Whither Faculty Development

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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 withhis wife Jessie
  McGeachy
• 1952 1st dean of the newmedical school at the
  U ofSaskatchewan

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Mcleod, contd.

• 1960 publicly supported the government during
  the Doctors strike
• 1962-70 executive secretary ? executive
  director of the ACMC
• gt1970 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 members 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.
  Dalhousies month long elective
• Certificate, scholars Masters 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 200479469-480

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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 doesnt 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, contd.

• 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, contd.

• 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 dont
  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 SchemaStages of Cognitive Development
Evolving Commitments
Multiplicity
Dualism
Relativism
Maker of meaning vs. receiver of meaning
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• The most important knowledge teachers need to do
  good work is a knowledge of how students are
  experiencing learning and perceiving their
  teacher's actions.
• - Steven Brookfield

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Stages of Development

• Reporter (What)
• Interpreter (Why)
• Manager (Next steps)
• Educator (Scholar)

RIME
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

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3
3
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• And of course, last but hardly least, I now tend
  to see people as patients. I noticed this
  especially with women. It is often asked whether
  male medical students become desexualized by all
  those women disrobing, all those breast
  examinations, all those manual invasions of the
  most intimate cavities. I found that to be a
  rather trivial effect.
• What I found more impressive was the general
  tendency to see women as patients. This clinical
  detachment comes not from gynaecology but from
  all the experiences of medicine

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• During my medicine rotation when, on a bus, I
  noticed the veins on a woman's hand how easily
  they could be punctured for the insertion of a
  line before noticing that she happened to be
  beautiful.
• - Konner Becoming a Doctor, 1987, p 366

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Lessons from a Seminar

• 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
  patients repeated appearances to K.M.S. any
  longer. Theres a patient, I said timidly

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• Dr Parkers response was reflexive and harsh.
  Im gonna have to ask you he stabbed the air
  in my direction with a stiff pointed finger If
  youre gonna keep interrupting me Im 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
  thoughtit 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, contd.

• 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

• Schedule a sacred idleness day.
• If you are resisting, list five benefits for
  having a day for yourself.
• Prevent encroachment into that day.
• Avoid making plans - trust your instincts to
  create the day.
• Eliminate guilt from your idleness day.
• Throw your head back and soak up every moment.

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Enhancing Self-Knowledge, contd.

• Kole KA et al Faculty Development in Teaching
  Skills An Intensive Longitudinal Model. Academic
  Medicine. 200479(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
  gt40 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 programs vision of good
  teaching, interwoven with coursework, and
  carefully monitored
• Strong relationships, based on common knowledge
  beliefs shared by all teachers
• Extensive use of case studies, teacher research,
  performance assessments, portfolio examinations
• - Darling-Hammond, 1999

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Fundamentals of a Faculty Development Program

• What if we got really serious about enhancing our
  teaching skills?

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Learning to be a Teacher

• Learn to think like a teacher (overcome the
  influence of being a student for 20 years the
  apprenticeship of observation)

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We need to focus more on understanding how
students learn so that we can be more helpful
Faculty development tends to focus on developing
knowledge and skills in the teacher
T
L
The relationship is central to enhancing learning
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Fundamentals of a Program

• 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, contd.

• 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, contd.

• 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 themselvesDo
  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.
  200022(5)503-512.
• Steinert Y Faculty development in the new
  millennium key challenges and future directions.
  Medical Teacher. 200022(1)44-50.
• Schmid KL The accreditation of university
  teachers an optometric viewpoint. Clinical and
  Experimental Optometry. 199881(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 Teachers Life. San
  Francisco Jossey-Bass, 1998.

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References, contd.

• 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.