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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

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 ofSaskatchewan

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Mcleod, cont’d.

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 Jock Murray, Dalhousie University 1995 Ian Hart, University of Ottawa 1996 Donald Wilson, AMS 1997 Richard Cruess, McGill University 1998 John Wade, University of Manitoba 1999 Arnold Naimark, University of Manitoba 2000 Martin Hollenberg, University of British

Columbia 2001 John Evans, Torstar Corporation 2002 Michael Kirby, Senate 2003 Michel Bureau, Fonds de la recherche en

santé du Québec 2004 Jean Gray, Dalhousie University 2005 symposium rather than a lecture

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Whither Faculty Development: Can We Do Better?

OUTLINE: Good news and bad The gap Fundamentals of a serious approach to faculty

development

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Objectives

At the end of this presentation, you will: 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

“…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? Many definitions:

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 Surveys of faculty development activities in

Canadian medical schools (McLeod, 1987 & McLeod, Steinert, Nasmith, Conochie, 1997) “…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

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

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

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-Century-Crofts.

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…Optimally, prospective and current teachers should have abundant opportunities to: 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 self-critiquers.”

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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?

“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

“Discipline expertise is sufficient to make you an expert teacher”

Where does this crazy idea come from??? 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

We act as if education is of fundamental importance to everyone….

…except the teachers

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Another Crazy Assumption

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 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. 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. Teaching effectively by computer conferencing or

videoconferencing How to deal with transference & counter-

transference 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 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? Needs assessment:

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

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

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 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

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

Dualism

Multiplicity

Relativism

Evolving Commitments

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

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 3 + 3 = 8

3 + = 3

3 3

+ = 6

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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.

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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“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…”

Lessons from a Seminar

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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

Parker Palmer 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

Peer consultation Co-teaching Video review Discussion group – encourage good talk about good

teaching

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Enhancing Self-Knowledge, cont’d.

Protected time Mentoring Reading and reflection Creative writing Sabbaticals, study

leave Discussion groups

Courses outside your own discipline

Humanities – art, theatre, film

Balint groups Sacred idleness (George

Macdonald)

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Sacred Idleness Day

1. Schedule a ‘sacred idleness’ day.2. If you are resisting, list five benefits for

having a day for yourself.3. Prevent encroachment into that day.4. Avoid making ‘plans’ - trust your instincts to

create the day.5. Eliminate guilt from your ‘idleness’ day.6. Throw your head back and soak up every

moment.

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Enhancing Self-Knowledge, cont’d.

Kole KA et al: Faculty Development in Teaching Skills: An Intensive Longitudinal Model. Academic Medicine. 2004;79(5):469-480. 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

Teacher expertise (teacher education, licensing, examination scores, & experience) accounts for >40% of student achievement (Ferguson, 1991)

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 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 ProgramWhat if we got really serious about

enhancing our teaching skills?

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Learning to be a Teacher

Learn to think like a teacher (overcome the influence of being a student for 20+ years – the “apprenticeship of observation”)

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T L

Faculty development tends to focus on developing knowledge and skills in the teacher

We need to focus more on understanding how students learn so that we can be more helpful

The relationship is central to enhancing

learning

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Fundamentals of a Program Early preparation:

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.

Longitudinal – spiral curriculum that helps faculty go deeper in understanding & skill based on developmental stages

Practice with feedback in the work setting: Peer consultation Video review

Rapidly accessible consultation for problems in the teacher-learner relationship

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Fundamentals, cont’d.

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 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):44-50.

Schmid KL: The accreditation of university teachers: an optometric viewpoint. Clinical and Experimental Optometry. 1998;81(3):104-111.

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. 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.