Approaches to faculty development. This figure was originally prepared for a chapter on “Becoming a Better Teacher: From Intuition to Intent.”23
Learning from experience
Health professionals often become adept at what they do by “the nature of their job responsibilities.”24 Although this type of learning is not often viewed as a form of faculty development, it is critical to the acquisition of professionally appropriate behaviors, identity formation, self-improvement, and renewal. Learning from experience can be further divided into learning by doing, learning by observing (and through role modeling), and learning by reflecting on experience.23 The challenge for faculty developers and educators is to capture the benefits of experiential learning, find ways to promote reflection in the clinical environment, and help to demonstrate that learning has occurred.
Learning from peers, residents, and students
Learning from experience can be augmented by peer feedback and learner assessments.23 Although physicians are often reluctant to seek feedback from peers, it can be extremely beneficial to discuss an educational challenge (or critical incident) with colleagues or ask them to provide feedback after having observed a specific teaching encounter. Peer coaching, which is sometimes called co-teaching, has particular appeal for the teaching and learning of professionalism because it occurs in the practice setting, enables individualized learning, and fosters immediate application.25 It also models many aspects of professional practice, such as the identification of individual learning goals, focused observation by colleagues, and the provision of feedback, analysis, and support,26 all of which are critically important in learning about professionalism and the acquisition of a professional identity. Soliciting feedback from learners can be equally helpful, despite the fact that most health professionals do not actively seek out student or resident perspectives.24 In fact, “taking the initiative to solicit [students’] observations and suggestions can be an integral part of the process of becoming a better teacher”23 (p. 79), as an appreciative inquiry of learner assessments can help to uncover personal strengths and areas for improvement. It can also facilitate a conversation about identity formation.
Online learning
Online learning is a potentially valuable form of self-directed learning. Given that time for professional development is limited, and the technology to create interactive instructional programs is now in place, the use of online faculty development should be explored.27 In many ways, online resources and learning programs could be considered as supplements to centrally organized faculty development programs;28,29 they could also be used in a “staged approach,” later in the development of teachers and faculty members. Importantly, online learning can allow for individualized programs targeted to specific needs, as long as educators do not lose sight of the value and importance of working in context, with colleagues.25
Learning from structured activities
Formal (structured) activities are the most common approaches to faculty development22 and include workshops and short courses, fellowships and other longitudinal programs, and certificate or degree programs.
Workshops and short courses are one of the most popular approaches30 because of their inherent flexibility and promotion of active learning through a variety of teaching methods: interactive lectures, small-group discussions and exercises, role-plays and simulations, and experiential learning.13 Without a doubt, workshops play an important role in faculty development for the teaching and learning of professionalism;1,2 they can also be used to learn about identity, professional identity, and socialization. Short courses have the added advantage of increased time and continuity.22
Fellowships, of varying duration, form another structured approach to faculty development, though their focus usually extends beyond teaching improvement to include educational leadership or scholarship. More recently, integrated, longitudinal programs (typified by teaching scholars programs) have been developed as an alternative to fellowship programs;31,32 these programs allow clinicians to maintain most of their clinical, research, and administrative responsibilities while furthering their own professional development in targeted areas (e.g., the teaching and learning of professionalism). Given the need to develop curricula that focus on professionalism and professional identity formation at both undergraduate and postgraduate levels, longitudinal programs that enhance capacity in this area will be of benefit to many.
Certificate or degree programs are becoming increasingly popular in some settings, due to the “professionalization” of medical education and an increasing desire to develop pedagogical standards at a global level.33,34 Tekian and Harris35 recently described seventy-six masters-level programs in the health professions. As the authors suggest, an advanced degree can offer essential grounding in educational theory and practice while providing the foundation for educational research and scholarship. These programs can also “prepare leaders in the health professions who can manage change within their institutions, overcome organizational barriers, and effectively direct the future of healthcare delivery systems”35 (p. 56), of critical importance to professionalism and the support of professional identity formation.
Work-based learning and communities of practice
A number of authors20,21,36–37 have highlighted the role of work-based learning as integral to professional development. In fact, it is in the everyday workplace, where teachers conduct their clinical, teaching, and research activities, that learning most often takes place. It is therefore surprising that we do not currently view work-based learning as a common venue for faculty development, for by working together in a clinical or classroom setting, teachers can acquire new knowledge and refine their approaches to teaching and learning. Professional identity is also nurtured or inhibited in the workplace, and it is therefore a critical venue for learning and self-improvement. Faculty development activities have traditionally been conducted away from teachers’ workplaces, requiring participants to take their “lessons learned” back to their own contexts. It is time to reverse this trend and think about how we can enhance the learning that takes place in the work environment; there is also value in rendering this learning as visible as possible so that it can be valued as an important component of faculty development.24 A pedagogy of the workplace includes individual engagement, sequencing of activities to create pathways for learning, the provision of guidance to promote learning, environmental affordances that enable access to learning, and reflection and role modeling.38,39 Clearly, all of these components are relevant to the acquisition of professional behaviors as well as a professional identity.
As outlined in Chapter 5, the notion of a community of practice is closely tied to that of work-based learning. Barab et al.40 (p. 495) have defined a community of practice as a “persistent, sustaining, social network of individuals who share and develop an overlapping knowledge base, set of beliefs, values, history and experiences focused on a common practice and/or mutual enterprise.” In many ways, becoming a member of a teaching community can be viewed as an approach to faculty development, and we should collectively explore ways to make this community – and the learning that it offers – more accessible to clinical teachers. We should also find ways of creating new opportunities for exchange and support, documenting the learning that takes place in the workplace, and valuing the communities of which we are a part.
Mentorship
Mentoring, a recognized component of a successful academic career,41 is often used to promote the socialization and development of clinical faculty.42 It is therefore surprising that mentorship is not more frequently described as a faculty development strategy,43 for mentors can provide guidance, direction, support, or expertise to faculty members on a range of topics, in a variety of settings. Mentors can also help teachers to understand the organizational culture in which they are working and introduce them to invaluable professional networks.44,45 Teachers often report that finding a mentor – and being mentored – is one of the most critical components to their becoming a better teacher.46 It behooves us to recognize the value of this important strategy as an approach to faculty development, especially as it can also help to promote professional identity formation (among faculty members and learners).
Interestingly, each of the above approaches can play an integral role in developing faculty members to promote professionalism and professional identity formation; each also has its own strengths and limitations. As a result, faculty developers should consider all of these approaches in the design of comprehensive faculty development programs. However, as there is still a place for formal (more structured) activities in promoting awareness, acquiring core knowledge, developing skills, and encouraging buy-in, we offer the following guidelines for designing structured faculty development initiatives.
Guidelines for designing formal faculty development initiatives
Guidelines for designing and delivering effective faculty development programs have been outlined previously.13,14 A brief summary of these recommendations is warranted here, as awareness of these principles is fundamental to the design of any program or activity.
Understand the institutional or organizational culture
Faculty development programs and activities take place within the context of a specific institution or organization. It is imperative to understand the culture of that institution and be responsive to its needs. Professional development programs should also capitalize on the organization’s strengths and work with the leadership to ensure success. In many ways, the cultural context can be used to promote or enhance faculty development efforts. For example, it has been noted that faculty development during times of educational or curricular reform takes on added importance.47 It is also important to assess institutional support for faculty development activities, identify available resources, and lobby effectively. Faculty development should not occur in a vacuum.
Determine appropriate goals and priorities
In designing a faculty development program or activity, it is imperative to clearly define goals and priorities. What is the program or activity trying to achieve – and why is it important to do so? It is equally important to articulate specific objectives, as they will influence the target audience (e.g., clinical teachers; program directors) as well as overall content and methodology. Determining priorities is not always easy and often involves consultations with diverse stakeholders. However, it is always essential to balance individual and organizational needs.
Conduct needs assessments to ensure relevant programming
All professional development activities should be based on the needs of the individual as well as the institution. Student needs, patient needs, and societal needs can also help to guide relevant activities. Assessing needs is required to refine goals, determine content, identify preferred learning formats, and ensure relevance. It is also a way of promoting early buy-in. Common methods for assessing needs include written questionnaires or surveys; interviews or focus groups with key informants (e.g., participants; students; educational leaders); observations of teachers “in action”; literature reviews; and environmental scans of available programs and resources.48,49 Whenever possible, faculty developers should try to gain information from multiple sources, distinguishing between “needs” and “wants.” An individual teacher’s perceived needs may clearly differ from those expressed by that teacher’s learners or peers.
Target diverse stakeholders
Rubeck and Witzke47 defined faculty development as the enhancement of faculty members’ knowledge and skills so that they can make educational contributions that advance both the pedagogical program and the process of teaching and learning. For educational and curricular reform to occur, faculty development initiatives should target curriculum planners responsible for the design and delivery of educational programs focused on the teaching and assessment of professionalism as well as the support of professional identity formation; administrators responsible for medical education and clinical practice as well as the institutions in which professional behaviors are displayed; and all healthcare professionals involved in teaching and learning. The latter group might include faculty members working in a university setting, clinical teachers of diverse backgrounds in the hospital and the community, and other members of the healthcare team.
Develop different programs and activities to accommodate diverse needs
One size does not fit all. Faculty development activities should be designed to accommodate diverse goals and objectives, content areas, and needs. In this context, it is also helpful to remember that faculty development can include faculty orientation, recognition, and support, and different programs and activities will be needed to accommodate diverse objectives. For example, think tanks may be appropriate to promote buy-in, to develop consensus, and to design an educational blueprint.1 Workshops may be more appropriate for knowledge or skill acquisition – or to heighten awareness and recognition of the importance of a particular topic.
Incorporate principles of adult learning and instructional design
Adults come to learning situations with a variety of motivations and expectations about teaching methods and goals. Incorporating key principles of adult learning50 (outlined in Chapter 5) into the design of a faculty development program can enhance receptivity, relevance, and engagement. In fact, these principles should guide the development of all programs, irrespective of their focus or format, because physicians demonstrate a high degree of self-direction and possess numerous experiences that can serve as the basis for learning.
Principles of instructional design (also outlined in Chapter 5) should be followed in the design and delivery of any faculty development initiative. For example, it is important to develop clear learning goals and objectives for a specific activity, identify key content areas, design appropriate teaching and learning strategies, and create appropriate methods of evaluation – of both the learners and the curriculum. It is equally important to integrate educational theory with practice (e.g., situated learning)19 and to ensure that the learning is perceived as relevant to the work setting and to the profession.51 Health professionals value interactive, participatory, and experientially based learning that builds on previous learning and experience.2,22 A positive learning environment that communicates respect and understanding of similarities and differences, as well as “equal” participation of all participants, is also essential, as is teacher readiness, buy-in, and commitment.
Offer a diversity of educational methods – in a variety of settings
In line with principles of adult learning, structured faculty development initiatives should try to offer a variety of educational methods that promote experiential learning, reflection, feedback, and immediacy of application.22 As stated previously, common learning methods include interactive lectures, case presentations, small-group exercises and discussions, role-plays and simulations, videotape reviews, and live demonstrations. Practice with feedback is also essential, as is the opportunity to reflect on personal values and attitudes. Online modules and self-directed readings are additional methods to consider. Most importantly, whatever the method, the needs and learning preferences of the participants must be respected, and the methods should match the intended objectives. It is also helpful to remember that healthcare professionals learn best by “doing,” and experiential learning should be promoted whenever possible.
Faculty development activities frequently take place in a centralized university or departmental setting. To be successful in this context, faculty development should occur where the teaching and learning of professionalism happens. Thus, some faculty development initiatives should move out of the university setting into the hospital and the community. Decentralized, site-specific activities have the added advantage of reaching individuals who might not otherwise attend faculty development activities, promoting experiential learning, and developing a departmental or program-based culture of self-improvement.52,53
Promote “buy-in” and market effectively
The decision to participate in a professional development program or activity is not as simple as it might at first appear. It involves the individual’s reaction to a particular offering, motivation to develop or enhance a specific skill, being available at the time of the session, and overcoming the psychological barrier of admitting need.47 Faculty developers face the challenge of overcoming reluctance and marketing their “product” in such a way that resistance becomes a resource to learning. In some settings, targeted mailings, professionally designed brochures, and product “branding” have been extremely valuable. In other contexts, continuing medical education credits, as well as free and flexible programming, help to enhance motivation and facilitate attendance. “Buy-in” involves agreement on importance, widespread support, and dedication of time and resources at both the individual and the systems level; it must also be deliberately sought in all programming initiatives.
Evaluate – and demonstrate – effectiveness
Evaluation is the final step in instructional design and of critical importance in faculty development programming. At a minimum, a practical and feasible evaluation should include an assessment of the utility and relevance of the content, teaching and learning methods, and participants’ intent to change. Moreover, because evaluation is an integral part of program planning, it should be conceptualized at the beginning of any program. It should also include qualitative and quantitative assessments of learning and behavior change, using a variety of methods and data sources.
In preparing to evaluate a faculty development program or activity, educators should consider the goal of the evaluation (e.g., program planning versus decision making; policy formation versus academic inquiry), available data sources (e.g., participants; peers; students or residents), common methods of evaluation (e.g., questionnaires; focus groups; objective tests; observations), resources to support assessment (e.g., institutional support; research grants), and models of program evaluation (e.g., goal attainment; decision facilitation).54–56 Each component requires careful planning and execution to ensure success. Kirkpatrick’s hierarchy of evaluation57 is also helpful in conceptualizing and framing the evaluation of effectiveness. This hierarchy includes the following levels:
Although program evaluation is fundamental to the design, delivery, and improvement of faculty development activities, it also helps to ensure scholarship in the teaching and assessment of professionalism as well as professional identity formation.
Principles underlying faculty development to support professionalism and professional identity formation
Although the guidelines outlined above are all relevant to faculty development designed to support professionalism and professional identity formation, many of them are generic in nature. Based on our experience in the design and delivery of faculty development programs in teaching and learning professionalism1,2 and supporting professional identity formation in a variety of contexts, we believe that certain principles and strategies emerge as critical to the success of programming in this area.
Teach the cognitive base
As stated at the outset, role modeling and the implicit teaching of professionalism and support of professional identity formation are no longer sufficient. We therefore need to equip our teachers with the cognitive base underlying professionalism and professional identity formation (as outlined in Chapter 1); we also need to develop a common language so that teachers will be able to communicate their vision with colleagues and learners. In line with this thinking, faculty development efforts should include the definition of professionalism, its historical roots, and the relationship between professionalism and the ever-changing social contract between medicine and society.5,58 Clinical teachers also need to acquire a common understanding of the attributes of professionalism and the behaviors expected of a professional. As teachers often see professionalism as a vague concept lacking a cognitive base, faculty development programs should provide teachers with operational definitions (outlined in Chapter 1) that can be taught and evaluated. Figure 1.3 in Chapter 1 outlines the core attributes of professionalism that form the norms and values of professional identity formation, and that we have used to guide teaching and learning in our setting. It is offered as an example to guide the work of others in this field. In designing faculty development initiatives to support professional identity formation, different content areas should be addressed. These include definitions of identity and professional identity; the changing nature of identity over time; the notion of multiple (and fluid) identities; the process of socialization and identity formation in medicine; the myriad of factors that influence identity formation (e.g., clinical experiences; role models; the healthcare and learning environment; peers and family members); and the role that learners play in the socialization process as well as their responses to this process (including joy and stress).59 The schemata described in Chapter 1 (in Figures 1.1, 1.4, and 1.5) can be helpful in trying to synthesize these complex influences.
Translate core content into practice
To be effective, the attributes of professionalism must be taught and demonstrated in the clinical setting. Accordingly, clinicians need to translate core content into practice and see its applicability and relevance. In our own setting, we chose to promote the latter by defining professionalism and its attributes using case examples and asking faculty members to complete action plans in order to ensure implementation following a faculty development workshop.1 With respect to identity formation, clinical teachers should be encouraged to think about their own identities (including their values, beliefs, and aspirations), their perceptions of major influences in becoming a physician (including both facilitators and barriers), and their views on how they have negotiated this process.
Start with a focus on teaching professionalism
The need to focus on teaching professionalism arises from several factors. Virtually every accrediting, licensing, and certifying body requires that professional behaviors in students and residents be assessed.60,61 However, if professionalism is to be assessed, it must first be defined and taught. Based on our own experience in this area,1,2 we believe strongly that a focus on teaching professionalism is less threatening to healthcare professionals than a focus on being professional. It is also easier to start with professional behaviors than with the nature of identity. We would therefore encourage colleagues to start with a focus on teaching and then examine the process of professional identity formation.
Enhance role modeling
As stated earlier (and highlighted in Chapters 1 and 6), role models – and role modeling – are critical to the acquisition of professional behaviors and the formation of a professional identity. As a result, any faculty development initiative designed to support professional identity formation must also address how clinical teachers behave as role models.62 Cruess et al.63 have described a number of strategies to improve role modeling at both the individual and the organizational level; these include the need to be aware of being a role model, protecting time for teaching, making the implicit explicit, and reflecting upon both positive and negative experiences. Kenny et al.64 recommended that faculty development activities try to clarify the meaning of roles and role modeling, discuss standards and expectations, and provide safe spaces for reflection and debriefing. All of these suggestions can be integrated into a faculty development activity that focuses on professionalism and professional identity formation. Importantly, improving role modeling cannot be accomplished at the individual level alone; the institution plays a key role and needs to value teachers and teaching, as the goal is to create an environment which supports positive role modeling.65
Promote reflection
Reflection “in action” and “on action” has been identified as central to the teaching and learning of professionalism.66 It is also central to the formation of a professional identity. Faculty development activities must therefore include activities that promote self-reflection, awareness, and change. If we believe that professional identity arises from “a long-term combination of experiences and reflection on experience”67 (p. 63), and that our learners require both experience and reflection for learning to occur, then we must model these strategies when working with faculty members. The literature on reflection68–71 has grown significantly in recent years and has highlighted the importance of a safe environment, peer support, and mentorship in promoting “mindfulness.” These attributes should also characterize a robust faculty development initiative.
A number of strategies to promote reflection among health professions teachers have been suggested.65 These include the use of written logs of teaching encounters, guided questions,72 personal narratives, and teaching portfolios, all of which can serve as stimuli for discussion during a faculty development activity. The review of critical incidents can be another way to promote reflection. Rademacher et al.73 described the use of critical incidents as a faculty development strategy to explore faculty members’ professionalism. More specifically, they used teachers’ personal experiences to identify challenges, discuss potential solutions, and highlight areas for further development. Although this approach is not commonly used, the analysis of critical incidents can be an innovative way in which to enhance experiential learning and reflective practice, key components of identity formation.
Capitalize on experiential and work-based learning
As stated earlier, much of faculty members’ learning takes place through experience and in the workplace. This is especially true when thinking about their acquisition of professional behaviors as well as their professional identities. It is therefore important to think about how faculty development can maximize experiential learning (often augmented by guided reflection) and promote work-based learning, which is characterized by observation, participation, and expert guidance in an authentic environment.38 In considering the use of work-based learning as a faculty development strategy, educators should question whether we have created a false dichotomy between work and learning, how we can guide participation while performing authentic activities, and how we can make workplace learning more visible.
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