Is faculty development critical to enhance teaching effectiveness?

India has the highest number of medical colleges in the world and, consequently, the highest number of medical teachers. The unprecedented growth of medical institutions in India in the past two decades has led to a shortage of teachers and created a quality challenge for medical education. In recent years, though medical advances have been understood and adopted by many institutions, the same is not true for educational planning and implementation. There is a need for well-trained faculty who will help improve programs to produce quality graduates. The existing teachers' training programs are insufficient; both in number and aspects they cover, to meet this demand. Provision of faculty development related to teaching and assessment strategies is widely perceived to be the essential ingredient in the efforts to introduce new curricular approaches and modify the educational environment in academic medicine. Analyses of the outcomes of efforts to revise health professions curricula have identified the availability and effectiveness of faculty development as a predictor of the success or failure of reform initiatives. This article will address faculty development for the purpose of enhancing teaching effectiveness and preparing instructors for potential new roles associated with curriculum changes.

Ben Franklin observed that “teaching is the occupation that is the most reflected upon, cherished, praised, rejoiced, and canonized, and at our deathbeds, possibly the most remembered aside from our dear ones, yet the least rewarded, in terms of earthly goods, of all the worthwhile and necessary pursuits.” Franklin went on to say, “A gifted teacher is as rare as a gifted doctor, and makes far less money.”[1]

“The most admirable of reforms cannot but fall short in practice if teachers of sufficient quality are not available in sufficient quantity. Generally speaking, the more we try to improve our schools, the heavier the teacher's task becomes; and the better our teaching methods, the more difficult they are to apply.” —Jean Piaget.[2]

As noted by Piaget, the success of educational reforms ultimately lies with individual instructors and their capacity, individually and collectively, to implement “new ways of doing things” during their day-to-day, hour-by-hour, moment-by-moment interactions with students.

The medical education system in India is one of the largest in the world.[3] It comprises 262 medical schools, most of them university affiliated, producing 29,172 doctors a year.[4] Medical schools in India have seen rapid growth in the last 20 years, almost doubling in strength.[5] This has created a marked shortage of teachers for medical schools. It has also been widely discussed that academic medicine is graying rapidly and struggling to attract younger medical professionals into the educational arm of the profession. This matter is of critical concern because the strength of educational programs rests on teachers and researchers who plan lifelong academic careers and get time to acquire competencies and academic credentials to become valuable contributors to the overall mission of the parent institution. In most cases, the older, “second career” recruits into medical education have little knowledge of educational theory and teaching practices.

Faculty development programs will meet the shortage of medical teachers and groom faculty for leadership roles to provide solutions for achieving better standards of health for the population. This paper provides information on and insights into faculty development that may be useful to medical schools in designing professional growth opportunities for their faculty.

WHAT IS FACULTY DEVELOPMENT?

LuAnn Wilkerson and David Irby, two of the most published authorities on faculty development in the health profession, have written, “Academic vitality is dependent upon faculty members’ interest and expertise; faculty development has a critical role to play in promoting academic excellence and innovation, and it is a tool for improving the educational vitality of our institutions through attention to the competencies needed by individual teachers and to the institutional policies required to promote academic excellence.”[6]

Faculty development has been described in various ways in the literature on cultivation of the professional skills of the academician, but consistent themes are evident. In one of the earliest works on the topic, Centra described faculty development as “the broad range of activities that institutions use to renew or assist faculty in their roles” and includes initiatives designed to improve the performance of faculty in teaching, research, and administration.[7] Bland et al. described faculty development as a “planned program to prepare institutions and faculty members for their academic roles including teaching, research, administration, writing/scholarship, and career management.”[8] Bligh proposed that the goals of faculty development are to improve practice in teaching, research, and institutional service and also to “manage change by enhancing individual strengths and abilities as well as organizational capacities and the overall culture.” Bligh noted that faculty development programs are tangible indicators of the institutions’ inner faith in their academic workforce.[9]

Finally, Steinart et al. proposed that it is reasonable for institutions to expect that faculty development will “result in improved teaching performance and better outcomes for students.”[10] According to Steinart et al., examples of such improvements include development and use of new teaching methods and evaluation techniques, enhanced processes for analyzing, planning, and implementing curricula, new perceptions about factors that influence relationships between students and teachers, and increased commitment to educational scholarship – investigating teaching and learning processes.

HOW IS FACULTY DEVELOPMENT ACCOMPLISHED?

With the phenomenal changes in educational and information technology, the role of a teacher has undergone dramatic changes. He/she is expected to possess skills and abilities to plan the curriculum, make rational use of the media technology, and design an assessment strategy. This is possible only through a systematic approach to faculty development.

In order to strengthen teachers’ training in health sciences in India, National Teacher Training Centers (NTTC) were established in 1974 at medical colleges throughout India, including Jawaharlal Institute of Postgraduate Medical Education (JIPMER) in Pondicherry, the Post Graduate Institute in Chandigarh, and Maulana Azad Medical College in New Delhi. NTTC activities included 6- to 10-day programs for medical educators and included topics on education objectives, curriculum design, teaching methods, and assessment. Faculty training courses facilitated the introduction of some innovations in various medical colleges in India and fostered the development of medical education units in other colleges. After 1999, only the NTTC at JIPMER continued to function.[5]

The National Conference on ‘Training Teachers Today for Tomorrow's Needs’ held under the auspices of MCI in September 1994 and also the workshop on ‘Medical Education - An Appraisal’ held under the auspices of MCI in May 1996 have made recommendations for establishment of Medical Education Unit in each medical college. The MCI in their revised regulations have also recommended establishment of such units in each medical college.[11]

As suggested by MCI, the development of medical education units in all medical colleges will go a long way in the development of teaching skills among their faculty. While training forms an essential requirement, it is also necessary to provide academic recognition to teachers for their contribution to teaching. Otherwise, teaching will be overtaken by the priorities of research and patient care. It is important to encourage and reward teachers who show a flair for teaching and adopt innovative teaching methods.[12]

The Foundation for Advancement of International Medical Education and Research (FAIMER) is also supporting faculty development in India. The FAIMER Institute, which offers a two-year part-time fellowship, teaches education methodology and leadership skills to faculty from developing countries from around the world, with an emphasis on faculty from South Asia. FAIMER Regional Institutes have been created in Mumbai, Ludhiana, and Coimbatore, and several others are anticipated in the near future.

FAIMER has used the following framework of human capacity building programs: (1) identify young and talented individuals with potential to become agents for change; (2) organize and deliver an effective learning intervention that is relevant for the environment; (3) facilitate the opportunity for real-life application of acquired knowledge and skills with support; and (4) promote development of a sustainable career path with opportunities for growth and advancement (Nchinda, 2002).[13]

Seven-tier hierarchy of faculty development strategies

Ullian and Stritter described a seven-tier hierarchy of faculty development strategies to enhance the teaching effectiveness of individual faculty and/or groups of faculty.[14] This hierarchy ranged from (1) individual, self-directed activities such as reading, reflection, and self-assessment, observation of “exemplary practice” videotapes (e.g., watching other teachers “in action” and noting techniques), evaluations of teaching effectiveness provided by students (e.g., course and instructor ratings), and analysis of “what would you do” case scenarios depicting student-teacher interactions; (2) shadowing experienced or exemplary teachers; (3) being videotaped and/or observed while teaching and receiving feedback in order to “see oneself from the students’ perspective”; (4) participating in brief duration (one-hour) lectures, journal clubs, or lunch-and-learn discussion groups that expose faculty members to theoretical literature or research reports that address educational issues; (5) participating in workshops and seminars of brief duration (three to six hours) focusing on specific instructor competencies such as providing feedback, asking questions to promote critical thinking, or constructing case-based examinations; (6) participating in pedagogical skills fellowships or teaching enhancement courses of several weeks’ to months’ duration; and (7) various organizational strategies to promote, assess, and reward teaching effectiveness including formalized mentoring programs for new and junior faculty and sabbaticals (often intended to allow faculty to experience alternative curriculum models at other schools) and providing mechanisms, including tuition support, for faculty to participate in graduate programs in education or academic leadership.

Evaluation of outcomes of faculty development programs to improve teaching effectiveness

the most comprehensive source of information about the effectiveness of faculty development initiatives to enhance teaching is the 2006 review by the Best Evidence in Medical Education Collaborative (BEME).[15] The summary report (BEME Guide No. 8) appears in the June 2006 issue of Medical Teacher. This report is an outstanding synopsis of the available research and provides useful guidelines for the design of faculty development programs and strategies to assess outcomes.

The BEME group used Kirkpatrick's four-level hierarchy of educational outcomes as the framework for classifying and analyzing findings from studies included in the dataset.[16] Kirkpatrick's model has four levels of educational outcomes: (1) the learner's reaction to the educational experience (opinions and perceptions); (2) indicators of learning, which include changes in attitudes, knowledge, and skills; (3) behavior, which includes changes in practice (i.e., modifications in methods); and (4) results, which refer to changes in the practices, policies, or infrastructure of the overall organization and/or changes in the practices/behavior of the students or colleagues of a faculty member who participated in a faculty development program.

Future of medical education: The saber-tooth curriculum

It is also critical for the content of the program to be pertinent to the roles and responsibilities of the faculty who participate. Several studies have demonstrated that careful needs assessment prior to conducting faculty development creates programs that are more likely to be attended, evaluated more positively, and to contain concepts and skills perceived to be transferable into the day-to-day work responsibilities of faculty.[17-23]

One of the most influential books on educational planning in the 20th century emphasized the importance of “getting the content of training right.” This book—The Saber-Tooth Curriculum—was written by Abner J Peddiwell and published in 1939, but still remains a required reading in schools of education and in many business schools.[24]

Today, needs assessment and anticipatory planning are just as important as they were in the Paleolithic era 50,000 years ago. Let us use those tools to keep medical education relevant and effective for the future.