The personal and professional impact of a fellowship in medical education

Evaluation of an Educational Scholarship Fellowship Program for Health Professions Educators

Introduction

Historically, the requirement to produce scholarship for advancement has challenged health professions educators heavily engaged in teaching. As biomedical scientists or healthcare practitioners, few are trained in educational scholarship, and related faculty development varies in scope and quality across institutions. Currently, there is a need for faculty development and mentoring programs to support the development of these skills.

Methods

The International Association of Medical Science Educators (IAMSE) established the Medical Educator Fellowship (MEF) Program to foster health professions educational scholarship. MEF addresses the following: curriculum design, teaching methods and strategies, assessment, educational scholarship, and leadership. Participants receive mentorship and faculty development, and complete an educational scholarship project. Using a logic model, we conducted a retrospective program evaluation with data from Program records, database searches, graduate surveys, and focus groups.

Results

Over 14 years, MEF graduated 61 participants with diverse terminal degrees from five continents and six academic program areas. Graduate survey responses indicated enhanced post-Program skills in all focus areas, that the majority would recommend MEF to a colleague, and that mentorship, networking, and professional development were strengths. Focus group outcomes indicated professional growth, increased confidence, and increased sense of community.

Conclusion

MEF addresses health professions educators' need for faculty development and mentorship in educational scholarship. Evaluation outcomes suggest that MEF effectively enhanced perceived skills across focus areas. Similar programs are essential to support faculty who dedicate significant time to teaching. Organizations like IAMSE can demonstrate the value of educational scholarship and positively impact health professions educator careers by supporting such programs.

Communities of practice to facilitate change in health professions education: A realist synthesis

BACKGROUND

Communities of practice could contribute to transformations in health professions education to meet complex and emerging challenges. However, little is known about the underlying mechanisms of communities of practice in this setting, and how context influences outcomes.

OBJECTIVE

To understand when, why and how communities of practice with health professions education faculty work to facilitate higher education change.

DESIGN

A realist synthesis according to the RAMESES standards and steps described by Pawson and colleagues.

REVIEW METHODS

Early scoping of the literature informed the development of an initial program theory to describe underlying assumptions about how communities of practice in higher education, implemented with health professions education faculty, were likely to work. The theory was tested and further refined through a realist synthesis. A systematic search for evidence using search terms 'faculty', 'communities of practice' and 'higher education' and related terms was supplemented with citation tracking and hand searching of significant authors and journals. Following study appraisal, data were extracted and synthesised from 21 manuscripts describing 16 communities of practice. The realist synthesis focused on identifying patterns in context-mechanism-outcome interactions, and the alignment with substantive theory.

RESULTS

From the included manuscripts, ten context-mechanism-outcome configurations were identified that describe a range of individual, interpersonal and institutional outcomes of communities of practice with health professions education faculty and context-mechanism interactions that contribute to achieving these outcomes.

CONCLUSIONS

This study expands theoretical understandings of how and why communities of practice work. There is value in communities of practice in the higher education sector, primarily in the field of health professions education. Communities of practice implemented in the context of complex change with participants who have a desire to participate can facilitate change in health professions education, including institutional level changes, through reflection, experiential learning and creating a shared agenda for change. Findings from this study can be used by policy and decision-makers within health education to best apply communities of practice to achieve meaningful outcomes.

Measuring the added value of virtual communities of practice for developing the educator role of critical care professionals

In healthcare settings, workplace learning is often supported by clinicians who strive to combine service provision and educator roles. We evaluated an international 12-month programme that supports widely distributed critical care health professional educators (HPEs) through a virtual community of practice (vCoP). Specifically, we evaluate if and how the vCoP approach affects learning experiences using an innovative evaluation framework in medical education-the value-creation framework (VCF). We used a mixed-methods approach to evaluation, including an anonymous survey and semistructured interviews. Themes from data sources were identified using the VCF as the common thread. Themes discussed by at least two-thirds of interview participants were analysed using narrative inquiry. 27 of 66 participants responded to the survey, and 15 participated in interviews. Positive and negative indicators of value creation were extracted and organised according to the framework's eight value cycles. Framework analysis made value-creation and potential flow-on effects in one value-creation cycle to another visible, offering insight into relationships. Themes from narrative inquiry elaborated on the results of the framework analysis. Using the VCF to evaluate the Incubator programme brings to bear the complexity of boundary-crossing HPE faculty development for critical care educators. The framework can be a valuable tool for evaluating a vCoP associated with faculty development programmes.

Dermatology residents as educators: a qualitative study of identity formation

BACKGROUND

One of the many identities a physician comes to form during their career is their identity as an educator. Exploring formation of this identity may enrich our understanding of how physicians make decisions related to their roles as educators, their behaviors, and how this ultimately influences the educational environment. It is the aim of this study to investigate educator identity formation of dermatology residents while early in their careers.

METHODS

Drawing on a social constructionist paradigm, we conducted a qualitative study, utilizing an interpretative approach. We examined longitudinal data over a 12-month period using dermatology residents' written reflections from their professional portfolios and semi-structured interviews. We collected this data as we progressed through and beyond a 4-month professional development program designed to encourage residents' growth as educators. Sixty residents in their second, third, or final year of residency programs located in Riyadh, Saudi Arabia were invited to take part in this study. Twenty residents participated with sixty written reflections and 20 semi-structured interviews. Qualitative data were analyzed using a thematic analysis approach.

RESULTS

Sixty written reflections and 20 semi-structured interviews were analyzed. Data was categorized according to themes corresponding to the original research questions. For the first research question regarding identity formation, themes included definitions of education, the process of education, and identity development. For the second research question, 1 theme entitled professional development program included, the following sub-themes: individual act, interpersonal activity, and an organizational undertaking, with many believing that residency programs should prepare residents for their educator roles. Participants also described newfound leadership ambitions of creating new dermatology fellowship programs as a result of taking part in the Resident-as-Educator program.

CONCLUSIONS

Our study provides insights on the dynamic formation of educator identities amongst dermatology residents. Investment in developing residents as educators through professional development programs may instigate transformational change on the individual physician level and profession's level.

Is it worth it? A qualitative analysis of the impact of medical education fellowships on careers

Objectives

Medical education fellowships provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. The objective of this study was to explore the impact of medical education fellowships on the careers of graduates.

Methods

The authors performed a qualitative study with a constructivist-interpretivist paradigm using semistructured interviews in 2021. The authors used a purposeful randomized stratified sampling strategy of graduates to ensure diversity of representation (gender, region, fellowship duration, and career stage). Two researchers independently analyzed interview transcriptions using a modified grounded theory approach.

Results

The authors interviewed 10 graduates and identified three overarching concepts: motivations for pursuing fellowship, benefits of training, and drivers of career development. Graduates sought training because of their desire for growth and career preparation and at the advice of mentors. Fellowships provided knowledge and skills in a structured learning environment, supported by mentors and a collaborative community. Fellowship training shaped the careers of graduates by increasing their self-efficacy, enhancing their outcome expectations, refining their goals, and influencing their professional identity formation. They acquired expertise that prepared them for jobs, developed credibility, felt competitive in the job market, anticipated successful promotion, reached for greater goals, broadened their educational worldview, and evolved their professional identity as a result of fellowship training.

Conclusions

Fellowship training in medical education provides knowledge and skills, a structured learning environment, and important relationships that shape the careers of graduates by impacting their self-efficacy, outcome expectations, goal creation, and professional identity formation.

I am an Educator: Investigating Professional Identity Formation using Social Cognitive Career Theory

PhenomenonClinician-educators (CE) are physicians who fill a unique role within academic medicine, as they are responsible both for patient care and for training future physicians via teaching, curricular design, and creation of educational scholarship. Development of a strong professional identity as an educator leads to greater career satisfaction and a higher likelihood of staying in academic medicine. However, little is known about how this identity develops, especially in the training environment where there are competing pressures to develop as a clinician and researcher. This study aimed to explore professional identity formation in residents and fellows interested in becoming educators. Approach: We used a longitudinal, qualitative approach to investigate professional identity formation in residents and fellows participating in the Clinician-Educator Training Pathway. The longitudinal nature allowed us to temporally explore which aspects of the program and experiences acted as barriers or facilitators of professional identity formation as a CE. Our study used the social cognitive career theory (SCCT) Career Choice Model, which considers contextual influences in addition to the three variables of self-efficacy beliefs, outcome expectations, and goals. Findings: We found that participants shared a common goal of building self-efficacy as an educator. Participants took actions to engage more deliberately in formal and informal teaching and acting as an educator by giving learner feedback, developing curricula, and consuming and conducting educational research, all of which increased self-efficacy as educators. At the beginning of the program, participants were unclear of the roles and trajectories followed to become CEs. Engaging with a community of CEs clarified pathways and presented role models that could be seen as possible selves. This study also elucidated contextual influences relating to personal factors, career opportunities, and potential for advancement that mediated the goals and actions taken by participants to become educators. Insights: This study demonstrates that the SCCT Career Choice Model provides an excellent framework for understanding professional identity formation in future educators. Our participants built self-efficacy, formed outcome expectations, and set goals and took specific actions toward the goal of becoming an educator. Participants tested the various role model attributes as possible selves to see how those would be effective in their own career. Reflection on expectations, career goals, and self-efficacy as a clinician and an educator can assist in identity formation as a CE and can assist those designing CE training programs to better support identity formation in their participants.

Professional Outcomes and Satisfaction Among Graduate Medical Education Wilderness Medicine Fellowship Alumni in the United States

INTRODUCTION

Wilderness medicine (WM) graduate medical education (GME) fellowships were established in 2003. Outcomes and satisfaction of US WM GME fellowship alumni can inform prospective applicants and program directors of the strengths of fellowships and professional gaps in them.

METHODS

A 34-question Qualtrics survey was emailed to 111 alumni from 17 institutions listed in the Wilderness Medical Society's GME database in May 2019. Professional service, scholarship, and satisfaction were queried. Results are represented as percent response (n=answered affirmative) based on the number of respondents per question.

RESULTS

The survey response rate was 41% (n=46); 67% reported (n=31) Fellowship of the Academy of Wilderness Medicine recognition. Within the last 5 y, 71% (n=32) reported publications in WM. Free text entry questions had 78% (n=28) describe improved clinical skills, and 68% (n=26) were exposed to new career choices in fellowship. Those who rated exposure to a variety of WM knowledge and skills highly rated the overall fellowship experience higher (P<0.001), as did those reporting a higher number of WM publications (P=0.023). Nearly half, 48% (n=21), felt they could hold their current position without fellowship training. In hindsight, 76% (n=34) would follow the same professional path.

CONCLUSIONS

WM GME fellowship alumni reported high rates of professional engagement and scholarly productivity in the subspecialty. Responding alumni overwhelmingly rated the fellowship experience positively. Fellowships that ensure a wide exposure to experiences and foster scholarly productivity are more likely to yield professionally satisfied graduates.

W. Post-residency medical education fellowships: a scoping review

The authors conducted a scoping review to investigate the structure, content, and potential impact of post-residency medical education fellowships. The authors searched eight databases to identify English-language articles describing longitudinal, post-residency medical fellowships that both focused on medical education and described the structure and content of the curriculum. The authors summarized the findings of each article and, for those articles that included a program evaluation, assessed the potential impact of the program via the Kirkpatrick's Four-Level Training Evaluation Model and the Medical Education Research Study Quality Instrument. Nine articles, describing a total of ten post-residency medical education fellowships, met inclusion criteria. Half of the programs were dedicated medical education fellowships and half were medical education tracks within a subspecialty fellowship. The content and educational strategies varied, with no two programs having the same curriculum. Most programs most focused on teaching skills, adult learning theory, curricular development, and medical education research/scholarship. Most programs used project-based learning, workshops, and faculty mentorship as educational strategies. Six of the articles included an evaluation of their program(s), all of which suggested positive changes, at least at the level of fellow behavior (Kirkpatrick level 3), and designs limited the strength of any conclusions drawn. This scoping review highlights the variation among medical education fellowships and the need for common curricular components, as well as program evaluation, across and within these fellowships. Additional assessment at higher levels of trainee outcomes will help guide the creation and revision of medical education fellowships, and inform the development of a core curriculum shared across programs. Such a core curriculum could then serve as the foundation for a certification program, by which a medical educator's expertise could be recognized, thus elevating medical education to the stature it deserves within the academic mission.

Navigating landscapes of practice: A longitudinal qualitative study of physicians in medical education

INTRODUCTION

Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physician-educators. Knowing how physician-educators find their way among different communities of practice (ie their landscape of practice) has implications for professional development but the limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice.

METHODS

11/29 physicians in one cohort of a masters in medical education programme were interviewed annually from 2016 (programme start) to 2020 (2 years post-graduation). We iteratively collected and analysed data, creating inductive codes and categorising coded data by mode of identification (engagement, imagination, alignment) and time. We organised narratives into time-ordered data matrices so that final analysis wove together mode, time and participant.

RESULTS

All participants consistently spoke of navigating their landscape of practice, which included the community created in the graduate programme; but that single community 'doesn't define the journey itself'. They shifted engagement from teaching individual learners to translating what they learned in the graduate programme to develop educational projects and produce scholarship. They shifted the imagination from relying on internal and external assessments to experience-inspired versions of their future self. And they shifted alignment from belonging to the graduate programme's community of practice, then belonging to different communities in their landscape of practice and ultimately focussing on communities that mattered most to them.

DISCUSSION

Physicians in a graduate programme in medical education navigated their dynamic landscape of practice by shifting how they engaged in medical education, as well as what they imagined and who they aligned with as physician-educators. Our work offers novel insights into how knowledgeability emerges through time as overlapping modes of identification.

Outcome assessment of medical education fellowships in emergency medicine

OBJECTIVES

Medical education fellowships in emergency medicine (EM) provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. Our objective was to characterize the career outcomes of medical education fellowship graduates.

METHODS

We solicited curriculum vitae (CV) from graduates of U.S. EM education fellowships by email. We abstracted data from CVs with a standard instrument that included program characteristics, employment history, leadership positions, awards, and scholarly productivity. We calculated and reported descriptive statistics.

RESULTS

A total of 71 of 91 (78%) graduates participated. Thirty-three completed a 1-year fellowship and 38 completed a 2-year fellowship. Nineteen (27%) completed an advanced degree during fellowship. Median (range) graduation year was 2016 (1997-2020). The majority, 63 of 71 (89%), work in an academic setting. Graduates held leadership positions in continuing medical education, graduate medical education, and undergraduate medical education. Forty-eight (68%) served on national medical education committees. The mean ± SD number of national medical education awards was 1.27 ± 2.03. The mean ± SD number of national medical education presentations was 7.63 ± 10.83. Graduates authored a mean ± SD of 3.63 ± 5.81 book chapters and a mean ± SD of 4.99 ± 6.17 peer-reviewed medical education research publications. Ten (14%) served on journal editorial boards, 34 (48%) were journal reviewers, and 31 (44%) had received a medical education grant.

CONCLUSION

EM medical education fellowship graduates are academically productive and hold education leadership positions.

The road to consultancy: an epidemiological study

BACKGROUND

Modern medical and surgical training pathways have developed globally in response to changing expectations and requirements for trainees.

AIMS

To determine the demographic, educational, and training characteristics of consultants in a model 4 teaching hospital, and to evaluate the requirements met by consultant physicians and surgeons prior to their appointment to consultancy.

METHOD

A single-centre study conducted by prospectively distributing written questionnaires. Data was collected and analysed using Microsoft Excel and SPSS.

RESULTS

This questionnaire was offered to 166 consultants, 110 of whom responded (66.0%). The vast majority were Irish (91.8%) and 70.9% male. The mean age to appointment was 35.7 ± 2.6 years. Radiology was the specialty with the youngest mean age at appointment: 34.4 ± 2.6 years, while surgery had the oldest: 36.7 ± 2.7 (P = 0.035). Overall, 80.9% trained via Higher Specialist Training (HST) schemes (89/110) and 68.2% completed a higher degree (75/110). Geriatric medicine and dermatology had the highest rate of completed higher degrees (100.0%, 3/3 and 3/3 respectively), followed by surgeons (92.3%; 24/26) and cardiologists (71.4%; 5/7). The overall duration of HST varied greatly; the mean surgical, medical and anaesthesiology durations were 6.7 ± 1.8 years, 6.6 ± 1.7 years, and 5.3 ± 2.0 years. A total of 75.4% of consultants completed fellowship (83/110).

CONCLUSION

This study highlights variations in postgraduate Irish medical training pathways and discrepancies in training requirements expected in each specialty. The establishment of a modern guideline for young trainees working towards consultancy may be imperative in ensuring trainees have insight into training requirements expected in their specialty.

Ripple effect of a clinical teaching fellow programme in an Australian paediatric hospital

AIM

Bedside teaching performed by experienced clinicians is an expected component of medical student training. As clinicians often have high clinical demands and a lack of formal training in teaching methods, clinical teaching fellowships have been established. In clinical teaching fellowships, clinicians with an interest and expertise in medical education provide medical students with standardised teaching. Studies about the impact of clinical teaching fellowships have demonstrated benefits for both clinical teaching fellows (CTFs) and medical students. However, studies have not evaluated the impact of these fellowships on other clinicians or learning relationships within the institution. In this study, we aimed to address this gap by gathering data on the perspectives of CTFs, medical students and hospital consultants.

METHOD

A mixed-method design was used, utilising a combination of surveys for CTFs, medical students and hospital consultants and semi-structured telephone interviews for CTFs. Quantitative and qualitative data were obtained.

RESULTS

The combination of data from CTFs, medical students and consultants enabled a more comprehensive understanding of the impact of the CTF programme within the institution. Although benefits were identified for CTFs and medical students, the consultant group noted that they were less involved in teaching medical students and that the CTFs were not well integrated into the ward team.

CONCLUSION

This research highlights the importance of considering not only direct outcomes of teaching and learning but broader influences on more implicit teaching opportunities and relationships within hospital teams.

The Nephrology Clinician Educator: Pathway and Future

In the medical profession, teaching has always been a routine expectation for practicing physicians. While this remains true today, in recent years, we have seen the emergence of a well-defined career pathway for those practicing physicians who want to focus on education: the clinician educator. This is a physician who is highly active in the practice of teaching, science of learning, service as a role model for young physicians, and leading educational programs. In nephrology, one can have a fruitful and fulfilling career as a lifelong clinician educator. As career interest in our specialty wanes, the clinician educator is the professional well suited to reverse this trend. In this article, we will further define the clinician educator and map out a pathway of skills needed to thrive in this rewarding career. We also provide recommendations to both educators and leaders to ensure the clinician educator pathway continues to grow.

Identification of capacity development indicators for faculty development programs: A nominal group technique study

BACKGROUND

Although there have been many research studies of the effectiveness of faculty development in health profession education, the contribution of these programs to organizational development through capacity development has not been studied. Further understanding of capacity development requires appropriate indicators and no previous indicators for faculty development of health profession educators were identified. The aim of the study was to identify indicators of capacity development in the context of faculty development programs at Tehran University of medical sciences (TUMS).

METHODS

A nominal group technique session was conducted with key informants from faculty development program providers to generate and prioritize a list of capacity development indicators.

RESULTS

A list of 26 indicators was generated and five categories were identified: Development and innovation in teaching and learning process, Development and innovation in communication and collaboration at different levels, Development and sustaining faculty development programs, Development of educational leadership and management, Development in scholarship.

CONCLUSIONS

Capacity development for faculty development interventions of health profession educators is a process of engagement within a wider system, including individual and collective action, and involves the socialization of the teachers into suitable roles through professional identity development and participation within the wider system.

Strengthening Teachers' Professional Identities Through Faculty Development

Although medical schools espouse a commitment to the educational mission, faculty members often struggle to develop and maintain their identities as teachers. Teacher identity is important because it can exert a powerful influence on career choice, academic roles and responsibilities, and professional development opportunities. However, most faculty development initiatives focus on knowledge and skill acquisition rather than the awakening or strengthening of professional identity. The goal of this Perspective is to highlight the importance of faculty members' professional identities as teachers, explore how faculty development programs and activities can support teachers' identities, and describe specific strategies that can be used in professional development. These strategies include the embedding of identity and identity formation into existing offerings by asking questions related to identity, incorporating identity in longitudinal programs, building opportunities for community building and networking, promoting reflection, and capitalizing on mentorship. Stand-alone faculty development activities focusing on teachers' identities can also be helpful, as can a variety of approaches that advocate for organizational change and institutional support. To achieve excellence in teaching and learning, faculty members need to embrace their identities as teachers and be supported in doing so by their institutions and by faculty development.

The impact and effectiveness of faculty development program in fostering the faculty's knowledge, skills, and professional competence: A systematic review and meta-analysis

BACKGROUND

Faculty vitality is the main ingredient to enhance professional education and competence. Enriching the faculty vitality in key domains of teaching, assessing, research, professionalism, and administration is perceived to improve educational environment significantly and enhances the academic performance of learners. Faculty development program (FDP) has been considered as a stand-alone educational pedagogy in fostering knowledge and professional skills of faculty. However, few studies have provided objective reports about the impact of such programs in a healthcare system.

METHODS

This research was conducted by selecting data sources of PubMed-Medline, Wiley online library, Cochrane library, Taylor & Francis Online, CINAHL, Springer link, Proquest, ISI Web of knowledge, ScienceDirect, EJS, EBSCO, Blackwell, Emerald and ABI Inform. This search followed a step-wise approach defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 37 studies that explored the impact of FDPs on medical and allied health faculty's professional development were selected.

RESULTS

This meta-analysis reported a mean effect size of 0.73 that reflects a significant and positive impact of FDPs in enhancing faculty's knowledge and professional competence (z-statistics of 4.46 significant at p-value < 0.05) using the random effects model and forest plot.

CONCLUSION

This article reiterates the incorporation of FDPs in all healthcare institutions for improving the academic performance of faculty with resultant enrichment of learners' knowledge and skills.

The influence of postgraduate qualifications on educational identity formation of healthcare professionals

Demand for postgraduate qualifications in medical education can be judged by the increase in providers worldwide over the last two decades. However, research into the impact of such courses on identity formation of healthcare professionals is limited. This study investigates the influence of such programmes on graduates' educational identities, practices and career progression. Informed by constructivist grounded theory (CGT), semi-structured interviews were conducted with 27 graduates (2008-2012) from one postgraduate programme, who were at different stages in their careers worldwide. The audio data were transcribed and analysed using a CGT approach. Participants enrolled in award-bearing medical education courses for various intrinsic and extrinsic reasons. The findings from this study highlight their development as educators, and educational researchers, leaders and learners, as their self-efficacy in educational practices and engagement in scholarly activities increased. Graduates attributed career progression to the qualification, with many being promoted into senior positions. They also described substantial performance attainments in the workplace. The findings contribute to understanding the complexity and nuances of educational identity formation of healthcare professionals. A qualification in medical education encouraged transformational changes and epistemological development as an educator. Awareness of these findings will inform both those considering enrolment and those supporting them of potential benefits of these programmes.

How Mentor Identity Evolves: Findings From a 10-Year Follow-up Study of a National Professional Development Program

PURPOSE

Despite academic medicine's endorsement of professional development and mentoring, little is known about what junior faculty learn about mentoring in implicit curricula of professional development programs, and how their mentor identity evolves in this context. The authors explored what faculty-participants in the Educational Scholars Program implicitly learned about mentoring and how the implicit curriculum affected mentor identity transformation.

METHOD

Semistructured interviews with 19 of 36 former faculty-participants were conducted in 2016. Consistent with constructivist grounded theory, data collection and analysis overlapped. The authors created initial codes informed by Ibarra's model for identity transformation, iteratively revised codes based on incoming data patterns, and created visual representations of relationships amongst codes to gain a holistic, shared understanding of the data.

RESULTS

In the implicit curriculum, faculty-participants learned the importance of having multiple mentors, the value of peer mentors, and the incremental process of becoming a mentor. The authors used Ibarra's model to understand how the implicit curriculum worked to transform mentor identity: Faculty-participants reported observing mentors, experimenting with different ways to mentor and to be a mentor, and evaluating themselves as mentors.

CONCLUSIONS

The Educational Scholars Program's implicit curriculum facilitated faculty-participants taking on mentor identity via opportunities it afforded to watch mentors, experiment with mentoring, and evaluate self as mentor, key ingredients for identity construction. Leaders of professional development programs can develop faculty as mentors by capitalizing on what faculty-participants learn in the implicit curriculum and deliberately structuring postgraduation mentoring opportunities.

Process-oriented evaluation of an international faculty development program for Asian developing countries: a qualitative study

BACKGROUND

Non-English-speaking developing countries in Southeast Asia have been provided only limited opportunities for faculty development in the education of health professions. Although there exist a few programs that have been shown to be effective, they are frequently presented with few explanations on how and why the programs work due to their outcome-oriented nature. This study explores the process of the Lee Jong-Wook Fellowship for Health Professional Education, an international faculty development program designed for capacity building of educators of health professions in Southeast Asian developing countries.

METHODS

Fellows were from Cambodia, Myanmar, and Laos. Qualitative data were collected from two types of semi-structured interviews - group and individual. Thematic analysis was conducted to explore the factors related to the effectiveness of the program, framed by four components of faculty development, which included context, facilitators, program, and participants.

RESULTS

From the thematic analysis, the authors identified a total of 12 themes in the four components of faculty development. In the context domain, the resource-poor setting, a culture that puts emphasis on hierarchy and seniority, and educational environment depending on individual commitment rather than broad consensus emerged as key factors. In the facilitators domain, their teaching methods and materials, mutual understanding between teacher and learner, and collaboration between facilitators mainly influenced the learning during the fellowship. In the program domain, the key advantages of the fellowship program were its applicability to the workplace of the fellows and enough allowed time for practice and reflection. Finally, in the participants domain, Fellows valued their heterogeneity of composition and recognized cognitive as well as non-cognitive attributes of the participants as essential.

CONCLUSIONS

This process-oriented evaluation reveals the diverse factors that contributed to achieving the intended outcomes of the fellowship. Although much evidence from best practices in faculty development are still valid, the findings suggest that the selection strategies, learning environment, and English communication should be given more consideration when organizing a program targeting these people and cultures. A comprehensive understanding of the process would contribute to developing tailored strategies for educators of health professions in developing countries in similar settings.

Integrating the teaching role into one's identity: a qualitative study of beginning undergraduate medical teachers

Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A qualitative study was performed, involving 18 beginning medical teachers at a Dutch medical school. The teachers were interviewed twice and kept a logbook over a period of 7 months. The study shows that the integration of the teacher role into the teachers' identity was hampered by the idea that teaching is perceived by others as a low status occupation. Some teachers experienced significant tension because of this, while others showed resilience in resisting the negative associations that were thought to exist regarding teaching. The teachers used five different identity narratives in order to integrate the teacher role into their identity, in which the positions of teacher and doctor or researcher were found to be combined, adopted or rejected in diverse ways. The five identity narratives were: (1) coalition between the I-position of teacher and other I-positions; (2) no integration of the I-position of teacher: holding on to other I-positions; (3) construction of the I-position of teacher and other I-positions as opposites; (4) coalition between the I-position of teacher and a third position of coordinator; and (5) meta-position: trivialising the importance of status. These identity narratives offer starting points for supporting undergraduate teachers during their early professional years.

Is being a medical educator a lonely business? The essence of social support

CONTEXT

Social support helps prevent burnout and promotes its positive opposite, work engagement. With higher work engagement performance increases. The context-specific aspects of social support for medical educators, in their educator role, are unknown. To help facilitate social support our study describes the essential elements of social support and their meaning for medical educators.

METHODS

We held interviews with medical educators purposefully sampled for diverse backgrounds and working circumstances and who spent a considerable amount of time on education. Both clinicians and basic scientists participated. The Pictor technique guided the interviews. Participants were invited to talk about the breadth of social support and elaborate on meaningful experiences. Template analysis was used for a descriptive phenomenological approach.

RESULTS

Thirteen medical educators were interviewed. We identified four themes: (i) sources of support and their intent (e.g. a superior with the intent to stimulate personal growth); (ii) the materialisation of support (e.g. sought or offered); (iii) its manifestation (e.g. the act of providing protected time); and (iv) the overarching effect of social support, both in terms of practical effects and the meaning of support. We identified three sorts of meanings of social support for educators. Receiving support could lead to (i) feeling reassured and confident; (ii) feeling encouraged and determined and (iii) a sense of relatedness and acknowledgement of the educator role.

CONCLUSION

Support for education comes from a wide range of sources because it is both sought and offered beyond the boundaries of the educational role. The resulting differences in support provided necessitate that educational leaders and policymakers consider the sources available to each educator, connecting educators where necessary. When facilitating or designing social support it is important that the need to feel reassured, encouraged or related is met.

Institutional factors affecting participation in national faculty development programs: a nation-wide investigation of medical schools

BACKGROUND

Medical schools have used faculty development programs as an essential means to improve the instruction of faculty members. Thus far, however, participating in such programs has been largely voluntary for individuals even though a certain degree of participation is required to achieve practical effectiveness. In addition, the learning behaviors of faculty members are known to be influenced by organizational contexts such as a hidden curriculum. Therefore, this study explored the organizational characteristics of medical schools affecting attendance at faculty development programs.

METHODS

Forty medical schools in South Korea were included in this study. In total, 1,667 faculty members attended the faculty development programs at the National Teacher Training Center for Health Personnel between 2007 and 2015. For independent variables, information on the basic characteristics and the educational states was collected from all the medical schools. Themes were identified from their educational goals and objectives by inductive content analysis.

RESULTS

The number of nine-year cumulative attendees from medical schools ranged from 8 to 104. The basic characteristics of the medical schools had little influence on faculty development program attendance, while several themes in the educational goals and objectives, including "cooperation", "serving various societies", and "dealing with a changing future" showed a significant difference in participation. The number of full-time faculty showed a significant positive correlation when it was smaller than the median, and the proportion of alumni faculty showed a significant negative correlation when it was higher than 50%.

CONCLUSIONS

This study adds to existing knowledge on factors affecting attendance at faculty development programs by identifying related institutional factors that influence attendance. While the variations depending on the basic characteristics were minimal, the organizational environment surrounding medical education significantly contributed to attendance. Addressing institutional as well as individual factors could contribute to improving participation by faculty members in faculty development programs.

Building Sustainable Professional Development Programs: Applying Strategies From Implementation Science to Translate Evidence Into Practice

INTRODUCTION

Multisite and national professional development (PD) programs for educators are challenging to establish. Use of implementation science (IS) frameworks designed to convert evidence-based intervention methods into effective health care practice may help PD developers translate proven educational methods and models into successful, well-run programs. Implementation of the national Educational Scholars Program (ESP) is used to illustrate the value of the IS model.

METHODS

Four adaptable elements of IS are described: (1) replication of an evidence-based model, (2) systematic stages of implementation, (3) management of implementation using three implementation drivers, and (4) demonstration of program success through measures of fidelity to proven models and sustainability.

RESULTS

Implementation of the ESP was grounded on five established principles and methods for successful PD. The process was conducted in four IS stages over 10 years: Exploration, Installation, Initial Implementation, and Full Implementation. To ensure effective and efficient processes, attention to IS implementation drivers helped to manage organizational relationships, build competence in faculty and scholars, and address leadership challenges. We describe the ESP's fidelity to evidence-based structures and methods, and offer three examples of sustainability efforts that enabled achievement of targeted program outcomes, including academic productivity, strong networking, and career advancement of scholars.

DISCUSSION

Application of IS frameworks to program implementation may help other PD programs to translate evidence-based methods into interventions with enhanced impact. A PD program can follow systematic developmental stages and be operationalized by practical implementation drivers, thereby creating successful and sustainable interventions that promote the academic vitality of health professions educators.

Measuring the Impact of Longitudinal Faculty Development: A Study of Academic Achievement

PURPOSE

Although faculty development programs in medical education have increased over the past two decades, there is a lack of rigorous program evaluation. The aim of this study was to determine quantifiable outcomes of Harvard Medical School's (HMS's) Fellowship in Medical Education and evaluate attainment of its goals.

METHOD

In 2005 and 2009 the authors collected curricula vitae (CVs) and conducted within-subject analysis of 42 fellowship graduates and also conducted comparison analysis between 12 academic year 2005 fellows and 12 faculty who did not participate in the program. The authors identified 10 metrics of academic advancement. CV analysis for the 42 graduates started 2 years prior to fellowship enrollment and continued for 2-year intervals until June 2009 (10 years of data collection). CV analysis for the comparison group was from 2003 to 2009. The authors also analyzed association between gender and academic outcomes.

RESULTS

Fellowship graduates demonstrated significant changes in 4 of 10 academic metrics by the end of the fellowship year: academic promotion, educational leadership, education committees, and education funding. Two metrics-educational leadership and committees-showed increased outcomes two years post fellowship, with a positive trend for promotions. Fellowship graduates significantly outpaced the comparison group in 6 of 10 metrics. Women did significantly more committee work, secured more education funding, and were promoted more often than men.

CONCLUSIONS

Findings indicate that the HMS Fellowship in Medical Education meets programmatic goals and produces positive, measurable academic outcomes. Standardized evaluation metrics of longitudinal faculty development programs would aid cross-institutional comparisons.

Creating a Cadre of Fellowship-Trained Medical Educators: A Qualitative Study of Faculty Development Program Leaders' Perspectives and Advice

PURPOSE

Well-trained educators fill essential roles across the medical education continuum. Some medical schools offer programs for existing faculty to enhance teaching and scholarship. No standard postgraduate training model exists for residency graduates to attain competency as faculty members before their first academic appointment. The objective of this study is to inform the development of postgraduate medical education fellowships by exploring perceptions of educational leaders who direct well-established faculty development programs.

METHOD

The authors undertook a qualitative study, using purposeful sampling to recruit participants and a constant comparative approach to identify themes. They conducted semistructured telephone interviews with directors of faculty development fellowships using an interpretivist/constructivist paradigm (November 2013). Questions addressed curricular and fiscal structure, perceived benefits and challenges, and advice for starting a postgraduate fellowship.

RESULTS

Directors reported institutional and participant benefits, notably the creation of a community of educators and pool of potential leaders. Curricular offerings focused on learning theory, teaching, assessment, leadership, and scholarship. Funding and protected time were challenges. Advice for new program directors included evaluating best practices, defining locally relevant goals; garnering sufficient, stable financial support; and rallying leaders' endorsement.

CONCLUSIONS

Medical education fellowships cultivate leaders and communities of trained educators but require participants to balance faculty responsibilities with professional development. Advice of current directors can inform the development of postgraduate programs modeled after accredited clinical specialty fellowships. Programs with the support of strategic partners, financial stability, and well-defined goals may allow new faculty to begin their careers with existing competency in medical education skills.

A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40

BACKGROUND

This review, which focused on faculty development initiatives designed to improve teaching effectiveness, synthesized findings related to intervention types, study characteristics, individual and organizational outcomes, key features, and community building.

METHODS

This review included 111 studies (between 2002 and 2012) that met the review criteria.

FINDINGS

Overall satisfaction with faculty development programs was high. Participants reported increased confidence, enthusiasm, and awareness of effective educational practices. Gains in knowledge and skills, and self-reported changes in teaching behaviors, were frequently noted. Observed behavior changes included enhanced teaching practices, new educational initiatives, new leadership positions, and increased academic output. Organizational changes were infrequently explored. Key features included evidence-informed educational design, relevant content, experiential learning, feedback and reflection, educational projects, intentional community building, longitudinal program design, and institutional support.

CONCLUSION

This review holds implications for practice and research. Moving forward, we should build on current success, broaden the focus beyond individual teaching effectiveness, develop programs that extend over time, promote workplace learning, foster community development, and secure institutional support. We should also embed studies in a theoretical framework, conduct more qualitative and mixed methods studies, assess behavioral and organizational change, evaluate transfer to practice, analyse key features, and explore the role of faculty development within the larger organizational context.

How do postgraduate qualifications in medical education impact on health professionals?

BACKGROUND AND PURPOSE

The number of degree-awarding programmes in medical education is steadily increasing. Despite the popularity and extensive investment in these courses, there is little research into their impact. This study investigated the perceived impact of an internationally-renowned postgraduate programme in medical education on health professionals' development as educators.

METHODS

An online survey of the 2008-12 graduates from the Centre for Medical Education, University of Dundee was carried out. Their self-reported shifts in various educational competencies and scholarship activities were analysed using non-parametric statistics. Qualitative data were also collected and analysed to add depth to the quantitative findings.

RESULTS

Of the 504 graduates who received the online questionnaire 224 responded. Participants reported that a qualification in medical education had significantly (p < 0.001) improved their professional educational practices and engagement in scholarly activities. Masters graduates reported greater impact compared to Certificate graduates on all items, including ability to facilitate curriculum reforms, and in assessment and feedback practices. Masters graduates also reported more engagement in scholarship activities, with significantly greater contributions to journals. These qualifications equally benefited all participants regardless of age. International graduates reported greater impact of the qualification than their UK counterparts.

CONCLUSION

A postgraduate medical education programme can significantly impact on the practices and behaviours of health professionals in education, improving self-efficacy and instilling an increased sense of belonging to the educational community.

How learning transfers: a study of how graduates of a faculty education fellowship influenced the behaviors and practices of their peers and organizations

PURPOSE

Faculty development programs have been criticized for their limited assessment methods, focused only on the learners and limited to satisfaction measures or self-reported behavior changes. Assessment of organizational impact is lacking. This study explored the impact of faculty education fellowship graduates on their organization and how that impact occurred.

METHOD

The design was a qualitative study of 13 departments across three institutions, partnered with the George Washington University School of Medicine and Health Sciences. In-depth interviews with 13 supervisors and 25 peers of graduates were conducted in fall 2012 to examine graduates' organizational impact related to program purposes: enhancing teaching skills, pursuing scholarship in education, and developing leadership potential. Triangulation, purposive sampling, rich descriptions, and member checks minimized bias and optimized transferability.

RESULTS

A model of how graduates of a faculty education fellowship transfer learning to peers and their organizations emerged. Analysis of interview responses showed that in the presence of environmental facilitators, graduates exhibited enhanced confidence and five new behaviors. Graduates raised peer awareness, leading to changes in individual and group practices and development of shared peer understanding. Analysis suggests they facilitated a culture of continuous learning around teaching, scholarship, and leadership.

CONCLUSIONS

This study enhances traditional assessment of faculty education fellowship programs by examining the impact that graduates had on peers and work groups. A model is proposed for how graduates interact with and impact work group processes and practices. This model can facilitate more comprehensive program assessments, which can demonstrate program impact beyond the individual participant.

The effect of primary care fellowship training on career satisfaction, happiness and perceived stress

PURPOSE

This study was designed to measure the impact of primary care fellowship training on the subsequent happiness, career satisfaction and perceived stress levels of fellowship-trained physicians as compared to a general population of Family Medicine physicians in North Carolina.

METHODS

A written survey instrument was completed by fellowship graduates of the Brody School of Medicine (n=53) and general population of Family Medicine physicians in North Carolina (n=203) in 2011. The survey included general demographic and practice variables, and validated psychological scales on subjective happiness, satisfaction with life, and perceived stress.

RESULTS

Fellowship graduates (n=50), and non-fellowship graduates (n=203), exhibited similar levels of satisfaction with life (fellows=27.36 SD 5.45, FM physicians=26.91, SD 5.99 on a 5-35 scale), statistically higher levels of perceived stress (fellows=5.92, SD 3.03, FM physicians=4.98, SD 2.70 on a 0-16 scale), and significantly higher levels of subjective happiness (fellows=5.61SD 83, FM physician=4.75 SD 1.00 on a 1-7 scale). Female fellow response was significantly higher on the Satisfaction with Life and Subjective Happiness Scores, and lower on the Perceived Stress Scale. Male fellowship graduates presented with a reverse relationship, with higher perceived stress and lower satisfaction with life and subjective happiness.

CONCLUSIONS

Fellowship training exhibited a positive psychological effect on the graduate respondents versus the general physician population. Scores on various well-being scales were higher than the general Family Medicine physician population as a whole, although stress levels were also higher. Female physicians seem to garner a much larger gain in satisfaction than male fellowship graduates, who score slightly worse than the general family medicine population on the satisfaction with life and Perceived Stress Scales.

Further dissemination of medical education projects after presentation at a pediatric national meeting (1998-2008)

BACKGROUND

Further dissemination of medical education work presented at national meetings is limited.

PURPOSES

The purpose of this study was to explore dissemination outcomes of scholarly work in pediatric medical education.

METHODS

Council on Medical Student Education in Pediatrics (COMSEP) members who presented at COMSEP national meetings from 1998 to 2008 received a questionnaire about scholarly dissemination outcomes. Descriptive statistics and chi-square analysis explored variables related to dissemination. Qualitative analysis of free text comments explored barriers to dissemination.

RESULTS

Outcomes were determined for 81% of presentations (138/171). The dissemination rate was 67% (92/138 presentations), with 47 publications (34%). Dissemination rates did not vary by presentation type (poster vs. oral) or project type. There was no relationship between presentation type, project type, and dissemination method. Barriers included perceived inadequate time, mentorship, and methodological skills for scholarly work.

CONCLUSIONS

Most projects were further disseminated. Additional resources including mentoring and protected time for scholarly work are needed by educators to optimize dissemination.

Defining a core curriculum for education scholarship fellowships in emergency medicine

A trained cadre of medical education scholars with a focus on methodologically sound research techniques is needed to ensure development of innovations that can be translated to educational practice, rigorous evaluation of instructional strategies, and progress toward improving patient care outcomes. Most established educational programs are aimed at existing faculty members and focus primarily on the development of teaching and leadership skills. At the 2012 Academic Emergency Medicine (AEM) consensus conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success," a breakout session was convened to develop training recommendations for postgraduate fellowship programs in medical education scholarship that would enable residency graduates to join academic faculties armed with the skills needed to perform research in medical education. Additionally, these graduates would enjoy the benefits of established mentorships. A group of 23 medical education experts collaborated to address the following objectives: 1) construct a formal needs assessment for fellowship training in medical education scholarship in emergency medicine (EM), 2) compare and contrast current education scholarship programs in both EM and non-EM specialties, and 3) develop a set of core curriculum guidelines for specialized fellowship training in medical education scholarship in EM. Fellowship-trained faculty need to be proficient in learner instruction and assessment, organizational leadership, curriculum development, educational methodology, and conducting generalizable hypothesis-driven research to improve patient care.

Implementing the leadership development plans of faculty education fellows: a structured approach

The literature about medical education faculty fellowship programs, which have grown in popularity, quantifies program characteristics, provides exemplars, and reports on delivery strategies. Evaluation is generally limited to satisfaction measures, with a few longitudinal studies of postprogram achievements, but none on the process of making these changes.The authors describe the development of faculty members' postfellowship leadership plans and a structured process to support plan implementation. They also compare the implementation of initiatives specified in individual leadership development plans of two cohorts of faculty. The participants were graduates of a fellowship program at the George Washington University School of Medicine and Health Sciences. One cohort participated in a structured process of monthly reciprocal peer coaching, followed by journaling and quarterly interviews with the program director; a second cohort functioned as a comparison with no structured process supporting them. (Study years are not provided because they could inadvertently lead to the identification of the participants.) Despite similar implementation challenges expressed by both cohorts, the cohort participating in the structured process implemented 23% more of their planned initiatives, including 2 times as many educational leadership initiatives and 3.5 times as many initiatives related to developing new curriculum. The combination of plan development, reciprocal peer coaching, journaling, and interview discussions provided faculty with focus, structure, and personal support. This structured process supporting leadership plan development and implementation can be easily transferred to other fellowship programs in medical education, adapted for use with residents and fellows, and used in similar development programs.

Who am I? Key influences on the formation of academic identity within a faculty development program

INTRODUCTION

Professional identity encompasses how individuals understand themselves, interpret experiences, present themselves, wish to be perceived, and are recognized by the broader professional community. For health professional and health science educators, their 'academic' professional identity is situated within their academic community and plays an integral role in their well being and productivity. This study aims to explore factors that contribute to the formation and growth of academic identity (AI) within the context of a longitudinal faculty development program.

METHODS

Using a qualitative case study approach, data from three cohorts of a 2-year faculty development program were explored and analyzed for emerging issues and themes related to AI.

RESULTS

Factors salient to the formation of AI were grouped into three major domains: personal (cognitive and emotional factors unique to each individual); relational (connections and interactions with others); and contextual (the program itself and external work environments).

DISCUSSION

Faculty development initiatives not only aim to develop knowledge, skills, and attitudes, but also contribute to the formation of academic identities in a number of different ways. Facilitating the growth of AI has the potential to increase faculty motivation, satisfaction, and productivity. Faculty developers need to be mindful of factors within the personal, relational, and contextual domains when considering issues of program design and implementation.

Faculty development as transformation: lessons learned from a process-oriented program

BACKGROUND

Faculty development programs tend to be oriented around content, yet many have produced positive outcomes unrelated to the content. We describe a faculty development program that utilized the processes of shared reading and guided reflection espoused by narrative medicine.

DESCRIPTION

To date, 25 preceptors in the Foundations of Clinical Medicine course have participated. The program consists of weekly seminars in which participants actively engage with text as a basis for conversation around content as well as teaching strategies.

EVALUATION

Using qualitative methods, we examined notes from seminars, in-depth interviews, and review of curricular documents; we used conceptual frameworks from education as interpretive lenses. Participants recognized both personal growth and transformation in relationships with each other, which created the opportunity, and the means, to address and reshape norms and teaching practices at the institution.

CONCLUSIONS

Process-oriented faculty development programs may foster growth of individuals, contribute to transformation in relationships, and ultimately influence teaching practices.

A national survey of medical education fellowships

PURPOSE

The purpose of our study was to determine the prevalence, focus, time commitment, graduation requirements and programme evaluation methods of medical education fellowships throughout the United States. Medical education fellowships are defined as a single cohort of medical teaching faculty who participate in an extended faculty development programme.

METHODS

A 26-item online questionnaire was distributed to all US medical schools (n=127) in 2005 and 2006. The questionnaire asked each school if it had a medical education fellowship and the characteristics of the fellowship programme.

RESULTS

Almost half (n=55) of the participating schools (n=120, response rate 94.5 %) reported having fellowships. Duration (10-584 hours) and length (<1 month-48 months) varied; most focused on teaching skills, scholarly dissemination and curriculum design, and required the completion of a scholarly project. A majority collected participant satisfaction; few used other programme evaluation strategies.

CONCLUSIONS

The number of medical education fellowships increased rapidly during the 1990s and 2000s. Across the US, programmes are similar in participant characteristics and curricular focus but unique in completion requirements. Fellowships collect limited programme evaluation data, indicating a need for better outcome data. These results provide benchmark data for those implementing or revising existing medical education fellowships.

The essential value of projects in faculty development

Projects--planned activities with specific goals and outcomes--have been used in faculty development programs to enhance participant learning and development. Projects have been employed most extensively in programs designed to develop faculty as educators. The authors review the literature and report the results of their 2008 study of the impact of projects within the Pennsylvania State University College of Medicine Junior Faculty Development Program, a comprehensive faculty development program. Using a mixed-methods approach, the products of project work, the academic productivity of program graduates, and the impact of projects on career development were analyzed. Faculty who achieved the most progress on their projects reported the highest number of academic products related to their project and the highest number of overall academic achievements. Faculty perceived that their project had three major effects on their professional development: production of a tangible outcome, development of a career focus, and development of relationships with mentors and peers. On the basis of these findings and a review of the literature, the authors conclude that projects are an essential element of a faculty development program. Projects provide a foundation for future academic success by enabling junior faculty to develop and hone knowledge and skills, identify a career focus and gain recognition within their community, generate scholarship, allocate time to academic work, and establish supportive relationships and collaborative networks. A list of best practices to successfully incorporate projects within faculty development programs is provided.

Strategies for creating a faculty fellowship in medical education: report of a 10-year experience

The authors present 10 strategies, plus challenges and opportunities, that have informed three well-established, yearlong medical education fellowships (defined as single cohorts of medical teaching faculty who participate in extended faculty development activities) during the period 1998 to 2008. These strategies include (1) defining an operating philosophy, values, and goals, (2) establishing a curriculum that reflects the roles and responsibilities of fellows and faculty, (3) employing a basic approach to adult learning, (4) striving to achieve a balance between stated objectives and openness of discussion, (5) creating optimum learning opportunities for the fellows to acquire and practice skills delineated in the curriculum, (6) fostering interdisciplinary communication, team development, and the creation of a learning community, (7) developing mindfulness and critical self-reflection, (8) systematically reviewing each session, (9) evaluating fellowship outcomes, and (10) planning for the future. This in-depth look presents both curricular content and process, providing a useful starting point from which those who develop and conduct educational faculty development activities at medical schools and academic medical centers may fashion and implement a local curriculum.