Transcript Whither Faculty Development

Whither Faculty
Development
Can We Do Better?
AFMC – AMS J. Wendell Macleod Memorial Lecture,
2006 Medical Education Conference (London ON)
Presented by Wayne Weston MD
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J. Wendell Macleod
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1905 – born in Kingsbury, Quebec
1930 – graduated in medicine at McGill
Worked closely with Norman Bethune
Served in the navy in WW II – Surgeon Commander
1946 – OBE
Practiced in Winnipeg with
his wife Jessie McGeachy
1952 – 1st dean of the new
medical school at the U of
Saskatchewan
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Mcleod, cont’d.
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1960 – publicly supported the government
during the Doctors’ strike
1962-70 – executive secretary  executive
director of the ACMC
>1970 – consultations in Haiti, China, Cuba;
co-authored “Bethune: the Montreal Years”
1980 – Order of Canada
2001 – died aged 96
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1994
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1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Jock Murray, Dalhousie University
Ian Hart, University of Ottawa
Donald Wilson, AMS
Richard Cruess, McGill University
John Wade, University of Manitoba
Arnold Naimark, University of Manitoba
Martin Hollenberg, University of British
Columbia
John Evans, Torstar Corporation
Michael Kirby, Senate
Michel Bureau, Fonds de la recherche en
santé du Québec
Jean Gray, Dalhousie University
symposium rather than a lecture
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Whither Faculty Development:
Can We Do Better?
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OUTLINE:
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Good news and bad
The gap
Fundamentals of a serious approach to faculty
development
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Objectives
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At the end of this presentation, you will:
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Be convinced that we need to provide more
intensive faculty development;
(Or at least you will seriously wonder about it)
Be able to list the arguments for enhancing our
faculty development efforts
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It is the mark of an
educated mind to be
able to entertain a
thought without
accepting it.
- Aristotle
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Education
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“…the entire process by which a culture
transmits itself across the generations.”
– Bailyn in Jeffrey & Manganiello p73
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What is Faculty Development Anyway?
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Many definitions:
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Some focus on growth and development of
individual faculty members
Others emphasize the importance of preparing
faculty for organizational needs (Jolly, 2002)
Some focus on the teaching role, others include
research, administration and personal
development
For this presentation I will focus on the
enhancement of each faculty member’s role
as a teacher
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The Good News – We are Getting
Better
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Surveys of faculty development activities in
Canadian medical schools (McLeod, 1987 &
McLeod, Steinert, Nasmith, Conochie, 1997)
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“…a major, positive transition during the past 10
years”
Review of the surveys submitted by the
faculty development offices in 2006 shows an
impressive range of activities in all schools
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Examples of Good News
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Larger numbers of workshops
Longer educational offerings e.g. Laval – 5 day
course with homework
More scholarly evaluation of impact e.g. Sherbrooke
Faculty development grand rounds e.g. UofT
Learning opportunities for residents e.g. Dalhousie’s
month long elective
Certificate, scholars & Master’s programs &
fellowships at many schools
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More Good News
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Research & scholarship in medical education
e.g. the Wilson Centre for Research in
Medical Education
Promotion on the basis of contributions to
teaching & education
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But…
We are not there yet.
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Wanted! Clinician
Researcher
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Classified Ads
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Wanted – clinician researcher
50% research, 50% clinical work
No research experience needed
We will provide an in-depth three-day course
on research to bring you “up to speed”
(optional)
Plus yearly one-day workshops to keep you
on the leading edge of research in your field
(optional)
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"Preparing to be an effective teacher is
arguably as challenging an undertaking as
preparing to be a clinician…
- Jason, H. & Westberg, J. (1982). Teachers & Teaching in US
Medical Schools. Norwalk, Connecticut, Appleton-CenturyCrofts.
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…Optimally, prospective and current teachers
should have abundant opportunities to:
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critically and systematically observe master
teachers in action;
practice instructional skills in ‘safe’ settings...;
critique their own skills...;
and be critiqued by others, both on their
instructional skills and their skills as selfcritiquers.”
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“Effective teaching may
be the hardest job
there is.”
-
William Glasser
(Developer of
“Reality Therapy”)
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“Medical students are, to a large extent, taught by
people who have undertaken little or no formal study
in the field of education.... Would you send your
child to a school where the teachers were untrained
at recruitment, where no instructions were given
them, and where promotion was independent of
teaching excellence?
Yes you would, provided it was a medical school.”
- Kent A: An Overview of Medical Education Today. Thesis
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Who attends?
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“Only 39% of teaching hospitals have
ongoing faculty development activities in
teaching skills for their departments of
medicine faculty, and, on average, fewer than
50% of their faculty participate.”
- Cole et al “Faculty Development in Teaching Skills: an Intensive
Longitudinal Model. Academic Medicine 2004;79:469-480
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A Crazy Assumption
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“Discipline expertise is sufficient to make you
an expert teacher”
Where does this crazy idea come from???
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Assumption that teaching is simply transmission
of information
Decades of experience watching teachers
Little understanding of the complexity of teaching
Tradition
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Conclusion
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We act as if education is of fundamental
importance to everyone….
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…except the teachers
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Another Crazy Assumption
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Taking academic courses on educational
topics will make you a good teacher
Academic – adjective – “irrelevant in
practice: theoretical and not of any practical
relevance” (Encarta dictionary)
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Some Examples of Difficult Tasks for
Teachers
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How to make a complex topic clear &
understandable
How to make a boring topic exciting
How to persuade “surface” learners to become
“deep” learners
How to provide helpful feedback to a student who
just “doesn’t get it”
How to confront a student about unprofessional
behaviour
How to tell a student that they have bad breath
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Difficult Tasks for Teachers, cont’d.
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Teaching several students at different levels at one
time
Fitting good teaching into a very busy clinic
Diagnosing the learner – figuring out where and how
they are stuck – & then finding a strategy to get
them unstuck
Motivating a student who seems to have no interest
in your subject
How to design & implement a remedial program for
a resident with multiple learning needs – knowledge,
clinical reasoning, professional attitudes & personal
problems
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Difficult Tasks for Teachers, cont’d.
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Teaching effectively by computer conferencing or
videoconferencing
How to deal with transference & countertransference in the teacher-learner relationship
Basing educational approaches on best evidence
Supporting a student or resident who has made a
tragic error leading to the death of a patient
Teaching students how to balance their time &
energy among career, personal & family life
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Why Most Faculty Development
Programs Fail
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One-shot workshops
Topics selected by "others"
Ignores the difficulties of changing
Follow-up evaluation is uncommon
Rarely addresses individual needs and concerns
Little recognition of the unique features of the
teaching-learning environment
Lack of conceptual framework
Based on Fullan MG with Stiegelbauer S:
The New Meaning of Educational Change. 1991.
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How Do We Decide on the Agenda for
Faculty Development?
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Needs assessment:
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Our best guess – of what they need or what they
will attend
Ask faculty what they want
Evaluate faculty teaching performance – students,
peers
Student learning needs
Future practice patterns
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Becoming a More Effective
Teacher
What Does it Take?
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From Ramsden P: What does it take to improve
medical students’ learning, in Balla, Gibson,
Chang: Learning in Medical School, 1989
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Silent Reflection
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Who were the 3 most important teachers in
your life?
What did they all have in common?
Do we adequately address these qualities in
our faculty development programs?
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Results
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Rarely include professional teachers
Parents, spouses, friends, neighbours,
pastors, siblings and other relatives.
What they had in common – integrity,
truthfulness, compassion, dedication,
empathy, attentiveness and love
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Effective Teachers
Understand
student
learning
Understand
self
Understand
subject
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Understand Student Learning
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What is our concept of learning?
Stages of development
Personal struggles
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Images of Learning
Adding bricks to the wall.
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“Schools teach you to imitate.
If you don’t imitate what the
teacher wants you get a bad
grade. Here, in college, it
was more sophisticated, of
course; you were supposed
to imitate the teacher in such
a way as to convince the
teacher you were not
imitating.”
- Robert Pirsig
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Images of Learning – 2
Transformation
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"Learning is not so much an additive process,
with new learning simply piling up on top of
existing knowledge, as it is an active,
dynamic process in which the connections
are constantly changing and the structure
reformatted."
- K. Patricia Cross
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Good Teaching
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Look for what the lives of teachers of liberal &
professional studies have in common with the
lives of grandparents teaching their
grandchildren how to sew, or how to fish
Or barge pilots or fly fishermen teaching
apprentices how to read a river
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The “Perry Schema”
Stages of Cognitive Development
Evolving
Commitments
Multiplicity
Dualism
Relativism
Maker of
meaning vs.
receiver of
meaning
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“The most important knowledge teachers
need to do good work is a knowledge of how
students are experiencing learning and
perceiving their teacher's actions.”
- Steven Brookfield
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Stages of Development
Reporter (What)
Interpreter (Why)
Manager (Next steps)
Educator (Scholar)
Pangaro, 1999
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Stages of learning
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Unconsciously incompetent
Consciously incompetent
Consciously competent
Unconsciously competent
Additional skill needed
for teaching – consciously,
unconsciously competent
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The Capacity to Deal with a Puzzling
Answer
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3+3=8
+
3
+
6
3
3
=
= 3
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“And of course, last but hardly least, I now tend to
see people as patients. I noticed this especially with
women. It is often asked whether male medical
students become desexualized by all those women
disrobing, all those breast examinations, all those
manual invasions of the most intimate cavities. I
found that to be a rather trivial effect.
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What I found more impressive was the general
tendency to see women as patients. This clinical
detachment comes not from gynaecology but from
all the experiences of medicine…
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…During my medicine
rotation when, on a
bus, I noticed the
veins on a woman's
hand – how easily
they could be
punctured for the
insertion of a line –
before noticing that
she happened to be
beautiful.”
- Konner: Becoming a
Doctor, 1987, p 366
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Lessons from a Seminar
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“Half an hour later the man with the hurt head had
poked his head into the room three more times. I
wrestled with my conscience. Could it really be that
none of them had noticed him? It did not seem
possible. Yet it seemed equally impossible that they
would be ignoring him. Surely one of us could talk to
him for a few minutes?
Despite the evidence that ignoring patients was
normative – a fact that I would soon learn beyond
any possible doubt – I was too disturbed by the
patient’s repeated appearances to K.M.S. any
longer. ‘There’s a patient,’ I said timidly…”
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Dr Parker’s response was reflexive and
harsh. ‘I’m gonna have to ask you’ – he
stabbed the air in my direction with a stiff
pointed finger – ‘If you’re gonna keep
interrupting me I’m gonna have to ask you to
leave.’ His tone, tense, defensive, and shrill,
differed dramatically from the ordinary loud,
pompous tone of the rest of his lecture…
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…It was the last message I needed to get
from him. K.M.S. was from then on not only
easy but second nature to me. I faded into
the woodwork in every situation. I rarely if
ever spoke unless I had been directly
addressed. This is the army, I thought…it
was a rule I followed throughout the rest of
my medical training.”
- Konner: Becoming a Doctor, 1987
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K.M.S. = Keep Mouth Shut!
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“They may forget what you said, But they will
never forget how you made them feel.”
~ Author Unknown
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"Teaching, like any truly human
activity, emerges from one's
inwardness, for better or worse.
As I teach I project the condition
of my soul onto my students, my
subject, and our way of being
together. The entanglements I
experience in the classroom are
often no more or less than the
convolutions of my inner life…”
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“…Viewed from this angle, teaching holds a
mirror to the soul. If I am willing to look in that
mirror and not run from what I see, I have a
chance to gain self-knowledge – and knowing
myself is as crucial to good teaching as
knowing my students and my subject."
-Parker Palmer from The Courage to Teach,
Jossey-Bass 1998, p. 2.
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Enhancing Self-Knowledge
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Parker Palmer
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No formulas for good teaching
Advice of experts is of limited value
Go “to the inner ground from which good teaching
comes”. But beware of self-deception
Go to the community of fellow teachers
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Peer consultation
Co-teaching
Video review
Discussion group – encourage good talk about good
teaching
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Enhancing Self-Knowledge, cont’d.
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Protected time
Mentoring
Reading and reflection
Creative writing
Sabbaticals, study
leave
Discussion groups
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Courses outside your
own discipline
Humanities – art,
theatre, film
Balint groups
Sacred idleness (George
Macdonald)
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Sacred Idleness Day
1.
2.
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6.
Schedule a ‘sacred idleness’ day.
If you are resisting, list five benefits for
having a day for yourself.
Prevent encroachment into that day.
Avoid making ‘plans’ - trust your instincts to
create the day.
Eliminate guilt from your ‘idleness’ day.
Throw your head back and soak up every
moment.
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Enhancing Self-Knowledge, cont’d.
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Kole KA et al: Faculty Development in
Teaching Skills: An Intensive Longitudinal
Model. Academic Medicine. 2004;79(5):469480.
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3 ½ hours/week September-June
Readings, demonstrations, presentations
Role-playing, videotape review, reflection,
discussion
Personal awareness sessions – sharing of
meaningful experiences with emotional content
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“A true teacher defends his pupils against he
own influence.”
- A Bronson Alcott: Orphic Sayings
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Impact of Teachers
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Teacher expertise (teacher education,
licensing, examination scores, & experience)
accounts for >40% of student achievement
(Ferguson, 1991)
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Review of over 60 studies – teacher
education and teacher ability (along with
small schools & lower teacher-pupil ratios)
are associated with significant increases in
student achievement (Laine, 1996)
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Effective Approaches to Teacher
Preparation
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Extended clinical experiences (at least 30 weeks)
that reflect the program’s vision of good teaching,
interwoven with coursework, and carefully monitored
Strong relationships, based on common knowledge
& beliefs shared by all teachers
Extensive use of case studies, teacher research,
performance assessments, portfolio examinations
- Darling-Hammond, 1999
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Fundamentals of a Faculty
Development Program
What if we got really serious about
enhancing our teaching skills?
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Learning to be a Teacher
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Learn to think like a teacher (overcome the
influence of being a student for 20+ years –
the “apprenticeship of observation”)
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We need to focus
more on
understanding
how students
learn so that we
can be more
helpful
Faculty
development
tends to focus
on developing
knowledge and
skills in the
teacher
T
L
The relationship is
central to enhancing
learning
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Fundamentals of a Program
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Early preparation:
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As a resident
Orientation & protected time
Mentorships
A supportive community of teachers
Co-teaching
Personalized – based on individual needs
Context specific components – pedagogical content
knowledge in own discipline based on a deep
understanding of the impact of ones teaching on
student learning
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Fundamentals, cont’d.
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Longitudinal – spiral curriculum that helps
faculty go deeper in understanding & skill
based on developmental stages
Practice with feedback in the work setting:
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Peer consultation
Video review
Rapidly accessible consultation for problems
in the teacher-learner relationship
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Fundamentals, cont’d.
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Opportunities for “sacred idleness” & reflection
Includes mentoring/coaching to develop skills in the
scholarship of teaching
IT support
Program evaluation, ongoing scholarship & research
 continual improvement
Strong, long-term institutional support e.g. protected
time & promotion
And it needs to be available to ALL faculty who teach
not just those who are keen
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“Be patient toward all that is
unsolved in your heart and try to
love the questions
themselves…Do not now seek
the answers, which cannot be
given you because you would not
be able to live them. And the
point is to live everything. Live
the questions now. Perhaps you
will then gradually, without
noticing it, live along some
distant day into the answer.”
- Rainer Maria Rilke
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Some Key References
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Sorcinelli MD et al: Creating the Future of Faculty Development –
Learning From the Past, Understanding the Present. Boston: Anker
Publishing, 2006.
Benor DE: Faculty development, teacher training and teacher
accreditation in medical education: twenty years from now. Medical
Teacher. 2000;22(5):503-512.
Steinert Y: Faculty development in the new millennium: key
challenges and future directions. Medical Teacher. 2000;22(1):4450.
Schmid KL: The accreditation of university teachers: an optometric
viewpoint. Clinical and Experimental Optometry. 1998;81(3):104111.
Darling-Hammond D, Bransford J (editors): Preparing Teachers for a
Changing World - What Teachers Should learn and Be Able to Do.
San Francisco: Jossey-Bass, 2005.
Palmer PJ: The Courage to Teach – Exploring the Inner
Landscape of a Teacher’s Life. San Francisco: Jossey-Bass,
1998.
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References, cont’d.
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Finkel DL: Teaching with Your Mouth Shut. Portsmouth NH:
Heinemann, 2000.
Wright WA and Associates: Teaching Improvement Practices –
Successful Strategies for Higher Education. Bolton MA: Anker
Publishing, 1995.
Bala JI, Gibson M, Chang AM: Learning in Medical School – A
Model for the Clinical Professions. Hong Kong University Press,
1989.
Brown AL, Cocking RR, Bransford JD (editors): How People
Learn: Brain, Mind, Experience, and School. Washington:
National Academy Press, 2002.
Ramsden P: Learning to Teach in Higher Education, 2nd edition.
London: Routledge, 2003.
Konner M: Becoming a Doctor: A Journey of Initiation in Medical
School. New York: Viking, 1987.
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