교수개발: 도착지가 아닌 여정 (Understanding Medical Education ch28)

교수개발: 도착지가 아닌 여정 (Understanding Medical Education ch28)

Developing Medical Educators A Journey, not a Destination 

Introduction

"Doctor"라는 말의 어원은 '가르친다to teach'이다. 그러나, 비록 대부분의 의사들이 그들이 가르치는 내용에 대해서는 전문가일지 몰라도, 어떻게 가르쳐야 하는가에 대해서는 거의 훈련받은 바가 없다. 그들은 또한 '의학교육자'라는 용어에 함축되고 있는 다양한 역할에 대해서도 거의 준비된 바 없다. Jason and Westberg 가 말한 바와 같이 '교수에게 가장 특징적인 단 하나의 과업task은 바로 교육teaching이다. 모든 다른 과업은 다른 세팅에서 추구할 수 있다. 그러나, 역설적이게도, 교수의 가장 중추적인 책무는 그들이 가장 덜 준비외어있는 부분이다.

The root of the word ‘ doctor ’ is to teach. However, although the majority of doctors are expert in what they teach, most have had little or no training in how to teach. (1) They are also minimally prepared for the many roles that are subsumed under the term medical educator. As Jason and Westberg (2) state, ‘ the one task that is distinctively related to being a faculty member is teaching; all other tasks can be pursued in other set- tings; and yet, paradoxically, the central responsibility of faculty members is typically the one for which they are least prepared ’

과거에는 학생의 경험을 수 년간 해본 충분히 똑똑한 사람이라면 누구나 성공적인 교수가 되는 방법을 배웠거나 혹은 자동적으로 배울 수 있다고 생각했고, 따라서 교수개발에 대한 서포트는 거의 없었다. 그러나 이는 더 이상 사실이 아니다. 점점 더, 최근 들어서, 다양한 규제기구에서 교육 혹은 교사에 대해서 인증을 하는 것에 관심을 기울이기 시작했다.

In the past, it was assumed that intelligent people who have been students for many years have learnt – or can automatically learn – to be successful faculty members, and little or no support for staff develop- ment was provided. (3) This is no longer true. Moreover, in recent years, a number of regulatory bodies have started to pay attention to the accreditation of teachers and teach- ing, (8,9)

의학교육자란 누구인가?

Who Is a Medical Educator?

의학교육 논문은 종종 '교사'혹은 '의학교육자'라는 단어를 상호교환적으로 사용하며, 명확하게 정의내리지 않는다. 이 용어는 다양한 개념을 포함한다.

The medical education literature tends to use the terms ‘ teacher ’ and ‘ medical educator ’ interchangeably, with no clear defi nitions. Defi nitions included a broad range of conceptualisa- tions, some of which are highlighted below:

의학교육자란 비판적으로 자신의 교육경험을 성찰하고 그들이 하는 것을 혁신 및 개선하고자 노력하는 사람이다.
The medical educator is someone who critically refl ects on the quality of the educational experience and tries to innovate and improve on what they have done.

의학교육자는 단순한 흥미 수준이 아니라 열정이 있어야 한다. 그리고 그 열정은 학생이나 학습자가 최고의 의사가 되게끔 발전할 수 있게 도와주는 의학교육자들을 위한 최선의 교육을 또는 최선의 교육을 이룰 수 있는 방법을 알려준다.

Medical educators have a passion, not just an interest, but a passion for bringing out the best, or fi nding ways to bring out the best, in students and learners that they work with to help develop the best physicians that we can …

의학교육자는 이론과 원칙을 행동에 적용하는 사람이다. 이는 교육/학자/교육과정설계/평가/연구 등을 포함한다.

A medical educator is someone who uses theories and principles of education in their activities. This includes teaching, scholarship, curricular design and evaluation, and research across the educational continuum …

이 정의에서 놀라운 것은 교육자로서 맡은 과업과 활동의 전 연속체상에 있어서 성찰/열정/혁신/informed practice의 중요성을 강조하는 것이다.

What is striking in these defi nitions is the emphasis on refl ection, passion, innovation and informed prac- tice across a continuum of tasks and activities.

의학교육자들은 교실에 있든, 임상현장에 있든, 자신의 경험과 가능한 근거를 자신의 교육행위에 적용하고, 미래 보건의료전문직의 교수-학습의 향상을 위하여 자신이 하는 일을 능동적으로 성찰하는 사람이다.

medical educators, whether in the clinical or classroom setting, will refer to individu- als who actively refl ect on what they do, using experi- ence and available evidence to inform their educational practice and to enhance the teaching and learning of future healthcare professionals:

 

교수개발이란 무엇인가?

What is Staff Development?

이 논문에서, 교수개발은 '교수의 다양한 역할을 renew or assist하기 위하여 기관이 활용하는 광범위한 활동'을 의미한다. 즉, 교수개발은 기관과 교수가 그들의 다양한 역할에 대해서 준비할 수 있도록, 교육/연구/행정 분야의 개인의 지식과 스킬을 향상시키기 위한 목적으로 계획된 프로그램이다.

In this paper, staff development will refer to that broad range of activities that institutions use to renew or assist faculty in their multiple roles. (14) That is, staff devel- opment is a planned programme designed to prepare institutions and faculty members for their various roles (15) and to improve an individual ’ s knowledge and skills in the areas of teaching, research and admin- istration. (16) The goal of staff development is to teach faculty members the skills relevant to their institu- tional and faculty position and to sustain their vitality, both now and in the future.

 

추가적으로, 교수개발은 조직변화 촉진을 위한 유용한 도구가 될 수 있다. 즉, 교수개발은 합의를 도출하고, 지지와 열정을 이끌어내며, 변화의 동력을 도입할 수 있다. 공식/비공식/잠재 교육과정을 바꿈으로써 기관 내의 문화를 변화시킬 수 있다.

In addition, staff development can serve as a useful instrument in the promotion of organisational change. (5,17) That is, staff development can help build consensus, generate support and enthusiasm, and implement a change initiative; it can also help change the culture within the institution by altering the formal, informal and hidden curriculum (18,19) and by enhanc- ing organisational capacities. (20)

다양한 방식으로, 교수개발은 개인과 조직 수준에서 중요한 역할을 한다.

In many ways, staff development can play an impor- tant role at both the individual and the organisational level. (22)

교수개발을 위한 교육과정?

A Curriculum for Staff Development?

효과적인 임상교육자의 특징과 행동

Attributes and behaviours of effective clinical teachers have been identifi ed in the literature. For example, Irby (23)

• 열정   enthusiasm
• 교육에 관한 긍정적 태도   a positive attitude towards teaching
• 학생과 환자와 라뽀   rapport with students and patients
• 접근가능성   availability and accessibility
• 임상역량   clinical competence
• 내용전문성   subject matter expertise.

핵심 교육 스킬 역시 밝혀진 바 있다.

A number of core teaching skills have also been identifi ed. These include:

• 긍정적 학습환경 조성   the establishment of a positive learning environ- ment
• 명확한 목표와 기대 설정   the setting of clear objectives and expectations
• 적절한 시간에 적합한 정보 제공   the provision of timely and relevant information
• 질문과 다른 교수법의 효과적 활용   the effective use of questioning and other instruc- tional methods
• 적절한 롤모델링   appropriate role modelling
• 건설적 피드백 제공   the provision of constructive feedback and objec- tive - based evaluations. (24)

Purcell and Lloyd - Jones 은 '많은 국가에 medical techer를 위한 다양한 교육자교육 프고그램이 있다. 그러나 '좋은 medical teaching'이란 무엇인가? 그것이 무엇인지 모르는 한, 어떻게 그걸 개발 할 수 있는가?'

As Purcell and Lloyd - Jones (11) state, ‘ in many coun-tries there is a plethora of teacher training programmes for medical teachers. But what is good medical teach- ing? Unless we know what it is, how can we develop it? ’

Bland 등은 성공적인 교수에게 필요한 스킬/목표 등을 다섯 가지 영역으로 정의하였다.

Bland et al. (15) defi ne an extensive set of essential skills, goals and objectives for successful medical faculty in fi ve domains:

• 교육   education
• 행정   administration
• 연구   research
• 문자 의사소통    written communication
• 전문 학술 스킬   professional academic skills.

교수의 역할 유형

Harris et al (3) presented a helpful overview of faculty members ’ roles, which include the following:

• 선생/행정가   teacher / administrator which encompasses chair, res- idency director or clinic director
• 선생/교육자   teacher / educator which includes director of educa- tion, pre - doctoral director or clerkship director
• 선생/연구자   teacher / researcher which comprises director of research or research faculty
• 선생/임상가   teacher / clinician which includes community precep- tor or clinical faculty.

명확하게, 비록 '근거-기반적' 태도의 배양을 교수개발 프로그램 개발의 지침guide로 삼아야 하지만, 레지던트와 교수의 인식이 언제나 일치하는 것은 아니다.  

Clearly, the perceptions of residents and faculty members are not always con- gruent, although an ‘ evidence - based ’ set of attitudes and behaviours should guide the development of staff development programmes.

 

또한 '의학교육자'라는 용어에 내재subsume되어있는 리더나 학자로서의 역할에 대해서는 서술된 것이 적다. Bordage 등은 교육과 리더십 스킬에 대해서 연구한 바 있다.

It should also be noted that much less has been written about the roles of educational leader and scholar roles that are often subsumed under the term ‘ medical educator ’ Bordage et al (27) surveyed the educational and leadership skills required of ‘ pro- gramme directors with major educational and leader- ship responsibilities ’

•    oral communication
•    interpersonal abilities
•    clinical competence
•    educational goal defi nition
•    educational design
•    problem solving and decision making
•    team building
•    written communication
•    budgeting and fi nancial management.

Scholarship의 네 가지 카테고리를 밝힌 바 있다.

Boyer (29) identifi es four categories of scholarship:

• 발견   discovery
• 통합   integration
• 적용   application
• 교육   teaching.

• 발견Discovery: 저널에 출판하고 연구비를 얻는 것. 전토적 의미에서의 연구와 같음
  peer - reviewed publications and grants are products of the scholarship of discovery which has been synonymous with research in the traditional sense.
• 통합Integration: 학문간 연결을 만드는 것, 자료를 revealing한 방법으로 사용하는 것
  The scholarship of integration has been defi ned as making connections across the disciplines, illuminating data in a revealing way,
• 적용Application: 한 분야의 지식을 봉사service에 사용하는 것. 이론을 실천에 적용하는 것. 의학교육에서는 펠로우십 프로그램 개발, 웹-기반 교육 자료 등이 통합과 적용의 사례이다.
  whereas the scholarship of application has been likened to ‘ service ’ in one ’ s own fi eld of knowledge, to the application of theory into practice. In medical education, fellowship programme devel- opment and web - based instructional materials are examples of the scholarship of integration and application
• 교육Teaching: 효과적으로 지식/스킬/신념을 의사소통하는 것. 더 나아가서 '교육'은 그것이 공공화되고, 동료의 review와 비판이 가능해지면 'scholarship'이 된다.
  The scholarship of teaching involves the capacity to effectively communicate one ’ s own knowledge, skills and beliefs. Moreover, teaching becomes scholarship when it is made public, is available for peer review and critique and can be reproduced and built on by other scholars. (31)

 

교사의 경험에 대해서 이해하는 것에 초점을 두는 것이 가치가 있을지도 모른다. Higgs and McAllister는 '임상 교육자의 경험'에 대해서 다음과 같이 연구했다.

it would also be worth focusing on a better understanding of the teacher ’ s experience. In an interesting study, Higgs and McAllister (32)  studied the  ‘ experience of being a clinical educator ’ 

• self에 대한 인식   a sense of self (or self - identity)
• 관계에 대한 인식   a sense of relationship with others
• 임상교육자로서의 인식   a sense of being a clinical educator
• 주체agency로서의 인식   a sense of agency, or purposeful action
• 역동적 자기-일치self-congruence의 추구   seeking dynamic self - congruence
• 성장과 변화의 경험   the experience of growth and change.

나의 의학교육자로서의 자부심은 내 학생의 눈에 빛이 켜지는 것을 볼 때, 그리고 그 빛이 왜 없어지는지를 알 때 생긴다.

My pride as a medical educator comes from watching the light go on in my students ’ eyes and knowing why the light goes off … (12)

주니어 동료들이 진료에 우수한 모습을 보일 때, 훌륭하게 했을 때, 내가 무언가 영향을 주었구나 라는걸 깨닫게 된다.

When I see junior colleagues work and demonstrate excellence in patient care, going the extra mile … I know that I have had an impact. (12)

어떻게 의학교육자를 키울 수 있을까?

How Can We Develop Medical Educators? 

의학교육자 양성을 위한 '공식적' 접근법 

‘ Formal ’ approaches to developing medical educators

워크숍, 세미나, 단기코스

Workshop, seminars and short courses

지금까지 대부분의 교수개발 프로그램은 교육향상에 초점을 두었다. 즉, 교사의 임상교육, 소그룹촉진, 피드백, 평가 등에 초점을 둔 것이다. 

To date, the majority of staff development pro- grammes have focused on teaching improvement. That is, they aim to improve teachers ’ skills in clinical teaching, small group facilitation, feedback and evalu- ation. (34)

보건의료전문직으로서, 교육리더로서, 연구자로서의 개인 수준의 발달이나 조직개발과 변화에 관해서는 관심을 덜 가져왔다.

Less attention has been paid to the personal development of health- care professionals, educational leadership and scholar- ship, and organisational development and change.

Cusimano and David 가 기술한 바와 같이, 더 많은 보건의료전문직이 타인을 교육하는 방법에 대해서 배움으로서, 의학교육이 지속적으로 변화의 원동력에 responsive할 수 있을 것이다.

As Cusimano and David (45) state, there is an enormous need for more healthcare professionals trained in methods of educating others so that medical education will continue to be responsive to driving forces of change.

펠로우십과 다른 종단 프로그램

Fellowships and other longitudinal programmes

다양한 길이와 형태의 펠로우십이 있으며, 여러 분야에서 활용되어 왔다. 더 최근에는 통합적 종단 프로그램이 개발되어 펠로우십 프로그램의 대안으로 활용되고 있다.

Fellowships of varying length, format and emphasis have been utilised in many disciplines. (46 – 48) More recently, integrated, longitudinal programmes have been developed as an alternative to fellowship pro- grammes or sabbaticals.

요약하면, 비록 펠로우십이나 종단 프로그램이 구조/길이/내용 등에서 다양하지만, 모두 교육의 전문성과 수월성 습득, 교육과정 설계와 평가, 교육리더십 등을 목표로 한다. 이들 중 많은 수에서 학문적 개발과 커리어 개발을 돕는 것도 목표로 하며, 교사와 교육자의 커뮤니티 생성을 돕고자 한다. 추가로, 새로운 지식과 이해의 전파를 장려하고자 한다.

In summary, although fellowship and other longitu- dinal programmes vary in structure, duration and content, they all enable the acquisition of expertise and excellence in teaching, curricular design and evalua- tion, and educational leadership. Many of them also provide assistance in academic and career develop- ment (53,54) and help create a community of teachers and educators. In addition, they encourage the dis- semination of new knowledge and understanding to further the fi eld of medical education.

학위 프로그램

Degree programmes

여러가지 세팅에서 점차 인증/학위 프로그램이 퍼지고 있다. 이러한 것을 어떤 연구자들은 의학교육의 'professionalization'이라 불렀다.

Certifi cate or degree programmes are becoming increasingly popular in many settings. In part, this is due to what some authors have termed the ‘ profes- sionalisation ’ of medical education. (10,11) 

여러 저자들이 의학교육자들을 certify할 것과, 이를 통해 글로벌 스탠다드를 준수ensure할 것을 주장하고 있다.

Several authors have argued for the need to certify medical educators and thereby ensure global standards;

( see Box 28.1 ).

또 다른 의학교육 석사학위 관련  리뷰를 보면, 내용과 프로그램의 퀄리티가 다양하다는 것을 보여주면서, 기준을 높이고 quality assurance가 필요함을 주장하였다.

Another review of Master ’ s degrees in medical education was conducted by Pugsley et al ., (58) who commented on the variabil- ity in content and quality among these programmes and argued for increased standards and the need for quality assurance.

 

동료 코칭

Peer coaching

동료 코칭의 핵심 요소는

Key elements of peer coaching include

• 개인의 학습목표를 밝히는 것 the identifi ca- tion of individual learning goals (e.g. improving spe- cifi c teaching skills),
• 동료에 의한 교육을 관찰하는 것에 초점 focused observation of teaching by colleagues, and
• 피드백 제공, 분석, 지지 the provision of feedback, analysis and support. (60)

종종 co - teaching  or  peer observation 이라고도 불리며, 이는 교육자가 실제 진료하는 환경에서 이뤄지기 때문에 학습을 개별화individualize할 수 있으며, 협력을 촉진한다.

some-times called  co - teaching  or  peer observation , has particu-lar appeal because it occurs in the teacher ’ s own practice setting, enables individualised learning and fosters collaboration. (61)

의학교육자 양성을 위한 '비공식적' 접근법

‘ Informal ’ approaches to developing medical educators 

비록 교수개발 프로그램이 의학교육자를 개발하기 위해 널리 사용되는 방법이지만, 여러 대안도 있다.

Although staff development programmes are a popular way of developing medical educators, a number of alternative approaches should also be con- sidered.

근무지 기반 학습

Work - based learning

근무지 기반 학습은, learning for work, learning at work and learning from work로서 정의되며, 종종 'learning on the job'이 교육에 처음 참여하는 시점이 되는 교수(의학교육자)들을 개발하는데 토대가 된다.

Work - based learning, often defi ned as learning for work, learning at work and learning from work, (21) is fundamental to the development of medical educators, for whom ‘ learning on the job ’ is often the fi rst entry into teaching and education.

따라서 의학교육자들이 일상의 경험을 '학습 경험'으로 인식하고, 동료 및 학생과 함께 성찰을 장려하는 것은 매우 가치있는 일이다.

It would therefore be extremely worthwhile to help medical educators see their every- day experiences as ‘ learning experiences ’ and encour- age them to reflect with colleagues and students

교수개발활동이 전통적으로 교육자의 근무지에서 벗어나서 진행되었다는 사실은 흥미로운데, 왜냐하면 이러한 경우 학습자는 배운내용을 다시 자신의 맥락에 가지고 돌아가야 하기 때문이다. 아마 이제는 이러한 전통을 뒤집어서 어떻게 근무지에서 일어나는 학습을 강화할 수 있을지를 고민해야 할 시기이다.

It is interesting that staff development activities have traditionally been conducted away from the educator ’ s workplace, requiring participants to take their ‘ lessons learnt ’ back to their own contexts. Perhaps it is time to reverse this tradition and think about how we can enhance the learning that takes place in the work environment. (62) 

실천공동체

Communities of practice

Barab 등은 실천공동체를 다음과 같이 정의했다.

Barab et al (64) defi ne a community of practice as a

‘ persistent, sustaining, social network of individuals who share and develop an overlapping knowledge base, set of beliefs, values, history and experiences focused on a common practice and/or mutual enter- prise ’

Lave and Wenger 는 실천공동체의 성공은 다음의 다섯 가지에 달려있다고 했다.

Lave and Wenger (63) suggest that the success of a community of practice depends on fi ve factors:

• 공동의 목표의 존재와 공유    the existence and sharing by the community of a common goal
• 그 목표를 달성하기 위한 지식의 존재와 활용   the existence and use of knowledge to achieve that goal
• 커뮤니티 구성원과의 관계의 특성과 중요도   the nature and importance of relationships formed among community members
• 커뮤니티와 커뮤니티 밖의 관계   the relationships between the community and those outside it
• 커뮤니티가 하는 일과 그 일의 가치의 관계   the relationship between the work of the commu- nity and the value of the activity.

실천공동체 배양하기

BOX 28.3 Focus on: Cultivating communities of practice

• 진화를 위한 설계   Design for evolution
• 내부자적 관점과 외부자적 관점의 상호대화   Open a dialogue between insider and outsider perspectives
• 다양한 수준의 참여   Invite different levels of participation
• 공공적 공간과 개인적 공간의 개발   Develop both public and private community spaces
• 가치에 초점을 두기    Focus on value
• 친숙함과 흥미로움을 합하기   Combine familiarity and excitement
• 리듬을 형성하기   Create a rhythm for the community

멘토십과 롤모델링

Mentorship and role modelling

멘토링은 교수들의 발달/사회화/성숙을 촉진하기 위해 흔히 사용되는 전략이다. Daloz는 멘토십 모델을 묘사하며, 세 가지 요소가 중요하다고 했다: 지지support, 도전challange, 개인의 커리어에 관한 비전

Mentoring is a common strategy to promote the development, socialisation and maturation of aca- demic medical faculty. (15,70) Daloz (73) describes a men- torship model that balances three key elements: support, challenge and a vision of the individual ’ s future career.

반면, 롤모델링은 (비록 그렇게 인식되고 있지는 않지만) 모든 교육자들의 역할의 발달의 수단이다.

Role modelling, on the other hand, is instrumental in the development of all medical educators ’ roles, although it is not usually recognised as such.

롤모델을 통해서 배운다는 것은 관찰과 성찰을 통해서 이뤄지는 것이며, 의식과 무의식적 활동이 복합적으로 섞여있는 것이다. 우리 모두는 관찰된 행동의 의식적 관찰에 대해서 알고 있으며, 효과적인 롤모델링에 무의식적 요소의 힘이 있음을 이해하고 있다. 우리는 롤모델은 멘토와 다르다는 것을 기억해야 한다. 롤모델은 사례를 제시하며 - 종종 다른 일을 하는 경우에도 - inspire and teach하는 것이며, 멘토는 동료colleague와 명시적 관계를 장기간 유지한다.

 Learning from role models occurs through observa-tion and refl ection and is a complex mix of conscious and unconscious activities. (74)  While we are all aware of the conscious observation of observed behaviours, understanding the power of the unconscious compo-nent is essential to effective role modelling. We should also remember that role models differ from mentors. (75)  Role models inspire and teach by example  –  often while they are doing other things; mentors have an explicit relationship with a colleague over time. (76)  

조직적 지원과 조직개발

Organisational support and development

 

교수들의 교수개발에 대한 요구설문을 보면, 교수개발을 ‘ development, orientation  and/or  support ’의 관점으로 바라볼 필요성을 강조한다. 흥미롭게도, 대부분의 프로그램은 '발달development'부분에 초점을 두고 있다. orientation이나 support에 초점을 두는 프로그램은 훨씬 적다.

 A recent survey of faculty members ’  needs for faculty development (77)  highlights the necessity to look at staff development as  ‘ development, orientation  and/or  support ’ . Interestingly, most programmes focus on the ‘ development ’ part. Much less has been written about faculty orientation and/or support.

의학교육자들에 대한 서포트는 다양한 형태를 가질 수 있다.

Support for medical educators can take different forms, including

• managerial and organisational sup- port,
• provision of information,
• recognition of teaching excellence and
• consideration of educational scholar- ship in promotion and tenure.

 

 

또한 다음과 같은 것도 있다.

Organisational support also includes:

•    the development of institutional policies that support and reward excellence in teaching (10)
•    a re - examination of the criteria for academic promotion and increased credit for educational initiatives (80)
•    an increase in training and mentoring programmes
•    enhanced resources for training teachers and junior faculty members.

교수개발의 효과에 대해서 알려진 것은?

What Is Known about Effectiveness?

 

다음과 같은 향상

Teachers also report

• a positive change in attitudes towards teaching as well as
• self - reported changes in knowledge about educational principles and specifi c teaching behaviours.

 

그 외에도 이러한 향상.

(34) Other benefi ts include

• increased personal interest and enthu- siasm,
• improved self - confi dence,
• a greater sense of belonging to a community, and
• educational leadership and innovation.

 

우리 세팅에서, 교수개발에 참여한 사람들은 비슷한 생각을 가진 동료를 만나는 것의 가치를 언급했고, 교육에 관한 헌신과 열정이 새로워졌다고 했다.

In our setting, participants in staff development activities have commented on the value of meeting like - minded colleagues and feeling a renewed sense of commitment and enthusiasm about teaching.

다른 사람들은 직관적으로 하던 것들에 대해 개념적 프레임워크의 가치를 알게 되었다.

Others have identifi ed the value of conceptual frameworks for what they do intuitively,

BEME

In 2006, as part of the Best Evidence in Medical Education (BEME) collaboration,

구체적으로, 교수개발 프로그램의 방법으로는..

More specifi cally, methods to evaluate staff development programmes have included:

• 종료 후 평가    end - of - session evaluations
• 후속 평가    follow - up survey questionnaires
• 사전-사후 검사   pre - and post - assessments of cognitive or attitudinal change
• 교육행동의 직접관찰   direct observations of teaching behaviour
• 학생 평가   student evaluations
• 교수들의 자기평가   faculty self - ratings of post - training performance.

흔히 겪는 문제로는

Common problems have included:

• 통제/비교집단 없음    lack of control or comparison groups
• 자기보고식 변화에 지나친 의존   heavy reliance on self - report measures of change
• 작은 표본 크기   small sample sizes.

어떤 이론적 프레임워크가 의학교육자들의 발달을 guide해줄 수 있을까?

What Theoretical Frameworks Can Guide the Development of Medical Educators? 

 

In fact, despite an emphasis on educational ‘ know how ’ and practice, theory is noticeably absent from the staff development literature. a number of educa- tional theories can be applied to faculty development and the development of medical educators. however, situated learning (83) appears to be one of the most useful overarching frameworks. Knowles ’ principles of adult learning (84,85) and Kolb ’ s experiential learning cycle (86) are also pertinent,

상황 학습

Situated learning 

상황학습은 지식은 맥락에 situated하며, 근본적으로 행동은 맥락과 문화에 영향을 받는다는 인식에 기반한다. 이렇게 지식이 실제적 맥락에 situated한다는 관점은 교수개발을 이해하고 교수들을 위한 교육활동의 설계와 전달에 중요한 함의를 갖는다.

Situated learning is based on the notion that knowl- edge is contextually situated and fundamentally infl u- enced by the activity context and culture in which it is used. (83) This view of knowledge as situated in authen- tic contexts has important implications for our under- standing of staff development and the design and delivery of instructional activities for faculty members.

상황학습이론은 새로운 행동의 습득을 촉진하는데 cognitive base와 경험학습이 함께 필요하다고 본다. 이는 교수-학습에서 authentic activity를 통한 학습활동을 하게 하여, 'know what'과 'know how' 사이의 간극을 좁히는 것이다. 이는 지식을 추상적/이론적인 것에서 사용가능하고 유용한 형태로 변환하는 것을 도와준다. 상황학습을 지지하는 사람들은 teaching of a subject와 배운 지식이 authentic context에서 사용되게 하는 활동의 균형이 필요하다고 한다. 이 두가지는 교수개발에 모두 필수적이다.

Situated learning theory brings together the cogni- tive base and experiential learning that is needed to facilitate the acquisition of new behaviours. That is, it bridges the gap between the ‘ know what ’ and the ‘ know how ’ of teaching and learning by embedding learning in authentic activities. It also helps transform knowledge from the abstract and theoretical to the useable and useful. (87) The proponents of situated learning suggest that there should be a balance between the explicit teaching of a subject and the activities in which the knowledge learnt is used in an authentic context – both essential principles in staff development.

상황학습의 중요 요소들 

Some of the key components of situated learning include:

• 인지적 도제교육   cognitive apprenticeship
• 협력적 학습   collaborative learning
• 성찰   reflection
• 실천   practice
• 학습스킬의 표현   articulation of learning skills. (88)

인지적 도제교육Cognitive apprenticeship은  상황학습의 근본적 요소로서, 교수개발에 특별한 관련성이 있다. 도제교육은 의학에서 친숙하고 널리 사용되어 온 방법이었다. 인지적 도제교육은 전통적인 방식과 차이가 있는데, 학습하게 될 과제를 수행하는 프로세스가 늘 관찰가능하지는 않기 때문이다. 모든 학습이 근무지에서 일어나지는 않으며, 새로운 상황에 대해서 스킬의 전이가 요구된다. 따라서 '전통적 도제교육'을 '인지적 도제교육'으로 변환하려면, 교사는...

Cognitive apprenticeship , a fundamental element of situated learning, has particular relevance to staff development. Apprenticeship is a familiar and per- vasive method of learning in medicine. (89) Cognitive apprenticeship differs from a more traditional approach in that the process of carrying out the task that is to be learnt is not always observable; learning is not always situated in the workplace; and transfer of skills to new situations is required. Thus, to translate the model of traditional apprenticeship to cognitive apprenticeship, teachers need to:

• 과제의 프로세스를 밝히고, 그것을 학생에게 관찰가능하고 명확하게 만들어준다.   
  identify the processes of the task and make them visible, or explicit, to the student
• 추상적 과제를 authentic context에 놓이게 하여, 학생들이 그것이 직무와 어떤 관련이 있는지 이해하게 한다.  
  situate abstract tasks in authentic contexts, so that students understand the relevance of the work
• 학습 상황을 다양하게 한다.
     vary the diversity of learning situations
• 공통적 측면을 설명해줌으로써 새로운 지식과 학습을 새로운 상황에 전이transfer할 수 있게 한다.
     articulate common aspects so that students can transfer their new knowledge and learning to new situations. (89)

인지적 도제교육은 네 가지 phase로 구성된다.

Cognitive apprenticeship consists of four distinct phases:

• modelling,
• scaffolding,
• fading and
• coaching. (Further details about cognitive apprenticeship can be found in Box 5.1 ).

협력적 학습Collaborative learning은 상황학습과 인지적 도제교육의 또 다른 중요한 특징이다. 다음과 같은 전략이 필요함

Collaborative learning is another important feature of situated learning and cognitive apprenticeship. Brown et al (83) identify the following strategies to promote collaborative learning:

•    collective problem solving
•    displaying and identifying multiple roles
•    confronting ineffective strategies and miscon- ceptions
•    developing collaborative work skills.

소그룹학습, 피어티칭, 그룹프로젝트 등이 협력적 스킬 습득을 촉진시켜준다. 팀워크가 보건의료에 있어서 근본적 요소이므로, 협력적 학습은 필수적이다.

Small group work, peer teaching and group projects can also facilitate the acquisition of collaborative skills. As teamwork is a fundamental component of health- care delivery, collaborative learning is essential in staff development.

성찰Reflection은 상황학습의 중요한 ingredient이며, 점차 많은 관심을 받고 있다. 현실에서 세 가지 종류의 성찰활동이 있다.

Reflection an essential ingredient of situated learn- ing, has received increasing attention in the medical literature. (90) In practice, there are three kinds of refl ective activity.

• Sch ö n (90) describes a spontaneous reaction (i.e. ‘ thinking on your feet ’ ) as ‘ refl ection in action ’ This type of refl ection, which is frequently described as a subliminal process of which the partici- pant is only partially aware, most likely involves pattern recognition; as well, it is usually triggered by recognition that ‘ something doesn ’ t seem right ’ (90,91)
• Thinking of a situation after it has happened and ini- tiating the ability to re - evaluate the situation is referred to as ‘ refl ection on action ’ This type of refl ection, in which the participant is fully aware of what has occurred, allows the participant to mentally recon- struct the experience, paying particular attention to context. Refl ection on action also forms a bridge between the re - lived situation and knowledge retrieved from internal memory or other external sources. (91)

• '행동을 위한 성찰' : 다음 단계를 위한 계획.
  While the development of the capacity to refl ect ‘ in ’ and ‘ on ’ action has become an important feature of medical practice, ‘ refl ection for action ’ (92) forms an additional avenue for professional training and improvement of practice, as it involves planning for the next step.

 

Lachman and Pawlina 이 말한 바와 같이, '성찰적 실천에서 오는 장점은, 새로운 혹은 개정된 교육과정의 목표를 달성하는 동시에, 교육과정의 구조construct를 넘어서까지 이어진다는 것이다. 성찰의 프로세스와 그 기초가 되는 비판적사고는 이론적 개념을 실천에 통합시키고, 경험을 통한 학습을 높여주고, 복잡한 상황에서 비판적 사고와 판단을 도와주고, 학생-중심적 학습이 일어나게 해준다.'

As Lachman and Pawlina (92) have observed, ‘ The benefi ts of refl ective practice, whilst meeting the objectives of new and revised curricula, extend beyond the construct of a medical curriculum. The process of refl ection and its basis of critical think- ing allows for the integration of theoretical concepts into practice, increased learning through experience, enhanced critical thinking and judgment in complex situations and the encouragement of student - centred learning. ’ Clearly, all of these benefi ts are of vital importance in the development of medical educators.

연습Practice 는 상황학습의 또 다른 중요 요소이다. 반복적인 연습은 협력과 성찰의 사회적 맥락에서 증가하는 전문성의 web 으로 스킬을 정제하고 확장하고 검증하게 해준다. 또한 스킬이 깊이 rooted 되게 해줘서 필요시 '자동적으로' 불러올 수 있게 해준다. 경험학습은 '연습'의 개념과 밀접하게 맞닿아 있다.

Practice is another central component of situated learning. Repeated practice serves to test, refi ne and extend skills into a web of increasing expertise in a social context of collaboration and refl ection. (88) It also enables skills to become deeply rooted and ‘ automati- cally ’ mobilised as needed. The notion of experiential learning is closely tied to the concept of practice.

 

설명하기Articulation은 두 가지 측면이 있다.

Articulation includes two aspects. (88)

• First, it refers to the concept of articulating or separating out differ- ent component skills in order to learn them more effec- tively. An example of this is effective communication with peers.
• Second, articulation refers to the goal of getting individuals to articulate their knowledge, rea- soning or problem - solving processes in a specific domain.

문제해결과정을 설명해봄으로써, 학습자는 자신의 사고과정을 더 잘 이해할 수 있다. 또한 무언가를 자신과 다른사람에게 더 잘 설명할 수 있다. 설명하기는 학습과 성찰을 보여지게visible 한다.

By articulating problem - solving processes, learners come to better understand their thinking proc- esses, and they are better able to explain things to themselves and to others. Articulation also helps to make learning – and refl ection – visible.

요약하면, 상황학습은 지식은 맥락적으로 놓여지며contextually situated, 기본적으로 활동activity, 맥락context, 문화culture에 영향을 받는다는 개념에 기반한다.

In summary, situated learning is based on the idea that knowledge is contextually situated and funda- mentally infl uenced by the activity, context and culture in which it is used.

상황학습과 밀접하게 연관된 것은 'legitimate peripheral participation'이라는 개념이다. social practice는 learning by doing과 도제식학습apprenticeship을 합해서 하나의 이론적 관점으로 만든 것으로, 초심자가 전문가가 되는 과정이라고 할 수 있다. 즉, 상황학습적 관점에서, 학습자는 자신이 일부분이 되어서 참여하는 커뮤니티에 점차적으로 참여도가 높아지면서  새로운 지식과 이해를 쌓게 된다. 학습자로서, 그들은 커뮤니티의 주변부periphery에서 시작하는데(왜냐하면 초기에는 '학습자'의 지위에 있기 때문에), 이를 legitimate peripheral participation이라고 한다.

Closely tied to the notion of situated learning is the concept of ‘ legitimate peripheral participation ’ (63) This social practice, which combines ‘ learning by doing ’ (also known as experiential learning) and apprenticeship into a single theoretical perspective, is the process by which a novice becomes an expert. That is, from a situated learning perspective, learners build new knowledge and understanding through gradual participation in the community of which they are becoming a part. As learners, they begin at the edge – or periphery – of the community, where because of their status as learners, they have what is called ‘ legiti- mate peripheral participation ’ (93)

많은 경우, 교사들도 비슷한 과정을 겪는다. 교사들이 커뮤니티에 참여하게되는 핵심 요소는 어떻게 지식이 구조화되는지를 이해하고 문제를 구조화하는데 참여할 기회를 갖게 되는 것이다. Wenger에 따르면, 사회적 참여는 비공식 학습의 핵심이다.

In many ways, teachers go though a similar process. A key element of participation in the community is the opportunity to see and participate in the framing of problems and understand how knowledge is struc- tured. According to Wenger, (65) social participation within the community is the key to informal learning.

성인학습의 원칙

Principles of adult learning 

 

비록 일부 사람들은 성인학습은 이론이 아니라 단순히 성인학습자에 대한 묘사라고 보기도 하나, 다른 사람들은 성인학습의 원칙(andragogy)가 중요한 이론적 construct을 구성한다고 본다.

Although some have argued that adult learning is not a theory (94) but merely a description of the adult learner others believe that the principles of adult learning (also referred to as andragogy) form an important theoretical construct. (95)

Knowles 는 andragogy란 용어를 처음 사용했으며, 이를 '성인의 학습을 도와주는 art and science'라고 했다. 핵심 원칙은 다음과 같다.

Knowles (84,85) coined the term andragogy, defi ning it as ‘ the art and science of helping adults learn ’ Key principles include the following:

•    Adults are independent.
•    Adults come to learning situations with a variety of motivations and definite expectations about particu- lar learning goals and teaching methods.
•    Adults demonstrate different learning styles.
•    Much of adult learning is ‘ relearning ’ rather than new learning.
•    Adult learning often involves changes in attitudes as well as skills.
•    Most adults prefer to learn through experience.
•    Incentives for adult learning usually come from within the individual.
•    Feedback is usually more important than tests and evaluations.

경험학습 사이클

The experiential learning cycle 

Kolb and Fry 는 학습사이클을 묘사하면서, 학습 프로세스에서 경험의 역할을 강조하였다. 이 모델은 모든 교육사건의 설계에서 고려되어야 할 필요가 있으며, 학습은 네 단계로 이뤄진 사이클이다.

• 즉각적인 구체적 경험이 관찰과 성찰의 토대가 된다.

• 이후 관찰은 동화assimilate되어서 개개인의 이론이 되며,

• 이 이론은 어떻게 행동해야 할 것인가에 대해서 새로운 함의를 주고,

• 이 모든 단계는 궁극적으로 새로운 경험을 갖게 해준다.

Kolb and Fry에 따르면, 학습자는 학습사이클의 각 단계를 경험할 기회가 있어야 한다. 즉, 이들은 다음의 능력이 필요하다. 

Kolb and Fry (86) provide a description of the learning cycle that highlights the role of experience in the learn- ing process.  In this model, which should be considered in the design of all instructional events, learning is viewed as a four - stage cycle ( see  Figure  2.2 ). Immediate concrete experience is the basis for observation and refl ection; observations are then assimilated into a personal theory, from which new implications for action can be deduced, and all of these steps eventually lead to new experiences. According to Kolb and Fry, (86)  learners need opportunities to experience each step of the learning cycle. That is, they need the ability to:

• 다양한 상황을 경험함   experience diverse situations (in both the classroom and the clinical setting)
• 배운 것을 관찰하고 성찰함   observe and refl ect on what they have learnt (often in a large group session)
• 스스로 이론을 개발하고 세계를 이해함   develop their own theory and understanding of the world
• 새로운 방식을 실험함   experiment new ways of being in order for learning to occur.

교수개발 프로그램을 어떻게 설계해야 하는가?

How Should We Design a Staff Development Programme?

조직문화를 이해하기

Understand the organisational culture 

Staff development programmes take place within the context of a specifi c institution or organisation. It is imperative to understand the culture of that institution and to be responsive to its needs.

• 조직의 강점, 리더/리더십
  Staff development programmes should also capitalise on the organisa- tion ’ s strengths and work with the leadership to ensure success.
• 문화적 맥락
  In many ways, the cultural context can be used to promote or enhance staff development efforts.
• '교육과정 개편의 시기에 교수개발은 중요성이 더해진다'
  For example, as some authors have suggested, ‘ staff development during times of educational or curricular reform can take on added importance ’ . (97)
• 기관 차원의 지원, 활용가능한 자원, 효과적인 로비
  It is also important to assess institutional support for staff development activities, ascertain available resources and lobby effectively.

 

교수개발은 혼자서 일어나는게 아니다.

Clearly, staff development cannot occur in a vacuum. (13)

적절한 목표와 우선순위 결정하기

Determine appropriate goals and priorities 

As with the design of any programme, it is imperative to define goals and priorities carefully.

 

우리가 무엇을 달성하고자 하며, 왜 그것이 중요한가?
What are we trying to achieve – and why is it important to do so?

프로그램 목표 설정, 프로그램의 선택, 내용과 방법의 선택

It is equally important to determine programme objec- tives as they will infl uence our target audience, choice of programme, overall content and methodology.

 

우선순위를 정하는 것은 언제나 쉬운 것은 아니며, 종종 핵심 이해관계자와의 상의가 필요하다. 그러나 언제나 조직의 요구와 개인의 요구의 균형을 잡아야 한다.

Determining priorities is not always easy, and it often involves consultations with key stakeholders. However, it is always essential to balance individual and organisational needs.

관련성을 담보하기 위한 요구사정 수행

Conduct needs assessments to ensure relevant programming

요구사정을 위해서 흔히 사용되는 방법으로는..

It is also a way of promoting early ‘ buy - in ’ Common methods include:

• 설문   written questionnaires or surveys
• 인터뷰   interviews or focus groups with key informants (e.g. participants, students, educational leaders)
• 교사 행동 관찰   observations of teachers ‘ in action ’
• 문헌 고찰   literature reviews
• 활용가능한 프로그램과 자원과 같은 환경 탐색   environmental scans of available programmes and resources. (98,99)

다양한 출처로부터 정보를 수집해야 한다. 'needs' 와 'wants' 를 잘 구분해야 한다. 명확하게, 개개 교수의 관점은 학생이나 동료의 관점과 다를 수 있다.

Whenever possible, we should try to gain informa- tion from multiple sources and distinguish between ‘ needs ’ and ‘ wants ’ Clearly, an individual teacher ’ s perceived needs may differ from those expressed by their students or peers.

다양한 요구를 수용하기 위한 다양한 프로그램 개발

Develop different programmes to accommodate diverse needs

• 목표가 강의법 스킬 향상이라면..
  For example, if our goal is to improve our colleagues ’ lecturing skills, a half - day workshop on interactive lecturing might be the programme of choice.
• 교육리더십과 학자로서의 활동을 향상시키려면..
  On the other hand, if we wish to promote educational leadership and scholarly activ- ity among our peers, a teaching scholar programme or educational fellowship might be the preferred method. (13)

이 맥락에서, 교수개발은 development, orientation, recognition and support을 포함함을 기억해두는 것이 좋다. 다양한 목적을 위해서는 다양한 프로그램이 필요하다.

In this context, it is also helpful to remem- ber that staff development can include development, orientation, recognition and support, and different programmes are required to accommodate diverse objectives.

성인학습의 원칙과 Instructional design의 원칙을 활용하기

Incorporate principles of adult learning and instructional design

 

Principles of instructional design should also be fol- lowed. For example, it is important to

• develop clear learning goals and objectives,
• identify key content areas,
• design appropriate teaching and learning strate- gies, and
• create appropriate methods of evaluation of both the students and the curriculum.

 

It is equally important to

• integrate theory with practice (100) and to 
• ensure that the learning is perceived as relevant to the work setting and to the profession.

 

Learning should be

• interactive,
• participatory and
• experientially based, using the participants ’ previous learning and experi- ence as a starting point.

 

구체적인 기획과 구성에 모든 이해관계자를 포함함으로써 긍정적인 학습환경을 조성할 수 있다. 또한 이론으로부터 실천에 필요한 정보를 얻어야 한다. 교수개발이니셔티브는 반드시 (업무와) 관련성이 있어야 하고 실용적이어야 한다.

Detailed planning and organi- sation involving all stakeholders is critical, as is the creation of a positive learning environment. However, although theory should inform practice, staff develop- ment initiatives must remain relevant and practical ( see Box 28.5 ).

 

다양한 교수법 활용하기

Offer a diversity of educational methods 

경험학습/성찰/피드백/즉각적 적용을 촉진하기 위한 다양한 교육방법을 시도해야 함

In line with principles of adult learning, staff develop-ment programmes should try to offer a variety of edu- cational methods that promote experiential learning, reflection, feedback and immediacy of application.

 

흔한 학습방법

Common learning methods include interactive

• lec- tures,
• case presentations,
• small group discussions and individual exercises,
• role - plays and simulations,
• videotape reviews and
• live demonstrations.

 

피드백 주기도 핵심이다.

Practice with feedback is also key, as is the opportunity to refl ect on personal values and attitudes.

 

 

추가적 방법

• Computer - aided instruction,
• debates and reaction panels,
• journal clubs and
• self - directed readings are additional methods to consider.

 

워크숍에 들어갈 수 있는 것

In line with our previous example, a work- shop on interactive lecturing might include

• interactive plenary presentations,
• small group discussions and exercises, and
• opportunities for practice and feedback.

 

펠로우십 프로그램에 들어갈 수 있는 것

A fellowship programme might include group

• semi- nars,
• independent projects and
• structured readings.

 

방법이 무엇이든, 학습자의 니즈와 학습선호가 존중되어야 하며, 방법은 목적에 부합해야 한다. 보건의료전문직은 'by doing'을 통해 가장 잘 학습하며, 경험학습이 가능하다면 늘 장려되어야 한다.

Whatever the method, the needs and learning prefer- ences of the participants should be respected, and the method should match the objective. Healthcare profes- sionals learn best ‘ by doing ’ and experiential learning should be promoted whenever possible. (13)

교수들의 동의buy-in를 얻고, 효과적으로 마케팅하기

Promote buy - in and market effectively 

교수개발프로그램에 참여한다는 결정은 보이는 것처럼 단순하지 않다. 여기에 관련되는 것으로는 제공되는 프로그램에 대한 반응, 특정 기술을 개발하고 향상시키려는 동기, 그 세션에 시간이 가능함, 심리적 장벽의 극복 등이 있다. 교수개발자로서, 우리의 과제는 이러한 reluctance를 극복하고, 우리의 '제품'을 "저항이 학습의 원천으로 바뀌는 방식"으로 팔아야 한다.

The decision to participate in a staff development pro- gramme or activity is not as simple as it might at fi rst appear. It involves the individual ’ s reaction to a par- ticular offering, motivation to develop or enhance a specifi c skill, being available at the time of the session and overcoming the psychological barrier of admitting need. (97) As faculty developers, it is our challenge to overcome reluctance and to market our ‘ product ’ in such a way that resistance becomes a resource to learning.

 

다음이 도움이 된다.

In our context, we have seen the value of

• targeted mailings,
• professionally designed brochures and
• ‘ branding ’ of our product to promote interest.

 

Continuing education credits, as well as free and fl ex- ible programming, can also help facilitate motivation and attendance.

 

Buy - in 이란, 중요성에 대한 동의, 폭넓은 지지, 시간과 자원의 헌신 등을 포함하며, 개인과 조직 수준 모두에서 고려되어야 한다.

Buy - in involves agreement on impor- tance, widespread support and dedication of time and resources at both the individual and the system level and must be considered in all programming initiatives. (101)

흔히 겪는 문제의 극복

Work to overcome commonly encountered challenges include:

• 프로그램 개발에 대한 기관의 지원 부족   lack of institutional support and resources for pro- gramme planning
• 목표와 우선순위 설정   defining goals and priorities
• 요구사정, 개인과 조직의 니즈 균형   assessing needs and balancing individual and organisational needs
• 동기부여   motivating faculty to participate
• 동의 구하기   obtaining faculty buy - in
• 문화 변화를 촉진하기    promoting a ‘ culture change ’ that refl ects renewed interest in teaching and learning.

교수개발자 양성

Prepare staff developers 

교수개발자의 recruitement와 preparation에 대한 보고는 거의 없다.

The recruitment and preparation of staff developers is rarely reported. However, it is important to recruit carefully, train effectively, partner creatively and build on previous experiences. (101) Medical educators can be involved in a number of ways: as co - facilitators, as programme planners or as consultants.

 

준비 미팅과 디브리핑 세션을 통한 개발.  동료에 의해서 존중받는 사람이어야 함. 교육에 대한 일부 전문성이 있어야 함. 한 번 가르치는 것은 두 번 배우는 것과 같다.

In our own setting, we try to involve new faculty members in each staff development activity and conduct a preparatory meeting (or ‘ dry run ’ ) to review content and process, solicit feedback and promote ‘ ownership ’ We also conclude each activity with a ‘ debriefing ’ session to discuss lessons learnt and plan for the future. Whenever possible, staff developers should be individuals who are well respected by their peers and have some edu- cational expertise and experience in facilitating groups. It has been said that ‘ to teach is to learn twice ’ this principle is clearly one of the main motivating factors for staff developers.

효과성 평가와 효과성 보여주기

Evaluate – and demonstrate – effectiveness 

The need to evaluate staff development programmes and activities is clear. In fact, we must remember that the evaluation of staff development is more than an academic exercise, and our findings must be used in the design, delivery and marketing of our programmes. It has also been stated earlier that staff development must strive to promote education as a scholarly activ- ity; we must role model this approach in all that we do. (5) 

In preparing to evaluate a staff development pro- gramme or activity, we should consider the

• 평가의 목표 goal of the evaluation (e.g. programme planning versus decision making, policy formation versus academic inquiry),
• 활용가능한 자원 available data sources (e.g. participants, peers, stu- dents or residents),
• 평가를 위한 흔한 방법 common methods of evaluation (e.g. questionnaires, focus groups, objective tests, observations),
• 평가를 지원하기위한 자원 resources to support assessment (e.g. institutional support, research grants) and
• 프로그램평가 모델 models of programme evaluation (e.g. goal attainment, decision facilitation).

practical and feasible evaluation 

At a minimum, a practical and feasible evaluation should include

• an assessment of utility and relevance, 
• content,
• teaching and learning methods, and
• intent to change.

 

Moreover, as evaluation is an integral part of programme planning, it should be conceptualised at the beginning of any programme. It should also include qualitative and quantitative assessments of learning and behaviour change using a variety of methods and data sources.

결론

Conclusion

우리는 의학교육이 사회적 노력social endeavour라는 것을 기억할 필요가 있다. McGill University의 교수들로부터 의학교육자가 되기 위한 핵심 특징(reflection, passion, enthusiasm and pride)과 스킬(ability to maintain multiple perspectives, situate learning, work with others and see the ‘ big picture ’ )을 찾아낸 바 있다. 또한 그들은 의학교육자를 형성하는데 community of scholars의 장점을 언급했다. 많은 방식으로, 이러한 제안이 의학교육자를 양성하고 우리 각자가 그 여정 속에서 즐거움과 만족을 찾을 수 있게 해줄 것이다.

We also need to remember that medical education is a social endeavour. Faculty members at McGill University have identified core attributes (including reflection, passion, enthusiasm and pride) and skills (such as the ability to maintain multiple perspectives, situate learning, work with others and see the ‘ big picture ’ ) needed to become a medical educator. (12) They have also highlighted the benefi t of a community of scholars in the formation of medical educators (as outlined in Box 28.2 ). In many ways, these suggestions can serve as a road map for developing medical educa- tors, as each of us finds joy and satisfaction in this journey of discovery:

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Chapter 28. Developing Medical Educators: A Journey, not a Destination

1. Tim Swanwick

1. Yvonne Steinert Associate Dean

Published Online: 28 JUN 2010

DOI: 10.1002/9781444320282.ch28

Copyright © 2010 The Association for the Study of Medical Education

Book Title

Understanding Medical Education: Evidence, Theory and Practice