Whither Faculty Development

1. Whither Faculty Development Can We Do Better? AFMC – AMS J. Wendell Macleod Memorial Lecture, 2006 Medical Education Conference (London ON) Presented by Wayne Weston MD

2. J. Wendell Macleod • 1905 – born in Kingsbury, Quebec • 1930 – graduated in medicine at McGill • Worked closely with Norman Bethune • Served in the navy in WW II – Surgeon Commander • 1946 – OBE • Practiced in Winnipeg withhis wife Jessie McGeachy • 1952 – 1st dean of the newmedical school at the U ofSaskatchewan AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

3. Mcleod, cont’d. • 1960 – publicly supported the government during the Doctors’ strike • 1962-70 – executive secretary  executive director of the ACMC • >1970 – consultations in Haiti, China, Cuba; co-authored “Bethune: the Montreal Years” • 1980 – Order of Canada • 2001 – died aged 96 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

4. 1994 Jock Murray, Dalhousie University • 1995 Ian Hart, University of Ottawa • 1996 Donald Wilson, AMS • 1997 Richard Cruess, McGill University • 1998 John Wade, University of Manitoba • 1999 Arnold Naimark, University of Manitoba • 2000 Martin Hollenberg, University of British Columbia • 2001 John Evans, Torstar Corporation • 2002 Michael Kirby, Senate • 2003 Michel Bureau, Fonds de la recherche en santé du Québec • 2004 Jean Gray, Dalhousie University • 2005 symposium rather than a lecture AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

5. Whither Faculty Development: Can We Do Better? • OUTLINE: • Good news and bad • The gap • Fundamentals of a serious approach to faculty development AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

6. Objectives • At the end of this presentation, you will: • Be convinced that we need to provide more intensive faculty development; • (Or at least you will seriously wonder about it) • Be able to list the arguments for enhancing our faculty development efforts AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

7. It is the mark of an educated mind to be able to entertain a thought without accepting it. - Aristotle AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

8. Education • “…the entire process by which a culture transmits itself across the generations.” – Bailyn in Jeffrey & Manganiello p73 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

9. What is Faculty Development Anyway? • Many definitions: • Some focus on growth and development of individual faculty members • Others emphasize the importance of preparing faculty for organizational needs (Jolly, 2002) • Some focus on the teaching role, others include research, administration and personal development • For this presentation I will focus on the enhancement of each faculty member’s role as a teacher AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

10. The Good News – We are Getting Better • Surveys of faculty development activities in Canadian medical schools (McLeod, 1987 & McLeod, Steinert, Nasmith, Conochie, 1997) • “…a major, positive transition during the past 10 years” • Review of the surveys submitted by the faculty development offices in 2006 shows an impressive range of activities in all schools AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

11. Examples of Good News • Larger numbers of workshops • Longer educational offerings e.g. Laval – 5 day course with homework • More scholarly evaluation of impact e.g. Sherbrooke • Faculty development grand rounds e.g. UofT • Learning opportunities for residents e.g. Dalhousie’s month long elective • Certificate, scholars & Master’s programs & fellowships at many schools AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

12. More Good News • Research & scholarship in medical education e.g. the Wilson Centre for Research in Medical Education • Promotion on the basis of contributions to teaching & education AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

13. But… We are not there yet. AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

14. Wanted! Clinician Researcher AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

15. Classified Ads • Wanted – clinician researcher • 50% research, 50% clinical work • No research experience needed • We will provide an in-depth three-day course on research to bring you “up to speed” (optional) • Plus yearly one-day workshops to keep you on the leading edge of research in your field (optional) AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

16. "Preparing to be an effective teacher is arguably as challenging an undertaking as preparing to be a clinician… - Jason, H. & Westberg, J. (1982). Teachers & Teaching in US Medical Schools. Norwalk, Connecticut, Appleton-Century-Crofts. AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

17. …Optimally, prospective and current teachers should have abundant opportunities to: • critically and systematically observe master teachers in action; • practice instructional skills in ‘safe’ settings...; • critique their own skills...; • and be critiqued by others, both on their instructional skills and their skills as self-critiquers.” AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

18. “Effective teaching may be the hardest job there is.” • William Glasser (Developer of “Reality Therapy”) AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

19. “Medical students are, to a large extent, taught by people who have undertaken little or no formal study in the field of education.... Would you send your child to a school where the teachers were untrained at recruitment, where no instructions were given them, and where promotion was independent of teaching excellence? Yes you would, provided it was a medical school.” - Kent A: An Overview of Medical Education Today. Thesis AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

20. Who attends? • “Only 39% of teaching hospitals have ongoing faculty development activities in teaching skills for their departments of medicine faculty, and, on average, fewer than 50% of their faculty participate.” - Cole et al “Faculty Development in Teaching Skills: an Intensive Longitudinal Model. Academic Medicine 2004;79:469-480 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

21. A Crazy Assumption • “Discipline expertise is sufficient to make you an expert teacher” • Where does this crazy idea come from??? • Assumption that teaching is simply transmission of information • Decades of experience watching teachers • Little understanding of the complexity of teaching • Tradition AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

22. Conclusion • We act as if education is of fundamental importance to everyone…. • …except the teachers AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

23. Another Crazy Assumption • Taking academic courses on educational topics will make you a good teacher • Academic – adjective – “irrelevant in practice: theoretical and not of any practical relevance” (Encarta dictionary) AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

24. Some Examples of Difficult Tasks for Teachers • How to make a complex topic clear & understandable • How to make a boring topic exciting • How to persuade “surface” learners to become “deep” learners • How to provide helpful feedback to a student who just “doesn’t get it” • How to confront a student about unprofessional behaviour • How to tell a student that they have bad breath AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

25. Difficult Tasks for Teachers, cont’d. • Teaching several students at different levels at one time • Fitting good teaching into a very busy clinic • Diagnosing the learner – figuring out where and how they are stuck – & then finding a strategy to get them unstuck • Motivating a student who seems to have no interest in your subject • How to design & implement a remedial program for a resident with multiple learning needs – knowledge, clinical reasoning, professional attitudes & personal problems AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

26. Difficult Tasks for Teachers, cont’d. • Teaching effectively by computer conferencing or videoconferencing • How to deal with transference & counter-transference in the teacher-learner relationship • Basing educational approaches on best evidence • Supporting a student or resident who has made a tragic error leading to the death of a patient • Teaching students how to balance their time & energy among career, personal & family life AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

27. Why Most Faculty Development Programs Fail • One-shot workshops • Topics selected by "others" • Ignores the difficulties of changing • Follow-up evaluation is uncommon • Rarely addresses individual needs and concerns • Little recognition of the unique features of the teaching-learning environment • Lack of conceptual framework Based on Fullan MG with Stiegelbauer S: The New Meaning of Educational Change. 1991. AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

28. How Do We Decide on the Agenda for Faculty Development? • Needs assessment: • Our best guess – of what they need or what they will attend • Ask faculty what they want • Evaluate faculty teaching performance – students, peers • Student learning needs • Future practice patterns AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

29. Becoming a More Effective Teacher What Does it Take?

30. From Ramsden P: What does it take to improve medical students’ learning, in Balla, Gibson, Chang: Learning in Medical School, 1989 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

31. AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

32. Silent Reflection • Who were the 3 most important teachers in your life? • What did they all have in common? • Do we adequately address these qualities in our faculty development programs? AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

33. Results • Rarely include professional teachers • Parents, spouses, friends, neighbours, pastors, siblings and other relatives. • What they had in common – integrity, truthfulness, compassion, dedication, empathy, attentiveness and love AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

34. Effective Teachers Understand student learning Understand self Understand subject AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

35. Understand Student Learning • What is our concept of learning? • Stages of development • Personal struggles AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

36. Images of Learning Adding bricks to the wall. AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

37. “Schools teach you to imitate. If you don’t imitate what the teacher wants you get a bad grade. Here, in college, it was more sophisticated, of course; you were supposed to imitate the teacher in such a way as to convince the teacher you were not imitating.” - Robert Pirsig AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

38. Images of Learning – 2 Transformation AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

39. "Learning is not so much an additive process, with new learning simply piling up on top of existing knowledge, as it is an active, dynamic process in which the connections are constantly changing and the structure reformatted." - K. Patricia Cross AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

40. Good Teaching • Look for what the lives of teachers of liberal & professional studies have in common with the lives of grandparents teaching their grandchildren how to sew, or how to fish • Or barge pilots or fly fishermen teaching apprentices how to read a river AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

41. The “Perry Schema”Stages of Cognitive Development Evolving Commitments Multiplicity Dualism Relativism Maker of meaning vs. receiver of meaning AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

42. “The most important knowledge teachers need to do good work is a knowledge of how students are experiencing learning and perceiving their teacher's actions.” - Steven Brookfield AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

43. Stages of Development Reporter (What) Interpreter (Why) Manager (Next steps) Educator (Scholar) RIME Pangaro, 1999 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

44. Stages of learning • Unconsciously incompetent • Consciously incompetent • Consciously competent • Unconsciously competent • Additional skill needed for teaching – consciously, unconsciously competent AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

45. The Capacity to Deal with a Puzzling Answer • 3 + 3 = 8 • 3 + = 3 + = 6 3 3 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

46. “And of course, last but hardly least, I now tend to see people as patients. I noticed this especially with women. It is often asked whether male medical students become desexualized by all those women disrobing, all those breast examinations, all those manual invasions of the most intimate cavities. I found that to be a rather trivial effect. • What I found more impressive was the general tendency to see women as patients. This clinical detachment comes not from gynaecology but from all the experiences of medicine… AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

47. …During my medicine rotation when, on a bus, I noticed the veins on a woman's hand – how easily they could be punctured for the insertion of a line – before noticing that she happened to be beautiful.” - Konner: Becoming a Doctor, 1987, p 366 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

48. Lessons from a Seminar • “Half an hour later the man with the hurt head had poked his head into the room three more times. I wrestled with my conscience. Could it really be that none of them had noticed him? It did not seem possible. Yet it seemed equally impossible that they would be ignoring him. Surely one of us could talk to him for a few minutes? • Despite the evidence that ignoring patients was normative – a fact that I would soon learn beyond any possible doubt – I was too disturbed by the patient’s repeated appearances to K.M.S. any longer. ‘There’s a patient,’ I said timidly…” AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

49. Dr Parker’s response was reflexive and harsh. ‘I’m gonna have to ask you’ – he stabbed the air in my direction with a stiff pointed finger – ‘If you’re gonna keep interrupting me I’m gonna have to ask you to leave.’ His tone, tense, defensive, and shrill, differed dramatically from the ordinary loud, pompous tone of the rest of his lecture… AFMC – AMS J Wendell Macleod Memorial Lecture – 2006

50. …It was the last message I needed to get from him. K.M.S. was from then on not only easy but second nature to me. I faded into the woodwork in every situation. I rarely if ever spoke unless I had been directly addressed. This is the army, I thought…it was a rule I followed throughout the rest of my medical training.” - Konner: Becoming a Doctor, 1987 AFMC – AMS J Wendell Macleod Memorial Lecture – 2006