20. The program director’s role in faculty development

Introduction

Faculty development is an essential element of residency education; program directors must understand its meaning, its role, and basic content areas and strategies. Postgraduate medical education is a ‘unique educational environment, with its emphasis on work-based learning, clinical supervision as a predominant method of training, performance-based assessment, and the challenge of simultaneously delivering education, training and service’.¹ Residency training occurs in an environment of complexity and shifting priorities of health care and PGME systems, and program directors must respond to these: faculty development can facilitate this response. In this chapter we define faculty development, describe the program director’s role in faculty development, list content areas and faculty development strategies, outline how these can be used as opportunities to engage faculty members, and provide some tips for success.

The definition of faculty development has evolved over time from ‘a broad range of activities institutions use to renew or assist teachers in their roles’² to initiatives designed ‘to prepare institutions & faculty members for their academic roles – teaching, writing, research, administration, career management’.³ Today the goal of faculty development ‘is to teach faculty members the skills relevant to their institutional setting & faculty position & to sustain their vitality, both now & in the future’.⁴ The target of faculty development now includes ‘all individuals involved in education of learners across the continuum, leadership and management in the university, hospital, community, and research and scholarship across the health professions’, and content and format of faculty development has become broader, including ‘all activities health professionals pursue to improve their knowledge, skills and behaviors as teachers, educators, leaders, managers, researchers, scholars in both individual and group settings.’⁵ This wide scope might be overwhelming to you as a new program director, so for the purposes of this chapter we describe faculty development as a range of activities to assist faculty members, in particular clinical teachers, in their academic roles, particularly as teachers and assessors. Program directors are usually not the sole faculty development ‘provider’, and they are not expected to be ‘experts’ in all content areas or faculty development strategies: program directors, like you, often work in concert with faculty development specialists in their department or university. As well, departmental teachers and clinical supervisors may participate in faculty development provided by other groups, for example the PGME offices or their specialty society.

As residency education evolves, clinical supervisors are being asked to take on new or changing roles, often in new contexts.⁶ Examples of these changes include: clinical teaching in new community-based rotations, delivering on-line learning to a resident half-day, interacting with learning portfolios, becoming mentors, or participating in competence committees.  Faculty members also need to learn about content areas they have not been explicitly taught (e.g. health advocacy, professionalism, communication skills), new curricular approaches (e.g. competency-based medical education, coaching) or the use of newer assessment tools (e.g. EPAs or field notes). It is also important for faculty members to be educated about larger shifts in medical education and healthcare; including, for example the field of Equity, Diversity, Inclusion and Accessibility. See Table 18.1 for a list of potential content areas for faculty development in residency education.  Many faculty members feel ill-prepared for these roles and new (to them) content areas. The program director is ideally placed to evaluate what areas are needed by their own department members and what faculty development strategies are likely to be effective in their own context.

Table 18.1 Common Faculty Development Content Areas in Residency Education

Content Areas	Content Areas
Communication skills	Providing feedback
Teamwork	Small group facilitation
Leadership skills	Lecturing / interactive lecturing
Patient safety	Teaching procedural skills
Quality improvement	Reflection
Research skills	Role modeling
Critical appraisal	Coaching
Health advocacy	Using portfolios
Social accountability	Multisource feedback
Wellness	Teaching in a simulation context
Time management	Competency based medical education
Ethics	E-learning and blended learning
Equity, Diversity, Inclusion and Accessibility (EDIA)	Distributed learning

‘Traditional’ approaches to faculty development have often included formal group activities such as workshops, usually held away from the clinical teacher’s workplace. Table 18.2A lists some of these formats. Recent reconceptualizing of faculty development proposes a move away from learning that occurs in ‘discrete finite episodes’ to a focus on continuous and authentic professional learning, and a move towards the notion of promoting learning that occurs in authentic contexts, Table 18.2B.⁷

Table 18.2 Faculty Development Strategies

Traditional Faculty development Strategies	Innovative, new(er) faculty development strategies
Workshops and other small group activities	Individual, informal, asynchronous, work-based
Short courses	Simulation methods, e.g. OSTEs (T=Teaching)
Lectures and other didactic activities	Peer coaching, mentoring
Longitudinal programs	Work-based learning
Self-instructional modules	Learning from experience, reflection
On-line formats	Social media
Role-play	Communities of learning / practice
Video review	Learner feedback
Microteaching	“Just-in-time” resources or support

Steinert⁸ has proposed a model where faculty development strategies are divided into four quadrants with axes of formal to informal, and individual to group. The program director may recognize opportunities within their own group for faculty development strategies outside the ‘formal group’ activities, e.g. by using resident feedback on teaching, incorporating faculty development into an existing community of practice, or learning by observing, doing and reflecting on the experience.

Whatever the faculty development format or strategy, it is likely to be more effective, and to change outcomes, if experiential learning is emphasized with opportunities for interaction, practice with feedback and application of concepts learned.  Using peers as role models & collegial support, and using multiple instructional methods also increase success (YS BEME). These aspects should be incorporated in the design and delivery of all faculty development initiatives.

Faculty development can ‘improve practice & manage change by enhancing organizational capacities and culture as well as individual strengths and abilities.⁹ Preparing faculty is a ‘necessary adjunct to facilitate the design, implementation and evaluation of new curricula’. ¹⁰ Faculty development may increase ‘buy-in’ or build capacity by improving knowledge or enhancing skills in a content area such that it can be better taught. ¹⁰ An approach to faculty development aimed at institutions and systems, as well as at individuals, may facilitate the adoption of a competency-based curriculum. ¹¹ ‘One of the early stages of curriculum change should be to focus on addressing the organizational culture and ensuring that there is faculty understanding of the need for change’. ¹⁰ Within a program or department, the program director can leverage faculty development to help address systems concerns or resistance to change (for example, to EDIA), promote curriculum renewal, enable innovation, empower individuals and teams, recognize and reward teaching excellence, and create new leaders.

As noted, shifts in medical education and healthcare systems are placing a greater emphasis on EDIA. Because of this, there are more demands for faculty development in providing safe healthcare and education environments in line with EDIA principles. Faculty development issues that may arise from this include: few healthcare providers with lived experience to speak to an issue (e.g., Trans or non-binary physicians), a situation where the faculty members who may need EDIA training the most do not participate, or a context where a resident may actually be the ‘expert’ in a particular topic.’ It can be worthwhile to connect with an EDIA leader within your hospital, PGME, or Faculty to brainstorm approaches to these common issues and how your role as program director can lend power to changing attitudes that prevent EDIA-focused faculty development.

Practically, what can a busy program director do to engage faculty members in residency education and improve their skills? The program director is likely the person who will identify the learning needs and priorities. This may be done by using program QI or accreditation data, updated accreditation standards, faculty performance evaluations, or resident feedback, or concurrent with the introduction of new curricular or assessment approaches. The program director can ask ‘What content area needs to be addressed?’ or ‘What skills needs improvement?’ (see Table 18.1 for some examples).  There are three elements of faculty development to be considered: the ‘content’ (i.e. what the learner – and sometimes the teacher – has to learn); the ‘process’ (i.e. how the student learns and is assessed on the content); and the faculty development formats and strategies (i.e. how to teach the teachers the content and process)¹⁰ as shown in Figure 1. Linking this back to the case scenario, the ‘content’ is communication skills. These skills need to be learned by residents, and likely need to be made clear to faculty members who may have not been explicitly taught them during their own training and now have to learn to teach and assess them. The ‘process’ is how to teach and assess communication skills; the program director may have access to frameworks or models to assist faculty, such as the Calgary-Cambridge model or multi-source feedback forms. Finally, the program director, likely in consultation with education experts, will need to find suitable faculty development formats or strategies (see Table 18.2). For common competencies or content areas it is likely that others have developed faculty development activities – these can be modified to fit the context that suits the department. An example might be to discuss a new assessment form at a department business meeting or grand rounds.

Conclusion

In summary, the scope of faculty development is much broader than ‘teaching teachers to teach’, although in residency training a major focus will be improving the teaching and assessment skills of the residency program’s clinical supervisors. Faculty development must address changing contexts (in health care and education), changing teacher roles and needed content areas. There is ‘evidence for the effectiveness’ of faculty development – innovative strategies and educationally sound formats exist & must be used. Faculty development is essential for enhancing the vitality of the institution as well as the individual and can be an agent of change. Program directors are uniquely placed to do faculty development as they are close to the needs of the program, and as they are an integral part of their division/department they are aware of the contexts of practice.

Further reading

• Steinert Y. (2010) From workshops to communities of practice. Med Teach;32(5):425-8
• Steinert Y et al. (2016) A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40. Medical Teacher, 38(8):769–786

References

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