Recently, over a 24-hour period, I had three experiences that caused me to reflect upon faculty development.
The first happened when one of our new faculty members came by my office to ask for help with an article he was hoping to submit to a journal. I read the article, made a few changes, and asked him where he was in the submission process. He admitted sadly that the article had been rejected twice and that he was almost ready to give up on it. As we discussed why it had been rejected, we began to dissect the article, its strengths and weaknesses, and why he had felt that it was important to publish it. His face lit up as he explained the importance of his findings, which had not been clear to me in my initial reading. He went on to show how the information contained in his article could potentially improve care and might prevent errors. His passion caused me to reread the article and help him refocus it so that the message he felt was most important came through clearly. We also looked at journals that might be most interested in his findings and how to get the attention of the editor and the reviewers with his submission letter. He left the office with renewed optimism.
A few minutes later, a midcareer faculty member joined me for a scheduled mentoring session about medical education research and the manuscript review process. As part of her learning experience, we read a research report that had been submitted to Academic Medicine and discussed the report’s strengths and weaknesses. We then looked at the reviews it had received and compared them against our impressions about the report. This led to a spirited discussion about the report’s topic and methodology and why our opinions about the methodology diverged from those of one of the reviewers. When we consulted the literature about the type of methodology used in the report, we found that the reviewer’s concerns had some basis after all.
Finally, I received an e-mail reminding me to submit my slides and questions for a lecture I was giving as part of a professional conference for practicing emergency physicians. The talk was meant to be provocative and conceptual, with more questions raised than answers. I struggled with the meeting’s evaluation instrument, trying to identify points that could make good multiple-choice questions, and to design questions so that they had clear answers without ambiguity. I was frustrated at having to shoehorn my presentation into an evaluation system it did not fit, and wondered what the participants would remember.
Here were three examples of faculty development of differing degrees of formality. I suspected that the one with the greatest impact was when I helped the new faculty member refocus his article, even though that was the least formal activity and the one I would get the least recognition for. This paradox led me to reflect upon faculty development to better understand the state of the field and how we in academic medicine might improve our approach to this confusing topic.
The first problem with faculty development I encountered in my search of the literature was the term faculty development itself. There is confusion about what we mean by faculty and what we mean by faculty development. Block et al1 describe the current dilemma around the definition of faculty that has been precipitated by the expansion of academic health centers’ (AHCs’) clinical activities. They note that as medical student education has moved from the hospital to the ambulatory setting, new roles for clinicians as supervisors of students and residents have raised questions about how to define these clinicians. Are they faculty? Are they staff? What training and evaluation should they receive? How should they be rewarded? If they are included as faculty, what are the implications for existing faculty? Block et al state that the fundamental requirement for persons to be faculty is that they be involved in the educational and/or scholarly activities of the institution. They note that there will be variability in what constitutes the key activities of faculty; these activities may involve leadership, quality improvement, and teaching, as well as scholarly activities using Boyer’s expansive four-part definition of scholarship: discovery, integration, application, and teaching.2
Deciding whom to include as faculty and what activities are key for faculty is important as one attempts to consider what might be appropriate activities to “develop” faculty. Steinert3 described faculty development as a planned program designed to prepare institutions and faculty members for their various roles, including teaching, research, and administration. Unfortunately, I have heard faculty development being used to describe activities ranging from a one-year sabbatical to a one-hour training session on billing and documentation, which illustrates the confusion about the meaning of the term.
Another problem with that term is that it implies a somewhat passive role for the faculty member, as if he or she were the substrate for some kind of chemical reaction. However, adult learning theories emphasize the importance of motivated, self-directed, active learners who learn because of a need to know and to solve problems.4,5 A passive, standardized approach to faculty development would likely fail to engage faculty in the process of their own development. O’Sullivan and Irby6 have proposed a model of faculty development in an attempt to capture the complex interactions between the individuals involved in the learning activities and the work environment. In their model, participants, facilitators, programs, and an educational context are all necessary and are embedded within a workplace community that can facilitate or impede development. The model of O’Sullivan and Irby moves away from the idea of faculty development as a linear process, in which individual faculty acquire a new skill or knowledge, to something more dynamic and interactive.
Keeping in mind the problems with the concept of faculty development, I suggest that we consider a different frame: that of identity, growth, and empowerment.
Identity acknowledges the broad range of individuals currently employed at AHCs who contribute to the education and scholarship that Block et al defined as fundamental for faculty. By placing identity at the center of faculty development, it also becomes possible to envision a developmental trajectory of professional identity for each faculty member similar to that described by Cruess et al7 for students. Professional identity formation for faculty development would allow the differentiation of faculty activities primarily into research, education, administration, clinical care, or some combination of these, recognizing that scholarship can be a component of any of them and that identity is fluid, allowing for various mixes of activities by faculty at different times and with different priorities for experiences to augment those identities.
Growth recognizes the intrinsic need for faculty to continue to learn and improve, and a work environment that will nurture and facilitate growth. Inclusion of growth as part of faculty development enlarges the scope of activities—such as reflection, narrative expression, and meditation—that can contribute to a healthy and productive academic career and can also incorporate individual differences.
I included empowerment in this frame in recognition of the hierarchical structure of AHCs that is particularly difficult for junior faculty, underrepresented minorities, and women to successfully navigate without assistance. Pololi et al8 described a peer mentoring program that identified empowerment as an important component, and several of the programs described in this issue of Academic Medicine9–14 similarly have emphasized the importance of empowerment in faculty development.
Most of those programs tend to follow an apprentice perspective,15 depending upon senior mentors and creating a supportive motivated community of practice using work activities to provide the stimulus for growth and learning. The programs are mostly clustered on developing medical educators, although there are examples of programs focused on clinical research, quality improvement, and clinical care.
Newman et al9 describe a longitudinal evaluation of graduates of a previously described educational fellowship16,17 compared with a control group, showing superior achievement of the fellowship graduates. Coates et al10 describe interviews with directors of eight medical education fellowships for faculty to learn how the fellowships influenced future faculty members’ activities, identity, and retention. These fellowships were institutionally based, generally one or two years in length, provided lectures on medical education theory and practice, and involved faculty from multiple specialties. They also typically granted at least 10% release time. Coates et al found that graduates of the programs often assumed leadership roles in medical education and developed a supportive community of education scholars. One participant noted:
Everybody says when they leave the program they feel re-invigorated, re-energized, and connected with people who love to teach. It is their passion, but not necessarily culturally valued. So I think that creating the community within the system is the most important [benefit] for these folks. It’s really an antidote to burnout.
Gooding et al11 describe another approach to the development of a community of scholars through creation of a hospital-based teaching academy to bring together those interested in scholarly activities associated with medical education. Members were chosen based on their commitment to medical education scholarship shown by their interest in pursuing an education project. In a survey of the members, the authors found that the academy enhanced the networking opportunities of participants and helped them—particularly women—develop identities as educators.
In the area of patient-oriented clinical research, Libby et al12 describe a two-year faculty development program at the University of Colorado Anschutz Medical Campus that provides 50% protected time with salary support for junior clinical faculty participants’ research and the support of senior mentors. The participants demonstrated increased grant success compared with that of a matched cohort of junior faculty who were not in the program. The authors felt that creation of a community of scholars with peer and senior mentors helped to make the program successful.
Baxley et al13 describe a faculty development program focused on, among other things, quality improvement and patient safety called the Teachers of Quality Academy. This program involved training faculty in both the content and process of quality improvement and patient safety over a year and a half, with each participant presenting a quality improvement project at the end of the program. Grant support provided release time for the 27 faculty who participated. Like other academies and fellowships described in this issue of Academic Medicine, this program also developed a cohesive learning community and resulted in scholarly presentations, the development of educational materials for students, and changes in clinical processes consistent with the new knowledge gained from the program’s quality and safety education.
The clinical arena is also amenable to faculty development through mentorship of junior faculty by senior faculty. Iyasere et al14 describe a clinical coaching program for hospitalists in which junior hospitalists can discuss difficult cases with more senior faculty. The program recognizes the importance of feedback and continued clinical growth in the newly graduated resident. Participants found the program to be valuable for learning and for improving patient care outcomes.
As I considered the programs described in this issue and my own recent experience with faculty development, it became apparent that there is something lacking in our current approach to this activity. While some faculty have the opportunity to benefit from excellent programs, they are the exception. For most faculty, their development is limited to occasional conferences and lectures, such as the one I was preparing.
Unlike undergraduate medical education and graduate medical education, which have defined competencies, individual assessments, clear goals, and leaders responsible for oversight of the programs, we have no defined approach for fostering the next phase of a faculty member’s career. It is during this next phase that faculty create their identities as teachers, researchers, clinicians, scholars, or administrators, and it is during this phase that they grow from being competent to expert and engage in activities that create new models of health care, discover new clinical treatments, and influence the careers of the next generation of health professionals through teaching. It should be our responsibility to help faculty become the best that they can be, just as we are responsible to help our students and our residents become the best that they can be. With our knowledge about adult learning theory, we could create programs tailored to the needs of each faculty member to help that individual reach his or her full potential.
Our current academic departmental structure, with chairs responsible for the oversight of faculty, is not up to task. Chairs are pulled in too many directions, particularly clinical chairs, who must oversee clinical operations, and faculty are often left drifting without direction. We are wasting talented faculty as they slip through the cracks fulfilling clinical needs but ignoring their own growth and identity formation. As AHCs continue to expand their activities to address population health, complex illnesses, quality improvement and patient safety, and personalized care, we cannot afford to waste our faculty talent.
We could begin by recognizing that faculty growth and development is a lifelong process. We should define, value, and nurture each faculty member’s growth, find alignment with institutional and population health needs, allocate resources such as mentor training and support to help meet individual goals, and monitor outcomes. Programs that provide collegial support and individual growth and the development of professional identity, such as those described in this issue, should become the standard and not the exception at our institutions. We need to move away from considering faculty development as a course or a training session and into a more comprehensive vision for faculty development. That vision could lead to a healthier, more capable workforce of medical educators, researchers, clinicians, scholars, and administrators who would be able to anticipate and address the educational needs of their students and the health care needs of the public and, in so doing, also meet their full potential as individuals and faculty.
With this issue of Academic Medicine, we initiate the next topic for our New Conversations feature: global health education. Farmer and Rhatigan18 begin this series of New Conversations with a Commentary, “Embracing Medical Education’s Global Mission.” One other New Conversations piece also appears, by Afkhami.19 We look forward to additional submissions to this New Conversation, which was initially described in our May issue.20,21
David P. Sklar, MD
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20. Sklar DP. Global health education in a changing world: The next new conversations topic. Acad Med. 2016;91:603–606.
21. Weinstein DF. Addressing comparisons, connections, and collaborations in medical education to enhance health across the world through new conversations: A guest editorial. Acad Med. 2016;91:607–608.