A Systematic Review of Faculty Development Initiatives Designed to Improve Teaching Effectiveness in Medical Education: BEME Guide No
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Medical Teacher, Vol. 28, No. 6, 2006, pp. 497–526 BEME GUIDE A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8 YVONNE STEINERT1, KAREN MANN2, ANGEL CENTENO3, DIANA DOLMANS4, JOHN SPENCER5, MARK GELULA6 & DAVID PRIDEAUX7 1McGill University, Montreal, Canada; 2Dalhousie University, Halifax, Canada; 3Austral University, Buenos Aires, Argentina; 4University of Maastricht, Maastricht, The Netherlands; 5University of Newcastle upon Tyne, Newcastle, UK; 6University of Illinois at Chicago, Chicago, USA; 7Flinders University, Adelaide, Australia ABSTRACT Background: Preparing healthcare professionals for . Participants reported positive changes in attitudes toward teaching is regarded as essential to enhancing teaching effective- faculty development and teaching. ness. Although many reports describe various faculty develop- . Participants reported increased knowledge of educational ment interventions, there is a paucity of research demonstrating principles and gains in teaching skills. Where formal tests of their effectiveness. knowledge were used, significant gains were shown. Objective: To synthesize the existing evidence that addresses . Changes in teaching behavior were consistently reported by the question: ‘‘What are the effects of faculty development participants and were also detected by students. interventions on the knowledge, attitudes and skills of teachers . Changes in organizational practice and student learning were in medical education, and on the institutions in which they work?’’ not frequently investigated. However, reported changes included Methods: The search, covering the period 1980–2002, greater educational involvement and establishment of collegiate included three databases (Medline, ERIC and EMBASE) and networks. For personal use only. used the keywords: staff development; in-service training; . Key features of effective faculty development contributing to medical faculty; faculty training/development; continuing medical effectiveness included the use of experiential learning, provision education. Manual searches were also conducted. of feedback, effective peer and colleague relationships, well- Articles with a focus on faculty development to improve designed interventions following principles of teaching and teaching effectiveness, targeting basic and clinical scientists, were learning, and the use of a diversity of educational methods reviewed. All study designs that included outcome data beyond within single interventions. participant satisfaction were accepted. From an initial 2777 Methodological issues: More rigorous designs and a greater abstracts, 53 papers met the review criteria. use of qualitative and mixed methods are needed to capture Data were extracted by six coders, using the standardized the complexity of the interventions. Newer methods of Med Teach Downloaded from informahealthcare.com by Boston University on 12/20/11 BEME coding sheet, adapted for our use. Two reviewers coded performance-based assessment, utilizing diverse data sources, each study and coding differences were resolved through discussion. should be explored, and reliable and valid outcome measures Data were synthesized using Kirkpatrick’s four levels of should be developed. The maintenance of change over time should educational outcomes. Findings were grouped by type of also be considered, as should process-oriented studies comparing intervention and described according to levels of outcome. In different faculty development strategies. addition, 8 high-quality studies were analysed in a ‘focused Conclusions: Faculty development activities appear highly picture’. valued by participants, who also report changes in learning and Results: The majority of the interventions targeted practicing behavior. Notwithstanding the methodological limitations in the clinicians. All of the reports focused on teaching improvement literature, certain program characteristics appear to be consistently and the interventions included workshops, seminar series, short associated with effectiveness. Further research to explore these courses, longitudinal programs and ‘other interventions’. The associations and document outcomes, at the individual and study designs included 6 randomized controlled trials and 47 organizational level, is required. quasi-experimental studies, of which 31 used a pre-test–post-test design. Key points: Despite methodological limitations, the faculty development literature tends to support the following outcomes: . Overall satisfaction with faculty development programs was Correspondence: Yvonne Steinert, PhD, Centre for Medical Education, Faculty of Medicine, McGill University, Lady Meredith House, 1110 Pine Avenue high. Participants consistently found programs acceptable, West, Montreal, Quebec, H3A 1A3, Canada. Tel: (514) 398-2698; fax: (514) useful and relevant to their objectives. 398-6649; email: [email protected] ISSN 0142–159X print/ISSN 1466–187X online/06/060497–30 ß 2006 Informa UK Ltd. 497 DOI: 10.1080/01421590600902976 Y. Steinert et al. Introduction academic vitality. Bligh (2005) has made a similar suggestion, stating that faculty development programs are outward signs Academic vitality is dependent upon faculty mem- of the inner faith that institutions have in their workforce, and bers’ interest and expertise; faculty development that successful faculty development is expected to result has a critical role to play in promoting academic in improved teaching performance and better learning excellence and innovation. (Wilkerson & Irby, outcomes for students or doctors. Examples of such 1998) improvements include the development of new teaching skills or assessment techniques, better ways of planning or Faculty development, or staff development as it is often implementing curricula, new ways of thinking about the called, has become an increasingly important component of student–teacher relationship, and increased commitment to medical education. Whereas it was once assumed that a educational scholarship. competent basic or clinical scientist would naturally be an To date, a number of publications have reviewed the effective teacher, it is now acknowledged that preparation for effectiveness of faculty development activities. In 1984, teaching is essential. Given the increasing complexity and Sheets & Henry observed that despite the growth in faculty pressures of healthcare delivery, new approaches to teaching development programs, evaluation of these initiatives was a and learning, and competing demands on teachers’ time, rare occurrence, usually consisting of short questionnaires faculty members require a broad range of teaching and tapping participants’ satisfaction. In 1990, Sheets & Schwenk learning strategies that can be used in diverse settings. reviewed the literature on faculty development activities for To help faculty members fulfill their multiple roles, a variety family medicine educators and made a similar observation, of faculty development programs and activities have been calling for more rigorous evaluations based on observed designed and implemented. These activities include work- changes in participant behavior. In 1992, Hitchcock et al. shops and seminars, short courses and site visits, fellowships summarized earlier reviews of the faculty development and other longitudinal programs. Many of these activities literature (e.g. Stritter, 1983; Bland & Schmitz, 1986; have been designed to improve teacher effectiveness across Sheets & Schwenk, 1990) and concluded that the concept the medical education continuum (e.g. undergraduate and of faculty development was evolving and expanding. postgraduate education), and they have been offered to In particular, they observed that teaching skills were a healthcare professionals at local, regional and national levels prominent aspect of faculty development, that fellowships (Clark et al., 2004; Skeff et al., 1997). However, were being used effectively to recruit and train new faculty, despite numerous descriptions of program development and and that the efficacy of faculty development needed better implementation, there is a paucity of research demonstrating research documentation. In 1997, Reid et al. reviewed 24 the effectiveness of faculty development interventions. The papers (published between 1980 and 1996) and concluded goal of this report is to present the results of a systematic that despite some positive outcomes for fellowships, work- review of the impact of faculty development initiatives on shops and seminars, methodological weaknesses precluded teaching effectiveness in medical education. It is hoped that For personal use only. definitive conclusions regarding faculty development out- such a review of existing research will help to synthesize our comes. In 2000, Steinert highlighted the need for faculty knowledge of the field and guide future program develop- development to respond to changes in medical education and ment and evaluation. healthcare delivery, to continue to adapt to the evolving roles of faculty members, and to conduct more rigorous program Faculty development evaluations. She also commented that faculty development programs need to broaden their focus, consider diverse Faculty development has been defined as that broad range of training methods and formats, and foster new partnerships activities that institutions use to renew or assist faculty in their and collaborations. roles (Centra, 1978), and includes initiatives designed