O'Sullivan, Patricia S. EdD; Irby, David M. PhD
Universities make large investments in their faculty members by supporting their career development as teachers, researchers, and service providers. Faculty development is one mechanism for improving the instructional competencies of teachers and the institutional policies required to promote academic excellence.1 Although research on faculty development has yielded some useful guidance, we argue that strengthening faculty development requires adoption of a broader conceptual framework that incorporates research from other related fields. By reframing faculty development in this broader context and applying current educational research frameworks, we can address new research questions, employ multiple research methodologies, and guide practice with new findings.
Faculty development in medical education began in the 1950s and advanced in subsequent decades through the activities of the Association of American Medical Colleges' Curriculum and Assessment unit (formerly the Division of Medical Education) and the funding of the Health Resources and Services Administration.2 Federal funding supported faculty development for teaching in primary care, particularly in general internal medicine and family medicine, which led to extensive implementation activities such as workshops, local faculty development training programs, and innovative curricula. Over the intervening decades, faculty development has continued to be part of the professional development of many medical educators.1,3,4 Faculty development programs address a variety of instructional needs for four different types of teachers: (1) students, residents, and fellows who are required to teach but have little expertise and/or are launching their medical education careers, (2) faculty members who teach at universities or community-based sites, but for whom teaching is a small component of their responsibilities, (3) faculty members who have a major teaching role, and (4) faculty members who want to become medical education researchers and faculty developers. Programs vary depending on which groups are being targeted.
When schools undertake curricular or pedagogical reform such as introducing small-group teaching, problem-based learning, team-based learning, or time-efficient precepting, faculty require development to improve teaching skills, expand pedagogical understanding, and overcome resistance to change. At other times, faculty members seek programs to improve their own teaching skills and use of new technologies. Some faculty members enroll in longitudinal faculty development programs, such as teaching scholars programs or medical education research fellowship programs, because they possess a deep interest in education, a desire to improve both the processes and outcomes of learning, and a commitment to approach their teaching in a scholarly manner.5
Participation in such faculty development programs should provide faculty members with entry into a new intellectual and social community of like-minded individuals who share a passion for teaching. Such communities often help participants overcome feelings of isolation in their own departments and divisions. Academies of medical educators6–8 meet this need to create a sense of community, or a “teaching commons,” as described by Huber and Hutchings.9,10 Academies also advance faculty development and advocate for the teaching mission.
Research on faculty development in medical education addresses such areas as participant satisfaction, participant achievement, on occasion the impact of participants' newly acquired teaching skills on their learners' performance, and in rare instances the learner's impact on patient care.4,11–13 Like much educational research, this research produces limited generalizable findings or significant insights that can guide practice.
Given these multiple functions of faculty development and the need for research that can guide practice, how should the research be framed? What questions should be addressed, and what methods should be used? In this article, we start with a brief review of the traditional model for faculty development as used in medical education. This model fails to draw from the literature on how physicians and faculty members make changes in their practice. Consequently, we turn to related fields such as teacher education, quality improvement, continuing medical education, and workplace learning, which use different research methods to examine professional development. As a result of this analysis, we describe an expanded model for faculty or professional development. We then reflect on the changes in educational research and pose relevant research questions associated with our new faculty model. In the final section, we propose a series of recommendations for the nature, method, and funding of faculty development research.
Faculty Development Frameworks and Associated Research Approaches
We frame this section by first describing the classic research model for faculty development in medical education, as depicted in Figure 1. In this figure, the research model is defined in a linear manner: The program influences the faculty member, who influences trainees, who in turn impact patient care and health outcomes. After describing this model, we examine how it relates to models in teacher education, quality improvement, continuing medical education, and workplace learning. The subsequent section will integrate these areas of research into an expanded model of faculty development.
Faculty development framework in medical education
McLean et al12 describe the history and current status of faculty development in medical education, which focuses on improving the knowledge, skills, and commitments of the individual faculty members who participate in faculty development programs. If we enhance these faculty members' abilities, we assume that student learning and satisfaction will subsequently improve. Following this causal line of reasoning to its obvious conclusion, better-prepared medical students and residents taught by participants in faculty development programs should deliver higher-quality patient care. As shown in Figure 1, this model implies a direct impact of the education of one faculty member on the behavior of learners, who then bring about change in patient care. It may be unrealistic to attribute linear cause and effect to such an attenuated chain of events. Consequently, the perspectives from related fields of inquiry on professional development can enrich this model.
Professional development frameworks in teacher education
In contrast to the traditional model of faculty development in medical education, Webster-Wright14 in a recent review emphasized a shift from faculty development, frequently called professional development, to “continual professional learning.” Research on continual professional learning examines how professionals learn, including the use of critical reflection and learning to teach in the classroom where instruction actually occurs. By acknowledging the powerful influence of the classroom, this research examines the rich context within which learning occurs and the co-construction of knowledge by the participants in that setting. This perspective highlights the importance of support for professional development in the workplace, connection with others in the settings in which teaching occurs, and time for learning within the work setting.15,16 Therefore, faculty development research, including medical education, should include a focus on how teachers learn and co-construct meaning in the context of everyday teaching practice.
Others in higher education and professions education embrace the concept of “communities of practice” as a powerful framework for enhancing professional learning.17–20 Using Desimone's21 model, faculty development should be embedded in teaching practice (classroom and/or clinical), and research should investigate how teachers learn new pedagogical content and skills individually and together, how teachers can be actively engaged in their own learning, and how teacher knowledge (about successful education methods) and beliefs (about how students and residents learn and the forces that influence and motivate learning) can be connected with expected changes. Faculty development programs should be of sufficient duration to make a significant impact, and, wherever possible, facilitators should seek to engage others involved in the local classroom teaching environment (not just participants in faculty development programs but also nonparticipating teachers and support staff) in order to improve student learning. This approach reflects a shift away from faculty development removed from the context of teaching and toward faculty development as an integral component of the instructional environment and change process. Additionally, there is a shift from the individual as the focus of investigation to a collaborative, relationship-centered model as a mechanism for improvement. This broader model, which allows for a breadth of research possibilities exploring how faculty development can be embedded in the workplace, should be applied to medical education research in faculty development.
Quality improvement framework
The quality improvement movement has a well-developed model for enhancing health care, as described by Ogrinc and Headrick.22 Their approach begins by identifying the quality gap between what are known to be best practices based on best evidence and what is actually done in the organization. The model consists of four steps: plan, do, study, act. Quality improvement efforts rely on teams that focus on measuring systems, processes, and outcomes; implement an improvement strategy; and measure the results of the intervention. Process analysis, measurement, and data analysis are essential to the model when collecting, analyzing, and displaying data to inform and drive change.
The quality improvement framework has much to offer faculty development. For example, the learning/performance gap of teachers is often assumed to be self-identified without any effort to substantiate that assessment, and little emphasis is placed on systematically studying the impact of implementing what was learned in the faculty development program. Best evidence may or may not guide faculty development programs and may or may not be shared with participants. The exclusive focus on individual faculty participants fails to appreciate the power and importance of the work environment and other people who work in that same educational setting. Rarely do participants leave a faculty development program with clearly defined improvement goals and measurement procedures for assessing them. Finally, faculty development programs tend not to examine the structure of work in classroom or clinical settings to determine how best to implement newly learned strategies. The quality improvement model that measures quality gaps on the basis of best evidence and assesses the work environment lends itself to faculty development research.
Continuing medical education framework
According to the most recent Cochrane review,4 participation in continuing medical education meetings makes a small-to-moderate improvement in professional practice with associated smaller improvement in patient care outcomes. Sessions that included both interactive and didactic material had the best outcomes; interactive sessions alone were the least effective. In a surprising contrast to other reviews of continuing medical education, this Cochrane review did not find any statistically significant effect of multifaceted interventions—such as outreach services, reminders, feedback, support services, and educational materials—compared with educational meetings alone. The authors of the report recommended targeting activities to those who do not choose to participate in continuing medical education programs, because those attending may already be performing well.
Faculty development and continuing medical education share much in common, and physicians often participate in both types of programs. The research done in continuing medical education challenges faculty development research to be more outcomes-oriented and to identify the instructional processes that are most effective for achieving those outcomes. The importance of needs assessment, alignment of content (knowledge and skills) and instruction with those needs, and measures of outcomes would help guide faculty development programs. This strategy, linked with the quality improvement processes noted earlier, would argue for the importance of having participants in faculty development programs identify a performance gap before the program and leave with a plan for what they will do and how they will measure the effectiveness of their newly acquired knowledge and skills. One gap identified in both faculty development and continuing medical education is examining the impact on those in the workplace who may not participate, as a secondary outcome.
Workplace learning framework
A surge of research in the past decade on learning in the workplace23,24 is directly relevant to clinical learning in medicine and other health professions. This body of research suggests that three factors (tasks, relationships, and work practices) affect participation in the workplace and, consequently, learning and practice. The tasks that are selected for the learner, the responsibilities assigned, and the sequencing of those tasks all impact how centrally or peripherally a learner will be able to participate in the work. Relationships within the practice community can enhance participation by creating an inviting environment, providing guidance, and encouraging personal engagement. The structure of the work, time pressures, workload, and work flow all influence participation. These social factors make a difference in participation and learning within a community of practice.
Faculty development programs, which usually pull participants out of their work environment, rarely address the challenges of translating the new learning into the workplace. However, faculty development programs would benefit from examining the powerful influences of the work environment, creating new models for conducting faculty development within intact work groups, and researching factors that create success and failure in various teaching settings.
Reframing the Model for Faculty Development in Medical Education
On the basis of this review of research on faculty and professional development in related fields, we argue for the creation of an expanded model to guide a more productive line of inquiry in faculty development than the classic faculty development model generates. The expanded model (see Figure 2) is grounded in social systems and focuses on two communities of practice: the faculty development community and the classroom/clinical workplace community. By drawing on the notion of a faculty development community, the model shifts away from an exclusive examination of individual participants in the program to a model that investigates faculty development as a social enterprise.
We create communities of educators through workshops, seminars, fellowship programs, and academies of medical educators and publicly address and debate issues associated with teaching and learning.9,10 Sullivan and Rosin25 promote such a model as a means of bringing faculty members from different disciplines together to learn from each other. Work being done in these smaller transitory faculty development communities can and should transform larger university environments. By extension, and drawing on the workplace learning literature, faculty development programs should send participants out with follow-up assignments for changes in their own classrooms and clinics on completion of the program.
Figure 2 visually positions the key components of faculty development as they are embedded both in the smaller faculty development community and in the larger academic community where teaching occurs. The figure identifies the four key components of faculty development (participants, program, facilitator, and context), which are part of the smaller, transitory faculty development community or teaching commons. Each of these four components is also associated with a component of teaching in the workplace (relationships and networks in the workplace; organization, systems and culture in the workplace; tasks and activities in the workplace; and mentoring and coaching in the workplace). This latter set of interrelated processes defines faculty development within communities of teaching practice.
Participants in this model, while referring to those involved in the faculty development program, inevitably extend out to include other teachers, health professionals, and staff members who work with these participants in their classrooms or clinics. This model emphasizes the importance of the social connections among all of these individuals. Recommendations, particularly from the teacher education literature, encourage participant reflection on their own teaching and that of others, collaboration with other educators in the program and in their local setting, supportive and guided participation in the new activities, and ongoing learning and development embedded within the community of teaching practice. Researchers should examine the network of these relationships in both the faculty development program community and the workplace community of teaching practice.
“Program” refers to the curriculum, content, and activities of the faculty development offering. Drawing on the quality improvement literature, we recommend that faculty development programs should be guided by best evidence (to select curricular content and instructional designs) and by needs assessment (based on identified performance gaps or instructional problems/opportunities). Other suggestions for faculty development programs based on multiple literatures include working in teams within the faculty development program and within the workplace, clarifying roles and responsibilities in and subsequent to the program, assessing learning needs and achievements in the workplace, documenting outcomes of the program to guide participant ongoing improvement, focusing on follow-up and reminder systems, and considering different strategies for simple versus complex changes.
Facilitators are another essential component of faculty development. As Borko26 points out, the facilitators' pedagogical knowledge and skills are critical to the success of a program yet absent from traditional faculty development research. In addition to leading the faculty development program, facilitators can establish an ongoing, online community that is initiated in the program but can extend to the work setting. Others have established on-site mentoring through peer coaching.27 The facilitator's role is an important part of faculty development and should be more fully explored.28,29
Finally, the organizational context has a large influence on faculty development programs (held in the classroom, clinic, or at a national meeting) and on the participants' subsequent success in the workplace (classroom or clinical setting). Baker and colleagues29 address the importance of organizational process and context, including examining the nature of the physical and social work environment (e.g., number of exam rooms in a clinic, conference room space, and number of team members for inpatient team conferences), the structure of the work itself, and the competing pressures on the teachers and learners. The organizational culture either supports or inhibits educational change through the enacted values of the organization, the incentives and disincentives for teaching, and the supportive or unsupportive nature of leadership. Programs rarely recognize and address administrative support and peer buy-in. Yet, without addressing these factors, real change will be difficult if not impossible to achieve. Recognition of context is important for the faculty development program, the facilitator, and the participants, and therefore it should be added to research on faculty development if we wish to document realistic outcomes of such programs.
Current models of faculty development fail to emphasize the power of communities of teaching practice and networks of relationships for supporting and strengthening instruction in the workplace. The educational workplace is as important to the success of the faculty development participants as are the program components. The individuals who participate in faculty development programs need to be supported within their own instructional settings. Reflective activities need to be built into the program so that, once the participants return to their work sites, they are supported and can share their new insights and challenges.
In summary, the conceptual model we propose has been evolving over the past decade in response to critiques of the classic model of faculty development and the evolving work on teacher education, communities of practice, workplace learning, continuing medical education, and quality improvement. Further, our model lays a foundation for considering how to advance the research on faculty development, making it more relevant to those who need that insight to guide professional development practices.
Educational Research Frameworks and Debates
To date, the methods used in faculty development research, both quantitative and qualitative, have included the following measures to indicate program success:
* Participant satisfaction with the faculty development programs
* Participant self-report of use of knowledge and skills
* Analysis of participants' curricula vitae
* Interviews with participants and sometimes with their learners
* Learner rating of participants' teaching
* Observations of participants' simulated and actual teaching
* Changes in participants' learners' performance on examinations
* Changes in participants' learners' impact on patient care outcomes
Despite the variety of studied outcomes, critiques of the research designs focus on the lack of control groups and the tendency to study individual participants who are educated outside of their teaching environments. Researchers tend to prefer experimental and quasi-experimental research designs, reflecting admiration for the successes of the biomedical sciences and acceptance of the positivist tradition. This tradition, employing the scientific method, seeks generalizable findings (such as which instructional methods work best for all learners in all settings) which therefore are not context dependent. Because the analyses often focus on individual faculty members and their behaviors, the results often fail to account for the social context of both the faculty development intervention itself and the realities of the workplace within which faculty members teach and learn. These studies lack much of the insight needed about facilitators, programs, contexts, and relationships to help others craft successful faculty development programs.
To examine our expanded model of faculty development in a scholarly manner, we need to use the best and most rigorous approaches available in educational research. Researchers have engaged in a vigorous debate over the nature and quality of educational research during the last two decades. The report from the National Research Council (NRC)30 reviewed outcome studies that employed traditional experimental and quasi-experimental designs and rigorous methods in educational research including randomization.31 Many in the education community voice concerns about the NRC report because of its focuses on outcomes and traditional research designs, which fail to address the important dimensions of educational process and context.32,33 A similar debate accompanies Institute of Medicine reports,34,35 which center on accountability, best evidence, and use of rigorous educational research methods.36
These reports argue that we must be creative and clever in conducting educational research, be accountable, and use designs that address important questions being asked about teaching and learning in complex situations. Albert37 summarizes these debates in medical education research as being about epistemology, methodology, purpose, and quality. He depicts medical education research as a struggle between two groups of researchers: those who seek to advance knowledge and build theories versus those who are responsive to practitioners' needs for guidance.
Recently, medical education researchers have called for a shift away from the standards used in biomedical research,38–40 emphasizing a need to employ high-quality methods appropriate for the study.39 Educational researchers, such as Howe,41 express concern about the growing scientific orthodoxy in educational research that parallels medicine's evidence-based movement, which excludes important aspects such as values, preferences, local norms, and politics in deciding what works best. Bredo42 describes the tension between reductionism, which examines and isolates individual parts to understand the whole, and holism, which studies the indivisible whole because to study isolated parts is to lose the meaning of the whole. Bredo concludes that all research methods, when rigorously applied, should be employed, rather than being constrained by strict adherence to reductionistic or holistic paradigms. Importantly, Bredo suggests employing different perspectives in a cyclical manner to guide and constrain the exploration so that no single approach dominates and limits the research endeavor.
The controversies within the general educational research community between experimentalists and contextualists are mirrored in the practitioner community of day-to-day medical teaching, where university-based educational research is often viewed as inconclusive, impractical, and irrelevant.43 If all teachers, administrators, and policy leaders are to take research on faculty development seriously, then the questions addressed and the research methods employed must be broader in scope and strong enough in design to illuminate the processes and outcomes of faculty development and to guide the entire enterprise. The transitions that are occurring in educational research away from the positivist paradigm portend new possibilities for educational research in faculty development.
We make two recommendations related to the nature of the research on faculty development and its use.
1. Promote high-quality, thematic, sustained, and cumulative research programs using various methods/models/paradigms in medical education.
2. Embrace the use of an incremental and cyclical approach to research, as advocated by Bredo,42 in order to develop a deeper understanding of how faculty development actually works.
Educational Research Questions for a New Model of Faculty Development
Our new model generates new research questions and promotes deployment of a broader array of research methods to elucidate more clearly what constitutes successful faculty development. We encourage research on the overall model (a holistic perspective) and on each separate component (a reductionist perspective), on the relationships or associations among the components, and on how each component leads to desired process and performance outcomes.
Researchers need to examine carefully the process of faculty development along with an assessment of the prior and subsequent teaching of participants to understand if what is taught in faculty development programs is actually employed in the workplace. Steinert and colleagues,11 in a systematic review of faculty development, called for process-oriented studies and the use of rigorous research methods. Understanding faculty development program processes is as important as determining changes in participant actions that lead to changes in their learners' performance and ultimately in changes to patient care. For example, what is the nature of the faculty development intervention? What pedagogical strategies work best? How do virtual and real collaborative learning communities strengthen faculty development programs?
This process-oriented inquiry leads to research on relationships within the program and within the academic workplace. Faculty development research has traditionally centered on the individual but now must also examine the role of the teams and communities of teaching practice in the workplace. For example, does it make a difference if participants in faculty development programs come as members of an intact work team (e.g., a team-taught course leadership team, a residency program leadership team, or a curriculum committee)? What are the relationships within the faculty development program and within the workplace? How do these relationships impact the achievement of desired outcomes? What happens if only one individual from a particular course or clinical education program participates in a faculty development program? How do they engage their colleagues? This line of research would put us a step closer to understanding how change in practice occurs within the teaching environment.
Drawing on the continuing medical education and quality improvement literature, faculty development programs need to develop a wide set of measures to assess change. Examples might include process measures related to program implementation, participant networks established through the program and subsequent organizational support for education and change, and the creation of a faculty development community or a teaching commons.9,10 Faculty development researchers should use standard measures of teaching effectiveness to assess teaching skills of faculty development participants, and we should engage participants in their own action research—initiating their own plan–do–study–act cycles, which we believe will lead to the outcomes advocated by the faculty development initiative.
While studying participants, we encourage researchers to test this expanded faculty development model as it applies to different career pathways, including the paths that students, residents, fellows, all teaching faculty, and those specializing in medical education may choose to take. Questions might focus on, What is the community with which each type of participant interrelates? What is the developmental trajectory of each individual or cohort of teachers? What are the differences in skills needed based on the role of the participant in the faculty development program?
We also assert that organizational and contextual factors strongly shape the success of faculty development programs and should be studied. This is critical because the context often is quite complex, uniquely local, and embedded in patient care. Research questions might include, How do teachers make changes in these contexts? How would the new teaching approaches impact the teacher's relationships with others in that environment? How does the local workplace culture impact changes in teaching and learning? Faculty development programs not only need to provide participants with optimal approaches and best teaching practices but also need to support participant interactions within their teaching context. If this were done, would it result in the desired learning outcomes?
Finally, our model calls for illuminating the underexplored role of the facilitator. Whereas articles in the literature discuss the notion of mentor and coach, research on the facilitator is not as well developed in faculty development. Questions to be addressed might include, Who serves in this facilitator role? How can this role be operationalized and sustained? How does this role impact the other programmatic components and result in change?
We offer these sample questions to stimulate a broader effort to elaborate on this model and expand research on faculty development. This is not intended to be a comprehensive set of questions or review of research on faculty development and related fields. Rather, we attempt to synthesize the key reviews in each field as exemplars of research methods and assumptions; therefore, the selections do not capture the richness and depth of research in these fields. However, these questions provide the reader with a coherent narrative about research across these interesting and related arenas and lead to two additional recommendations.
3. Test this expanded model of faculty development examining all the components and interrelationships with an emphasis on studying processes to better ascertain their impact on desired outcomes.
4. Test the application of the expanded faculty development model to various learners and career paths.
Educational Research and Financing
To institute this research agenda requires addressing the practical issues of infrastructure and funding at the national and local levels. Others have repeatedly called for a national investment in research on health professions education, but with little success.44,45 Substantial funding is needed to finance research associated with our model as a means of improving faculty development programs and assessing outcomes on faculty members, learners, and patients. No one would assume that such comprehensive research can be accomplished without funding any more than biomedical research can be advanced without funding. The health professions are unique in not having a federal sponsor of research on professional development. The National Science Foundation supports research on engineering education, and the Institute of Educational Sciences and the Fund for the Improvement of Postsecondary Education support research on education. We contend that funding from the federal government is essential and that multiple models already exist, including support for the clinical and translational sciences.46,47
Research on faculty development at the local level will also require sufficient funding. Local researchers must have the capacity to mount successful faculty development and conduct rigorous educational research. Our model for faculty development and the associated techniques is expensive to undertake, making it difficult to implement without an educational research infrastructure and/or an internal or extramural educational research grants program. Additionally, expanding the faculty development and educational research capacity in schools, departments, and hospitals will require creation of local networks that include educational researchers working alongside basic science and clinical teachers.
Regarding research funding, we offer these further recommendations:
5. Establish a National Institute or Center for Health Professions Education Research with associated training, career development, investigator-initiated research, and centers of excellence funding mechanisms. Such a center should be multidisciplinary and interprofessional.
6. Advocate state, local, and private funding to support educational research and faculty development.
To understand professional development practices well enough to offer policy guidance, a broader research framework that is rigorously investigated is needed for faculty development. We have argued for such a framework, drawing on work from related fields. We have offered recommendations for reframing educational research on faculty development and outlined an expanded model for this process. This expanded model calls for research on educational process and outcomes focused on both the faculty development community and the workplace community. Leadership, policy changes, educational research infrastructure, and incentives will be needed on the local and national levels to advance this agenda. Although many gaps exist in the current literature, we are excited about the possibilities this raises to advance the science of faculty development, and we look forward to learning from the results.
The authors wish to express their appreciation for the thoughtful edits and recommendations provided by Drs. Ruth-Marie E. Fincher, Cayla Ruth Teal, and Teri Turner. They are also indebted to the other members of their work group: Drs. Heidi Chumley, Larry Gruppen, William McGaghie, Gary Rosenfeld, and George Thibault.
This work was supported by a writing conference funded by the Medallion Fund and the Josiah Macy Jr. Foundation. The conference was entitled “A 2020 Vision of Faculty Development Across the Medical Education Continuum” and was held at Baylor College of Medicine on February 26 to 28, 2010.
The authors gave an oral presentation related to this article at the writing conference mentioned above.
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