This article in the To the Point series will focus on best practices regarding faculty development in medical education in the field of obstetrics and gynecology. Faculty development is an essential component in achieving teacher and learner satisfaction as well as improving learner outcomes. The Liaison Committee on Medical Education requires medical school faculty to have the capability and longitudinal commitment to be effective teachers. Although many programs have been created to address faculty development, there remains a paucity of literature documenting the impact of these programs on learner outcomes. We reviewed the qualities of an excellent medical educator, expectations regarding medical school teaching faculty, elements of comprehensive faculty development programs, and outcome measures for evaluating the effectiveness of these programs.
This article, part of the ongoing To the Point: Medical Education Reviews series produced by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), reviews the literature and discusses best practices regarding faculty development in medical education with a special focus on faculty development within the field of obstetrics and gynecology.
Although most faculty learned to teach by observing their teachers and mentors, formal training in educational methods has been absent in the curriculum of most training programs until recently. Recognizing this deficit in formal training, medical education organizations over the past 2 decades have designed numerous train-the-trainer opportunities, yet there remains a need to reach out to more faculty than the self-selected few who regularly attend these well-designed programs. Many descriptive articles have been written about faculty development curricula, satisfaction of the participating faculty, and self-reported change in teaching behaviors as a result of participation.
The international group, Best Evidence in Medical Education Collaboration, published a systematic review of faculty development initiatives seeking evidence that these programs supported outcomes beyond participant satisfaction. Yet there remains a paucity of higher-level evidence documenting the effect of comprehensive faculty development programs on learners’ outcomes. Evidence-based methodology in faculty development exists more in the realm of individual skills and behaviors, rather than evaluation of comprehensive faculty development curricula.
The purposes of this article was the following: (1) define the qualities of an excellent medical educator, (2) discuss expectations of medical school faculty teaching, (3) review the elements of a comprehensive faculty development program, and (4) suggest possible outcome measures for the evaluation of such programs.
Defining the qualities of an excellent medical educator
The qualities and skills of an excellent medical educator have been outlined in existing faculty development literature. In 2008, Rogers described faculty and learner definitions of an effective teacher titled, The Seven Habits of Highly Effective Medical Educators, as Table 1 describes (excerpt with permission from R. L. Rogers’ lecture given at the 2008 Annual Meeting of the Society for Academic Emergency Medicine). Academic medical faculty defined effective teachers as good role models, showing respect for learners, having enthusiasm for teaching, and admitting to their knowledge and skill limitations.
| Knowledge of educational theory Use of clinical teaching microskills Finds teachable moments Good listening skills Teaches at the learner’s level of understanding |
| Excited about the topic Inspiring |
| Timely Appropriate setting Objective Allows for self evaluation |
| Tailoring the teaching to the learner Addresses specific learning needs Adequate observation and supervision |
| Explains actions to the learner Makes difficult concepts easy to understand Points out errors without ridiculing Emphasizes concepts |
| Stimulates independent thinking Allows enough time to generate an answer Promote life-long learning skills |
| Demonstrates critical behaviors and skills Life-long learning Collaboration and communication skills Mentorship |
A 2009 study of teacher perceptions of desired qualities, competencies, and strategies for skilled clinical teachers was conducted using structured interviews of medical educators. Desired attitudinal qualities included a sense of humor, an attraction to teaching, and enthusiasm. The ability to draw on a wide educational repertoire and adapt to the student’s needs, whereas actively engaging the student in the learning process and having current knowledge of the field were viewed as desired strategies and competencies in expert teachers.
Students, on the other hand, defined an effective teacher as having the ability and motivation to find the teachable moment, and communicating in a supportive tone that invites questions. A multicenter focus group analysis was performed with emergency medicine clinical clerks and residents at 5 Canadian medical schools. When asked what the learners wanted from a good teacher, the top 5 principles were a positive attitude, taking time to teach, using teachable moments, tailoring teaching methods to the learner, and giving appropriate feedback. Using information from this study, Rogers described the 7 habits of an effective teacher using the acronym in Table 1 .
A descriptive study of medical students in the preclinical years asked students to identify and rank attributes of a good educator. The most highly rated attribute of an educator was being a good communicator followed by being approachable and able to relate to the students. Less highly rated, but still important attributes to the students, were having educators who were helpful, friendly, sensitive to their needs, possessing expert knowledge, enthusiastic, and patient. These attributes are difficult to measure and reward in an objective manner.
The inability to quantify excellence in medical educators is an obstacle to the robust evaluation of the impact of faculty development as well as to the academic promotion of medical educators using traditional promotion standards. A detailed educator portfolio (EP) was developed by members of the Academic Pediatric Association as a structured format for documenting qualitative and quantitative data such as 5-year educator goals and a teaching activities grid.
The American Association of Medical Colleges (AAMC) Group on Educational Affairs consensus conference in 2006 suggested a structured EP with 5 components for documenting educational scholarship: teaching, curriculum, advising and mentoring, educational leadership and administration, and learner assessment. Qualitative ratings of novice, intermediate, and expert are used to measure items such as educational philosophy, curriculum design, and methods of program evaluation, whereas quantitative measures may include number of courses or topics taught, teaching hours, number of learners, and teaching evaluations from learners and peers. This easily accessed tool can be used for individual promotion purposes.
Expectations of medical educators and medical schools
The Liaison Committee on Medical Education (LCME) establishes standards for function, structure, and performance of medical schools. The LCME requires that members of the medical school faculty have the capability and longitudinal commitment to be effective teachers (FA-4 in the LCME’s Functions and Structure of a Medical School). The LCME requires faculty to have knowledge of the discipline as well as understanding of curriculum design, evaluation, and instructional methods.
University-based and community-based faculties are held to the same standard, posing a challenge to clerkship directors and deans to provide adequate and measurable faculty development outcomes. The standard also delineates the responsibility of the medical school to possess a plan to provide access to expertise, resources, and documentation of faculty participation in faculty development programs.
Despite the mandates of the LCME to ensure high-quality medical education, evidence from the AAMC Graduation Questionnaire suggests that faculty in our specialty continue to have an opportunity to improve. Medical students rate the quality of their educational experience on the obstetrics and gynecology clerkship less favorably than the majority of other clinical clerkships, and this holds true for other parameters of direct faculty involvement in medical student clinical education ( Table 2 ).
| Variable | Students agree/strongly agree, % | Rank among core clinical clerkships (rank/# clerkships rated) | ||
|---|---|---|---|---|
| 2009 | 2005 | 2009 | 2005 | |
| Overall quality of educational experience | 73.8 | 65.9 | 6/9 | 7/9 |
| Faculty observed me taking a patient history | 52 | NA | 5/6 | NA |
| Faculty observed me taking a physical examination | 62.9 | 61.1 | 5/6 | 5/6 |
| Faculty provided me with sufficient feedback | 60.5 | 57.9 | 6/6 | 6/6 |
To address some of the deficiencies identified, many obstetrics and gynecology organizations such as the American College of Obstetrics and Gynecology, the Council on Resident Education in Obstetrics and Gynecology, and the Association of Professors of Gynecology and Obstetrics are focusing efforts to create more training-the-trainers programs. Examples of these programs are outlined in the next section.
Elements of comprehensive faculty development programs
Wilkerson and Irby defined faculty development as 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. The composition of a faculty development program is best dictated by learner needs and faculty teaching experience.
Most comprehensive programs offer elements from 4 main areas: professional development (academic responsibilities and orientation to the promotion process), instructional development (specific teaching skills and learning theories), leadership development (curriculum development and evaluation, scholarly program evaluation), and organizational development (develop policies to document teaching efforts, and systems to encourage and reward teaching and mentoring).
The tenets of faculty development have also evolved over the last 3 decades from behavioral theories (emphasis on behavioral objectives and feedback) to cognitive theories (emphasis on how students learn and practical knowledge) to social learning theories (emphasis on mentoring and improving the status of teaching in medical institutions). By structuring comprehensive faculty development programs to include each of these elements, faculty members of varying levels of experience and expertise can participate and document a continued commitment to being an effective medical educator throughout their career. Table 3 contains examples of comprehensive faculty development programs at both institutional and national levels along with current web links.
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