Faculty development is an important aspect of health professions education.1 It has been defined broadly as “all activities health professional pursue to improve their knowledge, skills and behaviors as teachers and educators, leaders and managers, and researchers and scholars, in both individual and group settings.”2 Although often envisioned as an individual skill training process, O’Sullivan and Irby3 propose expanding from an individual faculty development model to one that considers faculty development as a “social enterprise” embedded within broader faculty development and workplace communities.
Research highlighting the importance of relationships in the “enterprise” of faculty development is gaining traction, with increasing attention to the role of social support.1,4–6 For example, studies from other professional contexts highlight the learning that occurs via informal daily interactions and conversations with colleagues, which intermixes with learning from more formal academic sessions.7–12 However, few studies explicitly explore how social relationships mediate learning about teaching—particularly in a health professions context where faculty are often distributed, dispersed, and decentralized from the main academic campus. Faculty within the health professions are also unique in that they come from a variety of clinical and academic backgrounds, and many have primary clinical responsibilities and multiple professional identities, such as clinician, administrator, or researcher, in addition to teacher.
Given this social complexity, there is a need to take the abstract notion that faculty development has important social dimensions and make it more concrete by understanding how social interactions affect learning in context. By focusing on the processes and outcomes of relationships, social network analysis offers a way to explore social influences on teaching and learning in health professional faculty development. Despite the potential explanatory value of this technique, social network analysis remains underused in medical education, and analyses that attend to the qualitative nature of relationships are scarce.13,14
This study aimed to address these gaps by using social network analysis to visualize the informal social networks of teaching faculty and then qualitatively explore the influence of these relationships on learning about teaching in the health professions.
Method
Setting
The study was conducted in 2018 at a Canadian medical school with a 4-year undergraduate medical degree. This school is situated in a large, cosmopolitan city with broad social and cultural diversity. The study site itself is geographically diverse and home to a large, distributed medical faculty that educates over 175 students per year.
Participants
A purposive sampling approach was used to recruit participants from a cohort of teaching faculty in an undergraduate medical school curricular program. This program involves faculty who work with small groups of students throughout the year and has associated faculty development support including workshops. The curricular program involves 42 (26 female) individual teaching faculty. These individuals were sent a recruitment email from course administration with a reminder 2 weeks later. Eleven participants (10 female) consented to participate in the study. Table 1 lists participant characteristics.
;)
Table 1: Participant (Total = 11) Demographics
Design
The study design employed a qualitative social network analysis approach to focus attention on individuals’ relationships, using a relational lens to analyze and explain outcomes of human behavior and activity.11,15,16 The University of British Columbia’s Behavioural Research Ethics Board approved this study (approval number H18-00350).
Instruments
We used 3 main sources of data in this research: semistructured interviews, short demographic questionnaires, and participant-drawn sociograms to map individuals’ social networks.15,17 Interviews were conducted by the primary researcher (H.B.), a family physician who also teaches and is in a leadership position in faculty development at the study site university. Because H.B. was a recognized member of her faculty development team, participants were informed that she played no role in promotion and assessment of participants. After the first interview, H.B. and L.N. met to review the interview guide; no significant changes were made, as questions appeared to elicit data that richly answered the research question.
At the start of each interview, participants were asked to complete a short demographic questionnaire. This was followed by open-ended interview questions focusing on the influence colleagues have on participants’ learning about teaching (Box 1). Participants were then instructed to draw a sociogram of colleagues who were influential in their learning about teaching. H.B. created a mock sociogram to use as a prompt and explained how to emphasize the significance of relational ties: thicker lines represent closer relationships, dotted ties represent more fragmented relationships, larger nodes (circles) represent more influential relationships, and smaller nodes represent less influential relationships. Participant-drawn sociograms also functioned as a narrative stimulus for further questioning. We scanned sociograms after each interview and replaced original names with pseudonyms (Figures 1–3). Sociograms were analyzed alongside interview data and the demographic questionnaire.15,17
Figure 1.: Sociogram of a highly embedded participant.
Figure 2.: Sociogram of participant with few bridging ties among colleagues.
Figure 3.: Sociogram of participant with bridging ties among colleagues.
Analysis
Eleven interviews ranging from 45 to 60 minutes were transcribed, anonymized, coded, and analyzed thematically.18 Transcripts were analyzed in 3 stages. First, we generated initial codes. Next, we explored patterns in the data19 using ATLAS.ti software.20 Finally, we used a social network lens16,19 to interpret influential relationships comprising participants’ informal social structures. The primary researcher (H.B.) analyzed transcripts and met with L.N. (a social scientist outside the university faculty development team) to discuss findings during the 3 stages of analysis. This reflexivity was pivotal to the research process given that H.B. was known to some participants.
To deepen conceptual clarity, other social learning theories and frameworks were used to augment and extend understanding. For example, Vygotsky’s social learning theory21 was integrated into the third stage of analysis to emphasize colleagues functioning as a scaffold for participant learning. We referenced participant-drawn sociograms concurrently throughout analysis process as to augment participants’ narrative descriptions22 and used demographic data to provide contextual insights into participants’ backgrounds. These multiple data sources helped crystallize and deepen understanding of the interview transcripts.23 We agreed insights had reached sufficient conceptual depth of understanding to answer our research question after analyzing data from 11 participants.23,24
Results
Participant-drawn sociograms included 2 to 16 colleagues, with most participants identifying around 10. Networks primarily consisted of professional colleagues, but occasionally network members outside that professional social domain were named (e.g., a family member). Teachers who reported a primary work location distant from the main teaching site identified fewer colleagues in their professional networks and fewer bridging connections between these colleagues than participants working closer to the main teaching site.
We identified 4 ways social networks influenced faculty learning about teaching: (1) enabling and mobilizing knowledge acquisition, (2) contributing to professional identity formation around teaching, (3) providing opportunity for expression of vulnerability as a prerequisite for deeper sharing, and (4) augmenting and scaffolding learning from multiple knowledge sources. These are discussed in more detail below (all participant quotes are assigned anonymized initials).
Enabling and mobilizing knowledge acquisition
Participants described colleagues influencing their decisions to attend faculty development sessions, their learning within these sessions, and their application of learning afterward. One participant with multiple close and bridging ties within her network indicated that interactions with familiar colleagues exerted a powerful influence on her decision to attend faculty development sessions:
And so I would say, like, the shared agreement not to attend is as important as the shared agreement to attend. I think there’s a lot of, like, oh, I don’t really want to go to this [But] if the other 2 had said, like, well, we’re going to go, I’d be, like, well, fine. I’ll go. (CH)
Another participant with a similar network composition expressed similar views: “I would say I am increasingly more likely to go if it were one of the people from my network.” (CR)
However, this was not universally found in the data, as illustrated by this quote from a participant with more years of teaching and rich connections at the teaching site: “I will walk in and I see somebody and I go, oh, I can go sit beside them and have a nice chat and catch up…. But it’s not a—I don’t go or not go because of somebody.” (HE) However, although attendance with a colleague did not influence her decision to go, if a colleague was the facilitator of the event, it exerted a “social guilt”:
I just look for who it is … and if I know who it is delivering or who it is who’s sending the invitation sometimes there’s just social guilt where I’m like I should go, because I know these people. (HE)
Relationships also influence learning during formal faculty development sessions. For example, one participant emphasized the important role a familiar colleague can play in creating a comfortable environment to allow learning to happen:
I am always a little bit put out or uncomfortable in any sort of a session like that where you’re immediately put into an icebreaker situation…. I find that the discomfort of then having to interact with people who I don’t interact with regularly probably impedes my learning. (CR)
Participants also felt the facilitator’s own experience and knowledge on the topic was important to guide and direct the conversations beyond the level of the conversations already occurring in their networks. For example, a participant who was highly embedded and situated close to the academic site shared:
And then I think none of us found them [discussions] helpful … maybe the reason it felt less useful to have that group-centered discussion is because we’re already doing that. (CH)
Participants indicated conversations with colleagues after a faculty development session also influenced their perception of its utility and their ability to apply the new learning:
You think that something has gone well and then somebody points 1 or 2 flaws that were in it…. So I think when there’s people who you trust and who you think are credible in an area like teaching or education, their impression of something definitely is able to colour my impression. (CH)
Another participant with strong bridging ties (Figure 3) described how attending the same sessions with a participant in her network allowed her to take what she had learned in one session and apply it in a future session with this same person:
She was able to then say, hey, you know, remember that workshop that we went to and remember this particular thing that they were talking about…. And so it—yeah, it kind of built on something that we’d attended together. And we were able to then use that in this other session because we’d both been at the same session. (BE)
Social network relationships also influenced faculty learning about teaching from more informal, workplace-based (e.g., teaching sessions) sources of knowledge. Specifically, participants reported going to colleagues in their network for reassurance, feedback, or advice.
For example, when teaching sessions did not go as anticipated, participants found discussing it with a colleague in their network allowed them to broaden their perspective. Interestingly, this appeared to help to preserve their confidence:
Because sometimes you think, oh, that was just awful…. And then you talk to someone else and you think, oh, okay. Maybe it’s not so awful after all … and then also it helps with your confidence. (BT)
This same participant further described how her broadened perspective functioned to provide reassurance that she was still on track:
[What is helpful about it is] when I hear little tips about what maybe Amy’s doing in her group. And also … in the other person’s group. It just really helps to get a sense that, yeah, I’m on the right track. (BT)
Many participants also solicited feedback to direct their future practice:
I also had a chance to tell her what I was already doing with [the students] and just get some feedback around that too. Because I wasn’t too sure if I was handling it properly or not. (GE)
If you’ve been having a group where maybe the interaction isn’t the way you’re hoping it to be … it’s always good to talk to other people about how they’ve handled those situations. (KI)
I know in [course 1] there were other questions that I had in terms of when students share information where you’re thinking like oh, I guess they might have been mistreated or, like, it was something more serious happening or it looks like their preceptor was maybe incompetent and sort of how to handle that. (GE)
Professional identity formation
Participants did not naturally always see themselves as teachers, given their other primary roles, and described network members as helpful in developing their confidence and affirming their identities as teachers:
I think there’s a certain trust and support and vulnerability in a way, particularly for those of us that aren’t teachers. It’s not what we were kind of trained to do…. And to be surrounded by people that you feel have your best interest at heart because they’re people that … know you and care about you and trust each other. And are able to, like, offer feedback to each other and support and all of those kinds of things. (BE)
One of the ways this affirmation of the teacher role occurred was through showing mutual respect of each other’s teaching style, not necessarily through sharing similar teaching approaches:
I felt like she really respected the way I was doing it as well. Which just affirmed who I was, yeah, and how we were teaching the program. (BT)
Gestures of kindness among colleagues also helped to affirm teacher identity, particularly between colleagues of different backgrounds:
Or you just have an off day … she actually dragged food up for me which was very helpful. Those kind of things just really are really kind and helpful to make you—me feel affirmed in what I’m doing…. ‘Cause I’m a researcher, not a clinician, and I feel like sometimes—even though nobody never says anything to me, it’s just my own inferiority complex that comes out. (BT)
Expression of vulnerability
When participants characterized a colleague within their network as both credible and trustworthy, they were able to accept feedback, particularly negative feedback, more readily, and share more difficult (e.g., sensitive) information:
I mean, the thing I recognize is vulnerability and the thing I love … and that I can really excel in is that we can be really vulnerable with each other. And it’s really a trusting space versus there’s other areas in my life … where you cannot—it’s really hard to hear the negative feedback because it’s not a very trusting, vulnerable space to be. (JA)
Another participant elaborated how they perceived credibility in their colleagues. Although credibility was multifactorial, it needed to be combined with feelings of psychological safety:
I think the credibility comes—has a lot to do with a few things. So I think it’s for those who are more senior to me and who I’ve looked to as good role models … that credibility comes from, you know, that person as a physician…. I think there’s something to be said for a person’s sort of like social reputation as well. And it’s also, you know, people that I can connect with on a personal level as well, right, that I feel comfortable with and that, you know, I feel safe going to ask something or going to pick their brains about something. Or, you know, telling them that I had this awful experience. (KI)
While many participants described psychological safety and respect as important ingredients of collegial relationships, one participant described fostering a resolve to prioritize psychological safety when her colleague did not model this himself:
I remember as a teacher there were times where … he [mentor] yelled when things went sideways and stuff, where it didn’t feel safe. Where another was always cool as a cucumber and really calm and really encouraging and stuff. So I guess doing the same for my students and making them feel safe and not feeling bad. (JA)
Scaffolding learning
Faculty described collegial relationships functioning as a scaffold to augment their own learning in an area they valued, yet perceived as underdeveloped. For example, those with ample experience related to practice valued the learning offered by a colleague with less practical experience, but more perceived formal knowledge. Participants based more remotely in the community also valued having diversity within their network beyond individuals also colocated remotely, even if it required more deliberate and intentional effort to establish and maintain connections. For example, one participant felt that her clinical partners were all similar and homogeneous in terms of their approaches to teaching, as their teaching knowledge derived from their similar workplace-based experiences, so she intentionally sought out colleagues with different experiences and knowledge:
I guess I’m at a level where I’ve done this for so long … I go to Jenny because she’s closer to her own training and stuff. And plus she is doing a master’s, a higher level of education about education she kind of has a bit more of a wider sort of breadth and kind of more cutting edge information. (JA)
However, not surprisingly, participants with less clinical experience valued learning from clinicians with similar or more clinical experience:
They’d be people who are probably at a similar level of experience in terms of teaching as I am. Or more senior…. And maybe, probably truthfully, a little less so of people who are newer or more junior. (HE)
This valuing of more experience also extended to others’ knowledge of the “political” arena of work, particularly for those participants with fewer bridging and connecting ties within their networks. As a more isolated participant JA (Figure 2) described, “she just kind of knows the politics or just kind of how to prioritize sorts of things. So I consider her a mentor.”
Discussion
This qualitative social network analysis enabled us to purposefully defect attention away from the traditional emphasis on individual faculty in the faculty development literature1,25 to instead explore how social relationships influence learning about teaching. Our findings provide unique insights regarding how this occurs within a health professions context, which have practical implications for efforts to support the development of health professions faculty.
First, our findings show that faculty interact with multiple sources of knowledge and that social networks influence more formal educational spaces. This is consistent with prior work26,27 and emphasizes the importance of framing faculty development as a “situated construct.”27 A practical implication of this finding for faculty developers is to consider and recognize the social networks of their participants and the multifaceted influence they bring. Further, our insights emphasize that the expertise faculty “bring to the room”26 extends beyond individual expertise to also include relational expertise, which exerts influence even before getting to “the room” and continues to be influential after everyone has left as participants engage in conversations with colleagues after formal sessions and use their network relations to apply this information in practice. Advice, feedback, and reassurance from social networks appears particularly important to help faculty interpret difficult or complex events, as has been shown in undergraduate medical education28 and higher education.29
Second, our findings show how faculty’s identity as a teacher can be affirmed through relationships in their social networks. Teachers in the health professions often have multiple professional roles (e.g., clinician, administrator, researcher), and identity as a teacher did not always appear to be easily integrated into one’s sense of self. Strengthening teacher identity through professional social networks is important, as identity can influence career choices and teaching involvements.30 The results of this study support increasing attention in the literature to how faculty development can be used to strategically reinforce a teacher identity.30,31
Third, our findings illuminate how credibility combined with trustworthiness in social network relationships create a safe place for vulnerable expression of teaching concerns and dilemmas. This insight highlights the paradoxical tension between credibility and vulnerability in a teacher–learner relationship.32 The term “intellectual candor” has been offered as way to acknowledge and embrace this tension.32 While credibility can be viewed as co-constructed (“in seeking to promote our own credibility, we also construct the credibility of others”),32 participants in our study placed less explicit verbal attention on their own credibility, focusing instead on the credibility of others in their social network. However, the safety and trust requirement our participants spoke of could reflect an effort to co-construct their own credibility.
Fourth, study participants described using relationships in their networks selectively, to augment learning in specific areas. This illustrates how professional social networks serve to scaffold faculty learning about teaching33 and relates to other research showing how limited network size and diversity predict lack of expert teaching abilities.34 Vygotsky coined the term “more knowledgeable other,” which can refer to anyone with a better knowledge or understanding of the task or concept.21,35 In our study, “more knowledgeable” was inferred from greater clinical or teaching experience or recent formal training (e.g., a master’s degree in health professions education).
Implications
The use of a social network lens15 in this study allowed us to deepen and transform our thinking about faculty development practices. Our insights suggest an appreciation of how networks can influence decision making about attendance at events behooves faculty developers to recognize that participants interact with their multifaceted environment and engage in adaptive situated use of knowledge.27 More broadly, it also supports the notion that significant faculty development is occurring “outside the room” in an ongoing, informal basis. The importance of this informal learning from social network relationships supports broadening how we measure the impact of faculty development programs and interventions (e.g., by gathering qualitative feedback from participants to capture these insights).36 At an organizational level, it may be strategic to offer opportunities and spaces for faculty to connect before, between, and after teaching sessions to facilitate relationship building and informal sharing of experiences, resources, and information. This may be particularly beneficial for faculty who are remotely located and therefore potentially more disconnected from colleagues. It also may be fruitful to consider a network approach when developing communication strategies for faculty development events, as receiving an invitation from an influential peer is likely more effective than a mass mail-out. As well, with recent attention in the literature to strengthening teachers’ professional identities through faculty development initiatives,30 engaging in instructional practices—such as having faculty draw out their networks—may strategically reinforce their identity as a teacher embedded within a network. This exercise could also remind faculty developers of the value of the broader relational context of the participants in their program and underscore the importance of repositioning faculty development as nonhierarchical collective learning.
Limitations
“Every way of seeing is also a way of not seeing.”37 Therefore, the social network lens may have downplayed the individual factors that may influence a faculty’s member learning about teaching. Further, participants were asked about colleagues who were influential to their learning about teaching. The majority of colleagues described were characterized as positively influential, which may reflect a bias toward considering influential network relations as inherently positive and should be explored in future research. Future studies are also encouraged to explore how networks form, change, and evolve over time using sophisticated social network analysis tools and approaches.13,16 However, it is notable that given the broad range of participant backgrounds and experiences, it appears networks remain significant at different career stages. Finally, although the participants came from a wide variety of backgrounds, the majority identified as female. The influence of gender in faculty development appears to be understudied. Previous research has demonstrated the importance of networking and collaboration for all genders without significant differences in the faculty development needs of women and men.38 While this suggests gender did not influence our results, more research is needed to draw accurate conclusions.
In conclusion, this study illuminates how the professional collegial networks of faculty influence their learning about teaching in the areas of knowledge acquisition and mobilization, identity formation, vulnerable expression, and scaffold provision. The findings support recent calls to reorient faculty development in the health professions as a dynamic social enterprise.
Box 1
Examples of Semistructured Interview Questions
- 1. How would you describe the role your colleagues have on your processes of learning about teaching?
- a. Can you give an example?
- 2. Can you draw/map out the people you learn with?
- 3. Can you describe the characteristics of these colleagues?
- a. What are their professional backgrounds?
- b. What are their teaching experiences?
- 4. How would you describe your relationships with each of them?
- 5. How often do you interact with them?
- 6. Can you tell me about how they influence your teaching?
Acknowledgments:
The authors wish to thank Dr. Diana Dolmans for her feedback on the research proposal and study. They also thank the University of British Columbia’s (UBC’s) Center for Health Education Scholarship (CHES) for their support throughout the course of the project.
References
1. Steinert Y, Mann K, Anderson B, et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME guide no. 40. Med Teach. 2016; 38:769–786
2. Steinert Y. Faculty development: Core concepts and principles. Steinert Y, ed. In: Faculty Development in the Health Professions: A Focus on Research and Practice. Dordrecht, the Netherlands: Springer. 20143–25
3. O’Sullivan PS, Irby DM. Reframing research on faculty development. Acad Med. 2011; 86:421–428
4. Foo YY, Moody J, Cook S. Visualizing faculty development impact: A social network analysis. Perspect Med Educ. 2019; 8:191–196
5. Onyura B, Ng SL, Baker LR, Lieff S, Millar BA, Mori B. A mandala of faculty development: Using theory-based evaluation to explore contexts, mechanisms and outcomes. Adv Health Sci Educ Theory Pract. 2017; 22:165–186
6. Jippes E, Steinert Y, Pols J, Achterkamp MC, van Engelen JM, Brand PL. How do social networks and faculty development courses affect clinical supervisors’ adoption of a medical education innovation? An exploratory study. Acad Med. 2013; 88:398–404
7. Tasselli S. Social networks of professionals in health care organizations: A review. Med Care Res Rev. 2014; 71:619–660
8. Van den Bossche P, Segers M. Transfer of training: Adding insight through social network analysis. Educ Res Rev. 2013; 8:37–47
9. Roxa T, Martensson K. Significant conversations and significant networks—Exploring the backstage of the teaching arena. Stud High Educ. 2009; 34:547–559
10. Pataraia N, Falconer I, Margaryan A, Littlejohn A, Fincher S. Who do you talk to about your teaching? Networking activities among university teachers. Frontline Learn Res. 2014; 2:4–14
11. Van Waes S. The Ties That Teach: Teaching Networks in Higher Education [dissertation]. Antwerp, Belgium: Antwerp University. 2017
12. Martensson K, Roxa T. Working with networks, microcultures and communities. Baume C, Popovic C, eds. In Advancing Practice in Academic Development. New York, NY: Routledge. 2016174–187
13. Isba R, Woolf K, Hanneman R. Social network analysis in medical education. Med Educ. 2017; 51:81–88
14. Nimmon L, Cristancho S. When I say … networks and systems. Med Educ. 2019; 53:331–333
15. Daly AJ. Mapping the terrain: Social network theory and educational change. Daly AJ, ed. In: Social Network Theory and Educational Change. Cambridge, MA: Harvard Education Press. 20103–16
16. Nimmon L, Artino AR Jr, Varpio L. Social network theory in interprofessional education: Revealing hidden power. J Grad Med Educ. 2019; 11:247–250
17. Kadushin C. Understanding Social Networks: Theories, Concepts and Findings. New York, NY: Oxford University Press. 2012
18. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3:77–101
19. LeCompte MD, Schensul JJ. Data analysis: How ethnographers make sense of their data. LeCompte MD, Schensul JJ, eds. In: Designing and Conducting Ethnographic Research. Plymouth, UK: Rowman Altamira. 1999147–159
20. ATLAS.ti [computer program]. Version 8. Berlin, Germany: Scientific Software Development GmbH; 2018
21. Vygotsky LS. Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press. 1978
22. Cristancho S. Eye opener: Exploring complexity using rich pictures. Perspect Med Educ. 2015; 4:138–141
23. Varpio L, Ajjawi R, Monrouxe LV, O’Brien BC, Rees CE. Shedding the cobra effect: Problematising thematic emergence, triangulation, saturation and member checking. Med Educ. 2017; 51:40–50
24. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: Guided by information power. Qual Health Res. 2016; 26:1753–1760
25. Leslie K, Baker L, Egan-Lee E, Esdaile M, Reeves S. Advancing faculty development in medical education: A systematic review. Acad Med. 2013; 88:1038–1045
26. Ng SL, Baker LR, Leslie K. Re-positioning faculty development as knowledge mobilization for health professions education. Perspect Med Educ. 2017; 6:273–276
27. Baker L, Leslie K, Panisko D, et al. Exploring faculty developers’ experiences to inform our understanding of competence in faculty development. Acad Med. 2018; 93:265–273
28. Stasiuk S. Utilizing Social Network Analysis to Explore Meaning Making in Medical Students [masters thesis]. Maastricht, the Netherlands: Maastricht University. 2019
29. Gerken M, Beausaert SAJ, Segers M. Working on professional development of faculty staff in higher education: Investigating the relationship between social informal learning activities and employability. Hum Resource Dev Int. 2016; 19:135–151
30. Steinert Y, O’Sullivan PS, Irby DM. Strengthening teachers’ professional identities through faculty development. Acad Med. 2019; 94:963–968
31. Sklar DP. Moving from faculty development to faculty identity, growth, and empowerment. Acad Med. 2016; 91:1585–1587
32. Molloy E, Bearman M. Embracing the tension between vulnerability and credibility: “Intellectual candour” in health professions education. Med Educ. 2019; 53:32–41
33. Malik SA. Revisiting and re-representing scaffolding: The two gradient model. Cogent Educ. 2017; 4:1–13
34. Van Waes S, Van den Bossche P, Moolenaar NM, De Maeyer S, Van Petegem P. Know-who? Linking faculty’s networks to stages of instructional development. High Educ. 2015; 70:807–826
35. Learning Theories. Social development theory (Vygotsky).
https://www.learning-theories.com/vygotskys-social-learning-theory.html. Accessed July 9, 2020
36. Allen LM, Palermo C, Armstrong E, Hay M. Categorising the broad impacts of continuing professional development: A scoping review. Med Educ. 2019; 53:1087–1099
37. Burke K. Permanence and Change: An Anatomy of Purpose. New York, NY: New Republic Press. 1935
38. Seritan AL, Iosif AM, Hyvonen S, Lan MF, Boyum K, Hilty D. Gender differences in faculty development: A faculty needs survey. Acad Psychiatry. 2010; 34:136–140
