국제의과대학 교수개발: 중국의 의학교육자 대상 요구조사(Adv in Health Sci Educ, 2009)

국제의과대학 교수개발: 중국의 의학교육자 대상 요구조사(Adv in Health Sci Educ, 2009)

International medical school faculty development: the results of a needs assessment survey among medical educators in China

Yan Guo Æ Emily Sippola Æ Xinglin Feng Æ Zhe Dong Æ Debing Wang Æ Cheryl A. Moyer Æ David T. Stern

Introduction

• 중화 인민 공화국에서 1965 년 이전에 의료 교육은.... 

• 1966 ~ 1976 년 문화 혁명 기간 동안, 의학 교육은 농민, 공장 노동자 및 해방군의 사람들에게 최우선 적으로 제공되었습니다. 그 당시 교과 과정은 기초 과학보다 훨씬 더 정치 과학을 강조했다. 

• 1977 년 이후, 대학 입학은 경쟁이 치열 해졌고 1970 년대 초반에 훈련받은 많은 의사들이 재교육 과정remedial coursework를 완료하기 위해 직위에서 리콜되었습니다 (Reynolds and Tierney 2004). 

• 1980 년대 이래 일련의 개혁이 이루어져 서서히 전통 의학과 동종 요법 의학을 통합하는 포괄적 인 의학 교육 시스템을 형성하게되었다 (Lee and Lee 1997). 

• Prior to 1965 in the People’s Republic of China, medical education consisted of three options: 

• a vocational medical program with admittance to those with a junior high school education, 

• 5 years of medical school for those who had completed high school, and 

• tradi- tional Chinese medicine. 

• During the 1966–1976 Cultural Revolution, medical education was offered first and foremost to peasants, factory workers, and those in the liberation army. At that time the curriculum emphasized political science far more than the basic sciences. 

• After 1977, university admission became highly competitive, and many physicians trained in the early 1970s were recalled from their positions to complete remedial coursework (Reynolds and Tierney 2004). 

• Since the 1980s, a series of reforms have been made, gradually resulting in the formulation of a comprehensive medical education system that works to integrate traditional and allopathic medicine (Lee and Lee 1997). 

직업 교육은 3 년, 대학교 의학 교육은 5 년에서 8 년 사이입니다. 5 년간의 학습이 가장 일반적인 기간입니다. 커리큘럼 개혁에도 관심이 많다. Institute for International Medical Education의 Global Minimum Essential Requirements 의 개발 및 평가에 대응하기 위하여 몇몇 의과 대학은 커리큘럼의 개정 가능성을 모색하기 시작했다 (Schwarz 외 2004; Stern 외 2005). , 2006).

Vocational programs are 3 years while university medical education ranges from 5 to 8 years; 5 years of study is the most common duration. There is also widespread interest in curriculum reform, with several medical schools beginning to explore potential revision of their curricula in response to the Institute for International Medical Education’s development and assessment of Global Minimum Essential Requirements (Schwarz et al. 2004; Stern et al. 2005, 2006).

대만과 홍콩의 의학 교육은 중국보다 비교적 안정적입니다. 홍콩의 의학 교육 시스템은 100 년 이상 뿌리를두고 있습니다. 홍콩의 시스템은 임상 교육에 중점을 둔 것을 포함하여 영국 시스템과 가장 유사합니다. 4 년의 pre-degree 교육과 적어도 1 년의 졸업 후 수련이 필요합니다. 최근 홍콩에서의 커리큘럼 확장은 의대생의 훈련 과정에서 커뮤니케이션, 전문성 및 윤리와 같은 주제를 포함하는 것을 의미합니다 (Lee and Lee 1997).

Medical education in Taiwan and Hong Kong has been relatively more stable than in China. Hong Kong’s medical education system traces its roots back more than 100 years. Hong Kong’s system resembles the British system most closely, including its emphasis on clinical education. It requires 4 years of pre-degree medical education and at least 1 year of post-graduate training. In recent years, curricular expansion in Hong Kong has meant an inclusion of topics such as communication, professionalism, and ethics in the training of medical students (Lee and Lee 1997).

100 년이 넘는 대만의 시스템은 대만의 의학 교육 지도자들에 의해 사용 된 독일의 모델에 기초를 두고 있었습니다. 1954 년 이후, 대만인들은 독일 / 일본 의학 교육 시스템을 미국 모델로 대체했다. 그 이후 대만의 의학 교육은 통합 교과 과정, 소그룹 교육, 의학 및 일반 의학 교육에 대한 동등한 강조에 중점을두고있다 (Lee and Lee 1997).

Taiwan’s system, also more than 100-years-old, was initially based upon a German model being used by the Japanese leaders of medical education in Taiwan. After 1954, the Taiwanese replaced the German/Japanese system of medical education with the American model. Since then, the emphasis in Taiwanese medical education has been on an integrated curriculum, small group teaching, and equal emphasis on medical science and general medical education (Lee and Lee 1997).

Methods

Survey development

In 2003, researchers at an academic medical center in Beijing, China, and in the Mid- western United States began working together to develop an instrument to assess the needs of medical educators in China. The survey development process began with open-ended interviews with Chinese faculty about issues surrounding faculty development offerings in China. Such interviews yielded information about the context in which we would be surveying leaders, key terms to be used in the instrument, and other issues to be aware of in the development process.

At the same time, the U.S. team conducted a focus group with Chinese medical faculty visiting their university to determine their perspectives on international faculty develop- ment needs. The focus group was comprised of twelve visiting scholars from one of the leading medical schools in the People’s Republic of China at the University of Michigan Medical School. All 12 are senior faculty members in medical education at their home institutions. These issues were compared with the issues raised in the in-depth interviews of Chinese medical educators. Using inductive reasoning, grounded theory, and standard qualitative analysis techniques, themes were identified from the data. Similar themes arose in both the interviews and focus group, and those themes were used to generate draft items for a semi-structured questionnaire.

The instrument was initially constructed in English, and then translated into Chinese. The English version was pilot tested at a meeting in Chengdu, China, using a panel of eight medical education leaders. Revisions were completed shortly thereafter, and then the instrument was translated to Chinese. From there, Chinese researchers conducted a sub- sequent review of the instrument, and revisions were made to reflect common Chinese language usage. Finally, the instrument was translated back into English and to ensure that the overall intent of the questions was similar. Any inconsistencies were discussed among the project team and resolved by consensus.

The final instrument had 123 items covering 36 topics. Each of the 36 topics was categorized as 

• Medical Education (20 topics), 

• Hospital Management (14 topics), and 

• Research (2 topics). 

Participants were asked to rate their level of experience as well as their level of interest in pursuing further education for each topic area. Experience was rated on a 3-point Likert scale, and interest was rated on a 5-point Likert scale. 

An additional 25 questions addressed the subjects’ opinions and attitudes about the logistics of participation in a faculty development program, including...

• duration of the event, 

• personal barriers and benefits, 

• overall interest, and 

• value to the medical school community. 

Questions also included the subjects’ interest in having faculty members from their institutions participate in faculty development, even if they themselves were not able to participate. Subjects were also asked to complete a short demographic profile and answer seven questions about their institution. Due to concerns of confidentiality, data on institution name and region of origin were not collected.

Data collection

The survey was distributed in two settings. 

• The first portion of the implementation plan involved mailing the Chinese-language questionnaire to a list of medical school deans, associate deans, assistant deans, vice deans, and department chairs that we acquired from the Association of Chinese University Medical Colleges. The sample covered 106 medical schools of mainland China. 

• Another part of the survey was conducted at the Seventh Medical Education Conference for China mainland, Taiwan, and the Hong Kong Region, including participants from 30 medical schools in mainland China, one of the medical schools in Hong Kong, and the eight medical schools in Taiwan.

Data entry and analysis

Results

• One hundred nine faculty members from 39 of the participating institutions received surveys at the meeting in Changchun. Ninety-eight individuals completed them, yielding a response rate of 90%. 

• One hundred ninety-three faculty members from 106 institutions received surveys in the mass mailing. One hundred sixteen of those were returned, yielding a response rate of 60%. The final response rate was 71% (N = 214). See Table 1.

Of the respondents, men outnumbered women 5:2. Sixty-six percent (N = 152) of the respondents were over the age of 40, and deans were the most common professional position among all participants at 42% (N = 75). Almost 65% of respondents (N = 113) had been in their current position for 5 years or fewer. See Table 2.

had been in their current position for 5 years or fewer. See Table 2. The mean level of experience across all topics was 1.9 on a scale of 1–3. The overall interest level across the given topics was 4.0 on a scale of 1–5. Figure 1 illustrates the level of interest in each of the topics addressed on the survey.

Respondent demographics

Institutional information

Conference attendees rated their experience levels more highly in four topic areas than did the mailing group (seeTable 3). Mailing group respondents did not offer statistically significantly higher mean ratings for experience in any area. Conversely, the mailing group did rate their interest levels higher than the conference group in thirteen different topics (see Table 3). The conference group did not report statistically significantly higher levels of interest in any area. 

Experience differences

Interest differences

교수 학습 프로그램 참여에 대한 최대 장벽은 각각 그 시간에 일을 하지 못한다는 것과 등록비용이었고, 각각 46%와 42%였다. 19 %만이 가족과 떨어지는 것이 참여를 매우 어렵게 만든다고 하였다. 그러나 여성들은 남성보다 여성들이 이러한 프로그램에 참석하는 것에 대한 institutional 지원 부족이 참석하기 어려울 것이라고보고했다. 남성의 절반이 잠재적 장벽으로 제도적 지원이 부족한 반면, 71 %의 여성이 같은 수준의 난관을 보였습니다 (p = 0.008). 참여에 대한 다른 장벽은 모두 성별로 동일하게 평가되었습니다.

The greatest barriers to participation in faculty development programming are time away from work and tuition costs, with 46% and 42%, respectively, reporting that those would make it very or extremely difficult. Faculty surveyed generally did not consider time away from family to be a considerable barrier to such participation, as only 19% reported that it would make participation very or extremely difficult. However, women were more likely than men to report that lack of institutional support for attending these programs would make it difficult to attend. Half of men cited lack of institutional support as a potential barrier, whereas 71% of women reported the same level of difficulty (p = 0.008). All other barriers to participation were rated equally between genders.

교수진 개발 워크샵의 선호 형식을 설명하는 데있어 응답자는 짧은 세션 (3 주 미만)을 선호하고 73 %의 응답자가 하나의 긴 세션보다 두 개의 짧은 세션을 선호한다. 이 프로그램의 형식에 대한 선호도는 성별이나 연령에 따라 변하지 않았습니다. 응답자들은 미래 프로그램 (82 %)과 국제 연구 (77 %)가 가능한 참여를 매우 중요하게 고려한 것으로 나타났습니다.

In describing the preferred format of faculty development workshops, respondents prefer the idea of short sessions (less than 3 weeks), and two short sessions are preferred to one longer session by 73% of respondents. Preferences for the format of these programs did not vary based on gender or age. Respondents considered possible future collaborations (82%) and international study (77%) to be very or extremely important benefits to par- ticipation in such programs.

Discussion

응답자들은 의학 교육 분야에서 최고 수준의 경험을 갖고 있다고보고했으며, 이는 교수진 개발 워크숍의 목적에 가장 큰 관심을 끄는 주제입니다. 병원 관리 및 연구 분야에서 더 많은 경험을 가진 개인은 해당 분야의 교육 프로그램에 더 많은 관심을 가지고 있습니다. 흥미로운 질문이 제기됩니다. 

• 특정 주제 분야에서 고도로 숙련 된 교수진이 같은 지역에서 계속 교육을받는 것이 이익이됩니까? 

• 교수진이 충분한 훈련없이 광범위한 현장 경험을 쌓은 자리에 배치 되었습니까? 

• 경험이 많은 교수진은 기초 이상으로 배울 점이 더 많이 있음을 알고 있습니까? 아니면 실제 경험 수준을 과대 평가하고 있습니까? 

• 다른 한편으로, 적은 경험을 가진 교수진이 그 적자를 다루는 교수진 개발 기회를 찾도록 격려하는 것이 바람직할까요? 

• 그러나 특정 분야에서 경험이 부족한 교수진이 학교 활동에 참여하지 않는 경우, 그러한 교육은 시간 낭비입니까?

Respondents reported having the greatest levels of experience in Medical Education, and it is the topic of greatest interest for the purposes of a faculty development workshop. Individuals with a greater amount of experience in Hospital Management and Research have a greater interest in participating in educational programs in those areas. This raises interesting questions. 

• Are highly experienced faculty members in a given topic area going to benefit from continued training in the same area? 

• Have faculty members been placed in positions where they have gained extensive on-the-job experience without adequate training? 

• Do ‘‘experienced’’ faculty members realize how much more there is to learn beyond the basics? Or are they overestimating their true level of experience? 

• On the other hand, would it be preferable to encourage those faculty with less experience with a topic to seek faculty development opportunities addressing those deficits? 

• Yet if those faculty members with less experience in a given area are not going to be the ones participating in those activities at their schools, is such training a waste of time?

조사 보고서에 응답한 고위급 의학 교육자의 65 %가 해당 직책을 맡은 지 5년 미만이라고 지적하는 것은 가치가 있습니다. 이것 역시 흥미로운 질문을 제기합니다. 중국의 한 대학의 의료 센터에서의 리더십 위치에서의 이직은 지도자 및 교수진의 현재 간부가 적절하게 훈련되도록하기 위해 교수 개발 프로그램이 점점 필요하게 될 수 있습니다. 또한 한 번 제공되는 교수 개발 프로그램이 충분한 수의 교수진을 확보 할 수 있도록 매년 또는 반기마다 반복해야 할 수도 있음을 의미 할 수도 있습니다. 또한 이 설문 조사에서 5 ~ 10 년 내에이 설문 조사를 다시 실시하면 의견이 다를 수 있음을 의미 할 수도 있습니다.

It is worth noting that 65 percent of high-level medical educators who responded to the survey report being in their positions fewer than 5 years. This too raises some interesting questions. The turnover in positions of leadership in academic medical centers in China may be such that faculty development programs are increasingly necessary in order to keep the current cadre of leaders and faculty members adequately trained. It may also mean that faculty development programs offered once may need to be repeated annually or semi- annually to ensure they are covering sufficient numbers of faculty. It may also mean that the opinions expressed in this survey may be very different if we were to re-administer this survey in 5–10 years.

회의 참석자와 우편 발송 응답자의 차이점은 추가 검사가 필요합니다. 우편 그룹은 중화 인민 공화국의 의학 교육 교수로 구성되어 있으며 회의 그룹에는 홍콩과 대만의 교수가 포함되어 있지만 근본적인 차이점은 더 심해 보입니다. 연령대와 연령대가 비슷하지만 회의 참석자들은 이미 교육 및 경력 향상 이벤트에 참여하는 데있어 tuition cost가 감당할 수 있는 장애요인임을 입증했습니다. 컨퍼런스 그룹의 교수진은 컨퍼런스에 참석했기 때문에 다른가요 아니면 컨퍼런스가 다른 이유로 컨퍼런스에 참석합니까?

The differences in the conference attendees and the mailing respondents require addi- tional examination. While the mailing group is comprised entirely of medical education faculty in the People’s Republic of China, and the conference group also includes faculty from Hong Kong and Taiwan, the fundamental differences seem deeper. Those attending a conference, although they are similar in age and years in their positions, have already proven that tuition costs are a manageable barrier to participation in an educational and potentially career-boosting event. Are the faculty members in the conference group dif- ferent because they attend conferences, or do they attend conferences because they are different?

형식과 관련하여 응답자는 가능한 하나의 긴 세션보다 두 개의 짧은 세션과 같은 짧은 세션을 선호하는 것처럼 보입니다. Stancic et al.과 유사합니다. (2003), 이러한 프로그램의 형식에 대한 선호도는 성별이나 나이에 따라 변하지 않았다.

With regard to format, respondents appear to prefer short sessions, including two short sessions over one longer session if possible. Similar to Stancic et al. (2003), preferences for the format of these programs did not vary based on gender or age.

참여의 장벽은 예상했던 것만 큼 중요하지 않은 것처럼 보였다. 응답자의 42 %는 등록 비용이 문제라고 보고했으며 46 %는 시간을 중요한 장애물로 꼽았다. 설문 조사에 포함 된 다른 장애물 중 1 ~ 5 점은 평균 3.0을 초과했다. 그러나 여성들은 남성보다 교수 개발 프로그램 참여에 대한 제도적 지원이 적다. 이 발견은 우리 응답자의 1/4만이 여성이라는 점을 고려할 때 특히 주목할 가치가 있습니다. 종합하면, 중국의 의학 교육에서 리더십 직책을 맡고있는 여성들이 경력 향상을 향한 노력에서 unique 문제에 직면 할 수 있음을 알 수 있습니다.

The barriers to participation did not appear to be as significant as was anticipated. While 42% of respondents reported tuition costs as problematic and 46% cited time away from work as a significant barrier, none of the other barriers included in the survey exceeded a mean of 3.0 on a scale of 1 to 5. However, women perceived there to be less institutional support for participation in faculty development programs than men. This finding is especially noteworthy given that only one-quarter of our respondents were female. Taken together, this suggests that women in leadership positions in medical education in China may face unique issues in their efforts toward career advancement.

단점

Limitations

시사점

Implications

이 연구의 결과에 따르면 중국 및 주변 지역의 의과 교수가 동료와 함께 하는 development exercise에 관심이 있음이 분명합니다. 전반적으로, 우리 연구의 시니어 교수진은 젊고 야망이 많았으며 배우기를 열망했습니다. 그러나 그들이 현재 일하는 분야에서 관심이 가장 컸습니다. 시간, 비용, 여성에 대한 제도적 지원 부족과 같은 전통적인 교수 개발 워크숍에 참여하는 가장 큰 장벽은 교육 기관 내의 행정 구조를 목표로 삼아 극복 할 수 있습니다. 그러나 이러한 장벽은 의학 교육 리더들에게 동일한 유형의 정보와 경험을 제공하더라도 보다 효과적인 방법이 있는지에 대한 흥미로운 질문을 제기합니다

It is clear from the results of this study that medical faculty in China and surrounding areas are interested in pursuing development exercises with their colleagues. Overall, the senior faculty members in our study were young, ambitious, and eager to learn, but their interest was greatest in the areas in which they are currently working. The greatest barriers to participating in traditional faculty development workshops—time away from work, tuition costs, lack of institutional support for women—may be overcome by targeting the administrative structures within their home institutions. However, these barriers raise interesting questions about whether there might be a more effective way to deliver the same type of information and experiences for these leaders in medical education.

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Adv Health Sci Educ Theory Pract. 2009 Mar;14(1):91-102. doi: 10.1007/s10459-007-9093-z. Epub 2008 Feb 15.

International medical school faculty development: the results of a needs assessment survey among medical educators in China.

Guo Y1, Sippola E, Feng X, Dong Z, Wang D, Moyer CA, Stern DT.

Author information

1

Peking University Health Science Center, Beijing, People's Republic of China. Guoyan@bjmu.edu.cn

Abstract

To explore the need for faculty development among Chinese medical educators. Leaders at each medical school in China were asked to complete a 123-item survey to identify interest in various topics and barriers and perceived benefits of participating in faculty development programs. Interest levels were high for all topics. Experience with Hospital Management and Research positively correlated with interest in learning more (p < 0.001). Ninety-two percent believe that international experiences are very or extremely important to medical educators' career advancement. Chinese medical education faculty members have a strong interest in faculty development programs.

PMID:

 

18274879

 

DOI:

 

10.1007/s10459-007-9093-z

[Indexed for MEDLINE]