachers in figuring out how to apply those fundamentals to their teaching environment. That is, if a teacher is teaching in an inpatient clinical setting, how might he use principles of education to guide his teaching behaviors? Likewise, if a teacher is teaching in a large lecture environment, how might knowledge of how students learn affect the way she designs the educational intervention? As Searle and colleagues suggest, we continue to learn about how learning occurs.12 It will be important for faculty developers to follow those developments and use them both to guide how they provide professional development and what they teach faculty about teaching and learning. For instance, providing experiential approaches for faculty learning about teaching reinforces one of the theories of learning that guides effective teaching.13
ROLE OF THE FACULTY DEVELOPER The aspirations for faculty attitudes, attributes, knowledge, and skills described by Hatem et al.14 help to define the outcomes we seek for all medical educators. We propose that professional developers guide faculty toward those goals by assessing their current strengths and building upon them, taking a stance that those who choose to teach wish to teach well. This may mean that we as faculty developers work with them to achieve these goals with a variety of methods and timelines. A guiding question for faculty developers could be, “What can we do to understand the workplace environment in which faculty find themselves, and how can we help them find the tools to teach in the most efficient and effective way possible within that environment?” In addition, the professional development faculty might provide assistance in recognizing elements of the professional environment that are suboptimal, and assist in developing tools to rectify existing problems. Of utmost importance, though, is to maintain respect for the faculty’s reality and perspective on the impact of our own contributions. There is no point in attempting to impose a series of “shoulds” on a faculty overwhelmed by the “musts.” The role of the professional developer is to build on a faculty’s strengths and enthusiasm, to provide inroads into how one might teach effectively in his or her own context, and to suggest mechanisms for making the environment amenable to such teaching. As an example, we may provide a minimal role in helping faculty adopt a new technology but provide a central role in assisting them deploy it for the best educational use. It is also imperative that professional developers operate from an assumption that faculty members enter their programs with inherent or previously acquired strengths in teaching. Just as in problem-based learning, the interest of the group is to elicit and build upon the student’s prior knowledge about the problem at hand, so too can faculty members’ embedded, conscious, and subconscious models of teaching and learning be elicited and built upon. No learner, faculty or student, is a tabula rasa. The professional developer can consider the question, “How is the model I propose going to truly be applied in practice and what
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is the expected effect of that modification?” This honors the lived experience of educators while providing them tools they can use. If we trust that faculty who have taken on the obligation to teach want to succeed at doing so, we build upon their strengths. If we are sufficiently attentive to the environment in which they are obligated to teach and work, we can help them do so within the constraints of their situation while helping them explore whether and how their situation needs to change to allow success in all the realms they have been assigned or have decided to take on. This approach suggests that we may need to rethink the logistics of faculty development as well. Many institutions provide centralized faculty development workshops, requiring those are being “developed” to come to those who provide the development. Another common belief is that more is better—more time, more workshops, more talking. Instead, if we provide faculty with the most salient advice we can improve the efficiency and effectiveness of our interventions. This may mean brief, focused interventions, or making interventions available in multiple formats and forms, including online.8 Similarly we will achieve more if we avoid imposing “shoulds” on the faculty developers who face their own “musts.” Our focus is best realized where our educational expertise coincides with the faculty member’s need to know.
tervention, surgeons used the teaching model to teach a fellow surgeon about an element of their most commonly performed operation. In the trauma intervention, learners participated in three simulated trauma resuscitations: one preintervention to highlight any existing problems and two post, the first to solidify skills learned and the second to test the maintenance of the skills. All responded to problems the target audience identified. All entailed substantial investigative work on the part of the professional developers to understand the source of the problem and to assess what the audience would consider to be an effective solution. All proposed simple, memorable models for guiding future practice that faculty could adjust to meet their current needs.
BRIEF INTERVENTIONS THAT WORK We propose that the profile of effective professional development opportunities may be changing. If we can provide brief interventions for teaching faculty that provide them with new skills to either improve their teaching or their environment, we are fulfilling our goals while honoring the time commitments and acknowledging their working environment. O’Sullivan and Irby suggested that research in faculty development can take cues from literature on workplace learning.15 We concur, and also suggest that the practice of professional development can take place in situ, where teachers teach, whether in clinical settings or in classroom settings. For instance, one 30-min intervention focused on teaching in the operating room changed surgeons’ teaching behavior from the typical instrumental approach16 to a more deliberate approach to teaching.17,18 The changes in teaching behavior, reported by residents, were sustained 6 weeks after the intervention. Another intervention, 1 hour and 15 minutes, assisted trauma personnel in addressing communication and leadership issues in the trauma bay.19 Many of the changes taught in the intervention were sustained 3 weeks postintervention. A third intervention, a 5-min explanation plus a pocket card, improved the quantity and quality of feedback faculty gave Internal Medicine residents.20All of these interventions shared characteristics of what we know works in education. The trauma and the teaching in the operating room interventions had elements of interactivity, with opportunities to test the skills learned in the workshop. In the teaching in-
We know that most medical schools are fortunate if they have a small number of faculty with advanced degrees in education or faculty developers with sufficient expertise in education. If we are to ensure every faculty member at each institution receives instruction in these educational areas, most institutions are faced with reaching hundreds of geographically scattered faculty with widely varying levels of need. If we strive to develop and require minimum teaching competencies for faculty, those with expertise become more stretched for time and resources in trying to reach all faculty. Online faculty development is not the single answer to these problems but will be an essential tool in providing standardized content to educator faculty while allowing for some individualization of learning. One common thread found in the faculty development literature is the importance of applying learning theory to the professional development of faculty. Robin et al.10 reminded us that e-learning can be an effective, theory-based approach to providing education in multiple contexts. Collaborative tools such as wikis, blogs, discussion boards, and webinars provide interactivity and allow faculty from distant sites to exchange ideas. Such tools are now ubiquitous and easily accessible. Simulations such as screen-based virtual learners provide opportunities for skill practice and feedback, both of which we know to be central to learning. Freestanding topic-based teaching modules can provide efficient delivery of content for multitudes of faculty and can incorporate reflection and active learning exercises.
ONLINE PROFESSIONAL DEVELOPMENT Online professional development courses and resources for health professions faculty are promising adjuncts to traditional teaching formats and fulfill several needs for institutions and faculty. The Liaison Committee on Medical Education standard FA-4 states, Faculty members involved in teaching, course planning, and curricular evaluation should possess or have ready access to expertise in teaching methods, curricular development, program evaluation, and medical student assessment. Such expertise may be supplied by an office of medical education or by faculty and staff members with backgrounds in educational science.
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Online learning opportunities are not necessarily superior to face-to-face teaching formats, but they assist in overcoming significant barriers like time and distance, and can allow for more individualization of instruction.10 Organizations such as FAIMER (Foundation for Advancement of International Medical Education and Research) and advanced degree programs in medical education are examples of educator development programs that are already using various online learning as a supplement to in person teaching. There are other less tangible benefits to exploring learning technologies for faculty development. Giving faculty the opportunity to function as learners in a world of expanding instructional technologies, allows them to gain the perspective of their learners and identify methods of improving the use of these technologies. In addition, we cannot invite the best experts and facilitators to deliver every faculty development program at our own institutions. With appropriate resources and a centralized platform for delivering online teaching sessions, we can bring together the best faculty developers to create high-quality products. This addresses the greatest barrier to the creation of institutionally based online interactive learning modules that can track use and users, which is access to resources. We propose that the creation of a collaborative repository of such products, which MedEdPORTAL cannot support at this time, could serve as valuable and affordable resources for institutions faculty development curricula. Last, we cannot forget the greatest imperative for the incorporation of technologies into the faculty developers’ lexicon, which is the future expectations and demands of faculty. As Robin10 explained, the bulk of medical educator faculty have incorporated technology into their lives to varying degrees but this generation of medical students are “digital natives,” a term coined by Prensky,21 expecting the use of technology in their learning. This divide may explain why online faculty development options are only beginning to gain traction, because the end user has not demanded access to them. Faculty development needs will inevitably catch up with the technology by which our trainees are learning, if not now, then soon, when the “digital natives” constitute the faculty majority. OUTCOMES Although there are various levels of evaluation identified in the literature,22,23 it is admittedly difficult to assess professional development programs robustly. O’Sullivan and Irby15 suggested that the workplace learning literature offers suggestions on how we might integrate professional development into the workplace, which is an essential stance to ensuring that professional development is relevant and applicable to the particular environment in which faculty find themselves. The outcomes we study should be learner outcomes and faculty (our learners) outcomes. Patient outcomes are too far downstream to attribute solely to an educational intervention unless our education is focused on a clinical practice.
CONCLUSION We propose that professional developers can serve essential roles in ensuring effective, efficient education for medical students, and effectiveness and success for faculty members. We propose that effective educational interventions do not have to be “y’all come” workshops where faculty are taken from their environments in order to learn skills outside of their professional context, but instead can take place within context. Further, educational interventions do not have to be lengthy. In fact, effective interventions can be as short as 5 min as long as they address problems felt by faculty in a way that faculty can actually use in practice. Nor do interventions have to be in-person. Online interventions can provide faculty with “just in time” answers to questions about teaching and learning and can help address the issues that many medical schools face including lack of time and dispersed faculty. These evolutions in medical education professional development may allow faculty developers to more readily and effectively address the needs of their faculty.
REFERENCES 1. Austin AE, Sorcinelli MD. The future of faculty development: Where are we going? New Directions for Teaching and Learning 2013;133:85–97. 2. Hafler JP, Ownby AR, Thompson BM, Fasser CE, Grigsby K, Haidet P, et al. Decoding the learning environment of medical education: A hidden curriculum perspective for faculty development. Academic Medicine 2011;86:440–4. 3. Frankel RM, Eddins-Folensbee F, Inui TS. Crossing the patient-centered divide: Transforming health care quality through enhanced faculty development. Academic Medicine 2011;86:445–52. 4. Cooke M, Irby DM, O’Brien BC. Carnegie Foundation for the Advancement of Teaching. Educating physicians: A call for reform of medical school and residency.1st ed San Francisco, CA: Jossey-Bass, 2010. 5. Geraci SA, Babbott SF, Hollander H, Buranosky R, Devine DR, Kovach RA, et al. AAIM report on master teachers and clinician educators Part 1: Needs and skills. American Journal of Medicine 2010;123:769–73. 6. Skeff KM, Stratos GA, Mount JFS. Faculty development in medicine: A field in evolution. Teaching and Teacher Education 2007;23:280–5. 7. Clark JM, Houston TK, Kolodner K, Branch WT, Levine RB, Kern DE. Teaching the teachers—National Survey of Faculty Development in Departments of Medicine of US Teaching Hospitals. Journal of General Internal Medicine 2004;19:205–14. 8. Steinert Y, Mann K, Centeno A, Dolmans D, Spencer J, Gelula M, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Medical Teacher 2006;28:497–526. 9. Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: Changing what physicians need to know and how they learn. Academic Medicine 2011;86:429–34. 10. Robin BR, McNeil SG, Cook DA, Agarwal KL, Singhal GR. Preparing for the changing role of instructional technologies in medical education. Academic Medicine 2011;86:435–9. 11. Frankel RM, Eddins-Folensbee F, Inui TS. Crossing the patient-centered divide: Transforming health care quality through enhanced faculty development. Academic Medicine 2011;86:445–52. 12. Searle NS, Thibault GE, Greenberg SB. Faculty development for medical educators: Current barriers and future directions. Academic Medicine 2011;86:405–6. 13. Zull JE. Key aspects of how the brain learns. New Directions for Adult and Continuing Education 2006;110:3–9.
FUTURE PROFESSIONAL DEVELOPMENT 14. Hatem CJ, Searle NS, Gunderman R, Krane NK, Perkowski L, Schutze GE, et al. The educational attributes and responsibilities of effective medical educators. Academic Medicine 2011;86:474–80. 15. O’Sullivan PS, Irby DM. Reframing research on faculty development. Academic Medicine 2011;86:421–8. 16. Roberts NK, Brenner MJ, Williams RG, Kim MJ, Dunnington GL. Capturing the teachable moment: A grounded theory study of verbal teaching interactions in the operating room. Surgery 2012;151:643–50. 17. Roberts NK, Williams RG, Kim MJ, Dunnington GL. The briefing, intraoperative teaching, debriefing model for teaching in the operating room. Journal of the American College of Surgeons 2009;208:299–303. 18. Radford L, Roberts NK, Schwind C, Williams R, Dunnington G, Kim MJ. Evaluation of the briefing intraoperative teaching and debriefing (BID) model for teaching in the OR. Central Group on Educational Affairs, 2011.
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19. Roberts NK, Williams RG, Schwind CJ, Sutyak JA, McDowell C, Griffen D, et al. The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings. American Journal of Surgery. In review. 20. Peccoralo L, Karani R, Coplit L, Korenstein D. Pocket card and dedicated feedback session to improve feedback to ward residents: A randomized trial. Journal of Hospital Medicine Oct 28 2011. 21. Prensky M. Digital natives, digital immigrants. On the Horizon. 2001;9:1–6. 22. Kirkpatrick DL. Evaluation of training. In RL Craig, LR Bittel, eds. Training and development handbook (pp. 87–112). New York: McGraw-Hill, 1967. 23. Belfield C, Thomas H, Bullock A, Eynon R, Wall D. Measuring effectiveness for best evidence medical education: A discussion. Medical Teacher 2001;23:164–70.
Future Focus for Professional Development Nicole K. Roberts Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois, USA
Lisa D. Coplit Associate Dean for Assessment and Faculty, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
Professional development has evolved from individually focused sabbaticals and professional leaves to institutionally focused programs with an interest in developing faculty members’ ability to teach in various environments as well as to succeed in the many endeavors they undertake. We address various issues related to professional development in the medical school arena. Professional development in medical school takes place in a context where faculty are stretched to engage in research and service not only for their own sake but also to financially support their institutions. This obligates professional developers to acknowledge and address the environments in which teaching faculty work, and to use approaches to professional development that honor the time and efforts of teaching faculty. These approaches may be brief interventions that make use of principles of education, and may include online offerings. Professional development will be most effective when professional developers acknowledge that most faculty members aspire to excellence in teaching, but they do so in an environment that pushes them to address competing concerns. Offering professional development opportunities that fit within the workplace environment, take little time, and build upon faculty’s existing knowledge will assist in enhancing faculty success. Keywords
professional development, special issue
INTRODUCTION Professional development in higher education has evolved from a focus on individual sabbatical leaves and professional development seminars off site to a current focus on in-house and external programs that support institutional quality and change.1 Faculty in medical education are adapting to several major directional shifts including changes in educational approaches and technologies,1 changes in medical care and accreditation requirements,2 and the ever-increasing focus on teaching patientcentered clinical care and communication.3 Likewise, professional development in medical education continues to evolve to embrace the changing needs of its faculty. In 2010, the Carnegie
Correspondence may be sent to Nicole K. Roberts, PO Box 19681, Southern Illinois University School of Medicine, Springfield, IL 627949681, USA. E-mail: [email protected]
Foundation for the Advancement of Teaching put out its second call for reforms to improve the preparation of physicians, the first being the Flexner Report in 1910 (see the lead article of this issue of Teaching and Learning in Medicine for a detailed discussion.) They based their recommendations on site visits of 11 medical schools and three teaching hospitals and came up with the four I’s: 1. Standardization and Individualization—standardization of learning outcomes and individualization of the learning process 2. Habits of Inquiry and Improvement—of both their own practice and improvement of systems 3. Identity Formation—around the professional and ethical roles of being a physician 4. Integration—of basic, clinical, and social sciences; of their varying roles as a physician; and of patient care teams (interprofessional education)4 To achieve these goals for medical students, the authors describe the need for faculty training in mentorship, curriculum design, competency-based learner assessment, feedback, learning climate, and the hidden curriculum. ENVIRONMENTAL PRESSURES ON FACULTY DEVELOPMENT As professional developers work to create valuable programs for teaching faculty, one imperative they must recognize are the financial tensions inherent in clinical and basic science faculty roles. It is clear that states are supplying less and less funding for higher education, tuition is quickly reaching maximum capacity, national grant funding is diminishing and more people are competing for it, and donors have many causes within academic medical centers needing their support. Clinical faculty are thus under pressure to produce clinical revenues to support the educational enterprise, and basic science faculty are under pressure to acquire and maintain grants, also used to help support the educational enterprise. In this milieu, the professional developer faces the challenges of making education skills
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training feasible while allowing clinical and basic science faculty to be successful, thus ensuring faculty are able to maintain enough productivity to allow the entire enterprise to exist. In 2010, a position statement forecasting the needs for expert clinical teachers was published by the Alliance for Academic Internal Medicine (AAIM), the Report on Master Teachers and Clinician Educators. Responding to the competing demands of research and patient care, they describe the need for full time “master teachers.” These faculty would develop a broad range of expertise within medical education, spend most of their time teaching in patient care settings, engage in educational scholarship, serve as clinical administrative leaders, and mentor the next generations of master teachers. One of the articles in the report focuses on the critical role of professional development in shaping their vision of the master teacher’s expertise. They recommend extensive training ranging from learning theory, curriculum design, and learner assessment to leadership, mentoring, and educational research. Although the breadth and depth of the master teacher’s expertise, as described in the AAIM publication, pushes the limits of what is currently feasible, it is also relevant only for a small proportion of clinical teachers. If this model were adopted, professional development would be targeted toward a select few at each institution, and would be intensive, similar to obtaining an advanced degree in education. What we face now is the need to reach several hundred teaching faculty at each institution and focus on highly relevant and efficient educator skills training.5 Several articles in the professional development literature published in the last 10 years support the idea that programs focused on professional development are generally beneficial.6,7 Steinert et al.’s systematic review of faculty development initiatives for teaching effectiveness confirms that learning theories supporting the pedagogical choices for medical student training are important for effective faculty programs. They found programs that promote effectiveness include the use of experiential learning, the provision of feedback, effective peer and colleague relationships, the use of diverse educational methods, and a curriculum based on principles of teaching and learning.8
CONTENT OF PROFESSIONAL DEVELOPMENT Numerous authors have proposed possible content for professional development in medical school. Most frequently they focus on approaches to teaching, including models for teaching, and helping participants understand how learning occurs. An exciting addition to the content has been information about the neurobiology of learning. But authors have also advocated for teaching biomedical informatics,9 appropriate and educationally supported uses for instructional technology10 patient-centered care,11 a multitude of suggestions for professional developers to consider. However, professional development that focuses on teaching and learning, regardless of where that teaching and learning occurs, should focus on some fundamentals about the nature
of learning, and assist teachers in figuring out how to apply those fundamentals to their teaching environment. That is, if a teacher is teaching in an inpatient clinical setting, how might he use principles of education to guide his teaching behaviors? Likewise, if a teacher is teaching in a large lecture environment, how might knowledge of how students learn affect the way she designs the educational intervention? As Searle and colleagues suggest, we continue to learn about how learning occurs.12 It will be important for faculty developers to follow those developments and use them both to guide how they provide professional development and what they teach faculty about teaching and learning. For instance, providing experiential approaches for faculty learning about teaching reinforces one of the theories of learning that guides effective teaching.13
ROLE OF THE FACULTY DEVELOPER The aspirations for faculty attitudes, attributes, knowledge, and skills described by Hatem et al.14 help to define the outcomes we seek for all medical educators. We propose that professional developers guide faculty toward those goals by assessing their current strengths and building upon them, taking a stance that those who choose to teach wish to teach well. This may mean that we as faculty developers work with them to achieve these goals with a variety of methods and timelines. A guiding question for faculty developers could be, “What can we do to understand the workplace environment in which faculty find themselves, and how can we help them find the tools to teach in the most efficient and effective way possible within that environment?” In addition, the professional development faculty might provide assistance in recognizing elements of the professional environment that are suboptimal, and assist in developing tools to rectify existing problems. Of utmost importance, though, is to maintain respect for the faculty’s reality and perspective on the impact of our own contributions. There is no point in attempting to impose a series of “shoulds” on a faculty overwhelmed by the “musts.” The role of the professional developer is to build on a faculty’s strengths and enthusiasm, to provide inroads into how one might teach effectively in his or her own context, and to suggest mechanisms for making the environment amenable to such teaching. As an example, we may provide a minimal role in helping faculty adopt a new technology but provide a central role in assisting them deploy it for the best educational use. It is also imperative that professional developers operate from an assumption that faculty members enter their programs with inherent or previously acquired strengths in teaching. Just as in problem-based learning, the interest of the group is to elicit and build upon the student’s prior knowledge about the problem at hand, so too can faculty members’ embedded, conscious, and subconscious models of teaching and learning be elicited and built upon. No learner, faculty or student, is a tabula rasa. The professional developer can consider the question, “How is the model I propose going to truly be applied in practice and what
FUTURE PROFESSIONAL DEVELOPMENT
S59
is the expected effect of that modification?” This honors the lived experience of educators while providing them tools they can use. If we trust that faculty who have taken on the obligation to teach want to succeed at doing so, we build upon their strengths. If we are sufficiently attentive to the environment in which they are obligated to teach and work, we can help them do so within the constraints of their situation while helping them explore whether and how their situation needs to change to allow success in all the realms they have been assigned or have decided to take on. This approach suggests that we may need to rethink the logistics of faculty development as well. Many institutions provide centralized faculty development workshops, requiring those are being “developed” to come to those who provide the development. Another common belief is that more is better—more time, more workshops, more talking. Instead, if we provide faculty with the most salient advice we can improve the efficiency and effectiveness of our interventions. This may mean brief, focused interventions, or making interventions available in multiple formats and forms, including online.8 Similarly we will achieve more if we avoid imposing “shoulds” on the faculty developers who face their own “musts.” Our focus is best realized where our educational expertise coincides with the faculty member’s need to know.
tervention, surgeons used the teaching model to teach a fellow surgeon about an element of their most commonly performed operation. In the trauma intervention, learners participated in three simulated trauma resuscitations: one preintervention to highlight any existing problems and two post, the first to solidify skills learned and the second to test the maintenance of the skills. All responded to problems the target audience identified. All entailed substantial investigative work on the part of the professional developers to understand the source of the problem and to assess what the audience would consider to be an effective solution. All proposed simple, memorable models for guiding future practice that faculty could adjust to meet their current needs.
BRIEF INTERVENTIONS THAT WORK We propose that the profile of effective professional development opportunities may be changing. If we can provide brief interventions for teaching faculty that provide them with new skills to either improve their teaching or their environment, we are fulfilling our goals while honoring the time commitments and acknowledging their working environment. O’Sullivan and Irby suggested that research in faculty development can take cues from literature on workplace learning.15 We concur, and also suggest that the practice of professional development can take place in situ, where teachers teach, whether in clinical settings or in classroom settings. For instance, one 30-min intervention focused on teaching in the operating room changed surgeons’ teaching behavior from the typical instrumental approach16 to a more deliberate approach to teaching.17,18 The changes in teaching behavior, reported by residents, were sustained 6 weeks after the intervention. Another intervention, 1 hour and 15 minutes, assisted trauma personnel in addressing communication and leadership issues in the trauma bay.19 Many of the changes taught in the intervention were sustained 3 weeks postintervention. A third intervention, a 5-min explanation plus a pocket card, improved the quantity and quality of feedback faculty gave Internal Medicine residents.20All of these interventions shared characteristics of what we know works in education. The trauma and the teaching in the operating room interventions had elements of interactivity, with opportunities to test the skills learned in the workshop. In the teaching in-
We know that most medical schools are fortunate if they have a small number of faculty with advanced degrees in education or faculty developers with sufficient expertise in education. If we are to ensure every faculty member at each institution receives instruction in these educational areas, most institutions are faced with reaching hundreds of geographically scattered faculty with widely varying levels of need. If we strive to develop and require minimum teaching competencies for faculty, those with expertise become more stretched for time and resources in trying to reach all faculty. Online faculty development is not the single answer to these problems but will be an essential tool in providing standardized content to educator faculty while allowing for some individualization of learning. One common thread found in the faculty development literature is the importance of applying learning theory to the professional development of faculty. Robin et al.10 reminded us that e-learning can be an effective, theory-based approach to providing education in multiple contexts. Collaborative tools such as wikis, blogs, discussion boards, and webinars provide interactivity and allow faculty from distant sites to exchange ideas. Such tools are now ubiquitous and easily accessible. Simulations such as screen-based virtual learners provide opportunities for skill practice and feedback, both of which we know to be central to learning. Freestanding topic-based teaching modules can provide efficient delivery of content for multitudes of faculty and can incorporate reflection and active learning exercises.
ONLINE PROFESSIONAL DEVELOPMENT Online professional development courses and resources for health professions faculty are promising adjuncts to traditional teaching formats and fulfill several needs for institutions and faculty. The Liaison Committee on Medical Education standard FA-4 states, Faculty members involved in teaching, course planning, and curricular evaluation should possess or have ready access to expertise in teaching methods, curricular development, program evaluation, and medical student assessment. Such expertise may be supplied by an office of medical education or by faculty and staff members with backgrounds in educational science.
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Online learning opportunities are not necessarily superior to face-to-face teaching formats, but they assist in overcoming significant barriers like time and distance, and can allow for more individualization of instruction.10 Organizations such as FAIMER (Foundation for Advancement of International Medical Education and Research) and advanced degree programs in medical education are examples of educator development programs that are already using various online learning as a supplement to in person teaching. There are other less tangible benefits to exploring learning technologies for faculty development. Giving faculty the opportunity to function as learners in a world of expanding instructional technologies, allows them to gain the perspective of their learners and identify methods of improving the use of these technologies. In addition, we cannot invite the best experts and facilitators to deliver every faculty development program at our own institutions. With appropriate resources and a centralized platform for delivering online teaching sessions, we can bring together the best faculty developers to create high-quality products. This addresses the greatest barrier to the creation of institutionally based online interactive learning modules that can track use and users, which is access to resources. We propose that the creation of a collaborative repository of such products, which MedEdPORTAL cannot support at this time, could serve as valuable and affordable resources for institutions faculty development curricula. Last, we cannot forget the greatest imperative for the incorporation of technologies into the faculty developers’ lexicon, which is the future expectations and demands of faculty. As Robin10 explained, the bulk of medical educator faculty have incorporated technology into their lives to varying degrees but this generation of medical students are “digital natives,” a term coined by Prensky,21 expecting the use of technology in their learning. This divide may explain why online faculty development options are only beginning to gain traction, because the end user has not demanded access to them. Faculty development needs will inevitably catch up with the technology by which our trainees are learning, if not now, then soon, when the “digital natives” constitute the faculty majority. OUTCOMES Although there are various levels of evaluation identified in the literature,22,23 it is admittedly difficult to assess professional development programs robustly. O’Sullivan and Irby15 suggested that the workplace learning literature offers suggestions on how we might integrate professional development into the workplace, which is an essential stance to ensuring that professional development is relevant and applicable to the particular environment in which faculty find themselves. The outcomes we study should be learner outcomes and faculty (our learners) outcomes. Patient outcomes are too far downstream to attribute solely to an educational intervention unless our education is focused on a clinical practice.
CONCLUSION We propose that professional developers can serve essential roles in ensuring effective, efficient education for medical students, and effectiveness and success for faculty members. We propose that effective educational interventions do not have to be “y’all come” workshops where faculty are taken from their environments in order to learn skills outside of their professional context, but instead can take place within context. Further, educational interventions do not have to be lengthy. In fact, effective interventions can be as short as 5 min as long as they address problems felt by faculty in a way that faculty can actually use in practice. Nor do interventions have to be in-person. Online interventions can provide faculty with “just in time” answers to questions about teaching and learning and can help address the issues that many medical schools face including lack of time and dispersed faculty. These evolutions in medical education professional development may allow faculty developers to more readily and effectively address the needs of their faculty.
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FUTURE PROFESSIONAL DEVELOPMENT 14. Hatem CJ, Searle NS, Gunderman R, Krane NK, Perkowski L, Schutze GE, et al. The educational attributes and responsibilities of effective medical educators. Academic Medicine 2011;86:474–80. 15. O’Sullivan PS, Irby DM. Reframing research on faculty development. Academic Medicine 2011;86:421–8. 16. Roberts NK, Brenner MJ, Williams RG, Kim MJ, Dunnington GL. Capturing the teachable moment: A grounded theory study of verbal teaching interactions in the operating room. Surgery 2012;151:643–50. 17. Roberts NK, Williams RG, Kim MJ, Dunnington GL. The briefing, intraoperative teaching, debriefing model for teaching in the operating room. Journal of the American College of Surgeons 2009;208:299–303. 18. Radford L, Roberts NK, Schwind C, Williams R, Dunnington G, Kim MJ. Evaluation of the briefing intraoperative teaching and debriefing (BID) model for teaching in the OR. Central Group on Educational Affairs, 2011.
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19. Roberts NK, Williams RG, Schwind CJ, Sutyak JA, McDowell C, Griffen D, et al. The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings. American Journal of Surgery. In review. 20. Peccoralo L, Karani R, Coplit L, Korenstein D. Pocket card and dedicated feedback session to improve feedback to ward residents: A randomized trial. Journal of Hospital Medicine Oct 28 2011. 21. Prensky M. Digital natives, digital immigrants. On the Horizon. 2001;9:1–6. 22. Kirkpatrick DL. Evaluation of training. In RL Craig, LR Bittel, eds. Training and development handbook (pp. 87–112). New York: McGraw-Hill, 1967. 23. Belfield C, Thomas H, Bullock A, Eynon R, Wall D. Measuring effectiveness for best evidence medical education: A discussion. Medical Teacher 2001;23:164–70.
