의학교육연속체에 걸친 교육역량의 프레임워크(Med Teach, 2009)

의학교육연속체에 걸친 교육역량의 프레임워크(Med Teach, 2009)

A framework of teaching competencies across the medical education continuum

Prof W. M. Molenaar MD, PhD, A. Zanting, P. van Beukelen, W. de Grave, J. A.

Baane, J. A. Bustraan, R. Engbers, Th. E. Fick, J. C. G. Jacobs & J. M. Vervoorn

Introduction

지난 수십년간 일반적인 고등교육의 퀄리티, 그리고 의학교육의 퀄리티가 관심을 받아왔다. 학생들은 선생님들이 자신의 분야에서 전문가일 것 뿐만 아니라, 그들의 학습과정을 코칭해주고, 동기부여를 해주고, 롤모델의 역할을 해줄 것을 요구해왔다. 고등교육에서 Medical teaching은 특별한 위치에 있는데, 이것은 임상적 맥락, 근무지-기반 학습에 대한 강조, 긴 교육기간continuum(UME부터 전공의 수련, CME까지) 등 때문이다. 이는 '학생'이 점차 '선생'으로 이행하는 과정이기도 하다. 즉, 시니어 레지던트는 주니어 레지던트를 가르치면서 동시에 그 자신이 피교육자이다. 더 나아가서 대부분의 medical teacher들은 진료/연구/교육, 그리고 이제는 경영management까지 상충하는 과제를 수행해야 한다.

Over the past decades the quality of higher education in general and in medicine in particular has gained attention (Eitel et al. 2000; Harden & Crosby 2000; Hand 2006; McLean et al. 2008; Sutkin et al. 2008). Students request that teachers not only are experts in their fields, but also are able to coach them in their learning process, motivate them and serve as role models (Harden & Crosby 2000; Tigelaar et al. 2004; Sutkin et al. 2008). Medical teaching takes a special position in higher education, because of its clinical context, the strong emphasis on work place learning and the long educational continuum, from undergraduate through specialty training to continuing medical education. This also makes the transition from ‘student’ and to ‘teacher’ gradual, i.e. the senior interns residents will often teach/coach their juniors at the same time as being trainees themselves (General Medical Council 1999; Forum on Academic Medicine 2004). Moreover, most medical teachers have competing tasks in patient care, research, teaching and now become management.

 

교육은 점차 의사의 역할에서 필수적인 부분이 되어가고 있다.

Education has increasingly recognized as an essential part of the physician’s role.

• CanMEDS In the widely used CanMEDS model of physician’s competencies it is integrated and specifically mentioned in the competency ‘scholar’ (2005).

• GMC In the UK the General Medical Council has made the role of the doctor as teacher explicit (General Medical Council 1999, 2006); and

• 교육역량에 관한 공식적 요건 formal requirements for the educational competencies of medical teachers are now being introduced (Purcell & Lloyd-Jones 2003).

• 현대화된 히포크라테스 선서의 네덜란드 버전 In the modernized Dutch version of the Hippocratic Oath teaching is represented as well, translated as follows: ‘I shall advance the medical knowledge of myself and others’.

 

이렇게 medical teaching에 대한 인식이 확산되면서 교수개발 프로그램도 발달하였다. 그러나 이러한 프로그램은 내용, 방법, 프로그램이 다양하다. 마찬가지로 teacher에게 요구되는 역량에 대한 묘사도 분야마다 다르거나 특정 부분에 집중되어 있다.

This recognition of medical teaching has led to the develop-ment of educational staff training programs (Steinert et al. 2006;McLean et al. 2008). These teacher development programs vary widely both in relation to contents and in relation to their methods and programming. Similarly, the available descrip-tions of competencies for teachers in medicine and related fields use different approaches and often focus on clinical or undergraduate training or on specific medical specialties(Hesketh et al. 2001; Nelson 2002; Tigelaar et al. 2004; Hand2006). 

 

전체 프레임워크

The full framework of the competencies can be foundonline at www.medicalteacher.org.

Methods and procedures

테스크포스

The task force

구성원(8명)

The task force was composed of one representative from each of the eight Dutch medical schools, one from the only Dutch veterinary school and one from the Academic Center for Dentistry in Amsterdam (ACTA); the other two Dutch dental schools were covered by representatives of Medical Schools. Throughout the text ‘medical’ includes dentistry and veterinary medicine as well. 

일반 원칙

General principle

teacher의 역할은 continuum에 걸쳐서 매우 다양하지만, 다양한 역할을 위한 핵심 역량이 존재한다고 결론지음.

The task force was aware of the wide variation of teacher roles in the medical education continuum. Nevertheless, the task force concluded that the core competencies required for performing the various teaching roles are largely similar, provided that the descriptions of the competencies are general, leaving room for local detailing. 

프레임워크 개발

The development of the framework

(1) Domains: Six teaching domains, in which teachers/supervisors perform were defined, following the suggestion of the Association of Universities in The Netherlands:.

• Development 

• Organization 

• Execution 

• Coaching 

• Assessment 

• Evaluation 

• 개발(기획) Development: 완전히 새로운 개발 또는 기존의 프로그램 도입
  This may concern both completely new development and adaptation of existing units/programs. 

• 조직화 Organization: 교육과 관련된 모든 로지스틱스 및 조직에 대한 것
  This concerns all aspects of logistics and organization involving education. 

• 수행 Execution: 실제 교육에 대한 것(개발은 완료되었고, 평가가 뒤따는 상황)
  This relates to the actual teaching (Development has been concluded; assessment and evaluation will follow). 

• 코칭 Coaching: 학생의 학습프로세스의 코칭과 교사들의 교육활동에 대한 코칭에 대한 것
  This concerns the coaching of the learning process(cognitive, metacognitive and affective) of students/residents(micro level) and the coaching of the educational activities of teachers (meso- and macro-level). 

• (학생)평가 Assessment: 형성평가와 총괄평가. 그리고 모든 종류의 평가법에 대한 것
  This domain relates to both formative (feed-back) and summative (decisive) assessment and to all assessment methods, such as written, oral, observations,reports and portfolio. 

• (프로그램)평가 Evaluation: 모든 교육프로세스에 대한 평가이며, 질관리를 포함함.
  This concerns all aspects of the educational process and includes quality assurance. Within each domain sub domains were distinguished(Table 1). 

Table 1에서 domains 과 sub-domains 은 교육 프로세스의 시간순서로 배열되어 있다.

Table 1 gives an overview of the teaching domains and sub domains in which teachers perform their activities.The main domains are indicated in the top row, whereas the columns indicate the sub domains identified for each of the domains; both domains and sub domains are ordered according to the chronology of the teaching process. The sub domain construction of exam (shaded) is worked out in more detail in Table 2. 

 

(2) Organizational level: 교사의 활동은 세 종료의 레벨로 구분될 수 있다
In contemporary higher educa-tion teachers perform at different levels in the organization. Therefore three levels were distinguished:

• 마이크로(가르침): 작은 교육단위(강의, 소그룹, 개별학생에 대한 코칭, BST, 임상 컨퍼런스)
  Micro level (teaching): Primarily performing at the level of small teaching units, such as lecture, small groups, coaching individual students or residents,bed-side teaching, clinical conference. 

• 메소(조화시킴): 교육과정/훈련 프로그램(과목, 블록, 임상실습, 일렉티브)의 서로 연관된coherent 부분을 조화시키고 개발하는 것
  Meso level (coordinating): Coordinating and devel-oping a coherent part of a curriculum or (residency)training program, such as courses, blocks, clerk-ships, lines, electives. 

• 매크로(리더십): 교육과정의 주요 파트에 대한 책임
  Macro level (leadership): Responsible for (major parts of) a curriculum or (residency) training program. 

(3) Competencies: 많은 고등교육프로그램은 전문직으로서의 수행에 필요한 역량 습득을 중심으로 움직인다. 따라서 우리는 교사에게도 같은 원칙을 적용하였다. AUN의 가이드라인을 따랐다. 각 영역의 역량은 특정 맥락에서 관찰가능한 행동으로 묘사된다(does, shows). 역량은 다음의 세 가지로 구성된다
Many higher education programs are centred around the acquisition of competencies as hallmark of professional performance. We have there-fore chosen the same principle for the teachers, thereby also following the guidelines of the Association of Universities in The Netherlands and others (Nelson2002; Hand 2006). The competencies in each of the domains are described as observable behaviour in a specific context: the teacher/supervisor ‘does’, ‘shows’.It is assumed that the competencies are composed of: 

• 지식(이론): 아는 것. Knowledge (theory): the teacher/supervisor ‘knows’ 

• 스킬: 할 줄 아는 것. Skills: the teacher/supervisor ‘is able to’ 

• 태도: ~라 생각하고 ~에 준비된 것. Attitude (motivation): the teacher/supervisor‘thinks’, ‘is prepared to’ 

결과

Results

프레임워크

The framework

조직수준으로 진행할수록(좌->우) 교사는 점점 더 큰 교육단위의 책임을 가지게 된다. 즉, 강의나 학생의 관리(micro)에서, 블록이나 임상실습 로테이션으로(meso), 그리고 학부 또는 레지던트 교육과정으로(macro) 발전해나간다. meso 또는 macro 수준에서만 다른 (주니어)동료들에 대한 코칭과 서포트가 포함된다.

Progressing in organizational levels (from left to right) the teacher becomes responsible for increasingly larger units in a curriculum or training program, e.g. the own series of lectures or supervision of a medical student (micro level), a whole block or a clinical rotation (meso level) or (major parts of) an undergraduate curriculum or residency training program (macro level). Note that at meso and macro level, but not at micro level, coaching and supporting of other (junior) colleagues is introduced.

다양한 그룹에서 활용하는 방식(자세한 내용은 논문에)

Application by various groups

Teachers/clinical supervisors

Teacher trainers

For teacher qualification review committees

The framework may be used in internal and external quality assurance

For human resource managers, heads of departments and program directors

Institutional boards

고찰

Discussion

우리는 학부교육과정 뿐만 아니라 전체 ME연속체에 대해서 만들었다. 

The decision to focus not only on the undergraduate curriculum, but on the whole medical educa- tion continuum proved very challenging, but necessary.

CanMEDS프레임워크에도 teacher/educator가 scholar 역할 아래 있지만, 주로는 의사의 역량에 대한 것이다. Harden과 Crosby도 teacher의 12개 역할을 밝힌 바 있지만, 여기서 assessor는 '학생'에 대한 평가자와 '교육과정'평가자를 모두 포함하는 개념이다. 우리 TF는 이 개념을 분명히 구분하고자 했다.

the CanMEDS (2005) framework is intended to describe the competencies of the physician and not primarily the educator, although the teacher/educator is represented in the role of ‘scholar’. In (undergraduate) medical education the 12 roles of the teacher described by Harden and Crosby (Harden & Crosby 2000) are well known. However, in these roles the ‘assessor’ includes both the students’ assessor and the curriculum evaluator, whereas the task force wanted to clearly distinguish these domains, following the guidelines of the Association of Universities in The Netherlands.

이 프레임워크에서 micro meso macro 수준은 다른 연구자들의 teaching pyramid의 서로 다른 위계에 대응된다.

The micro, meso and macro levels of the organization in this framework roughly correspond to the different levels of teaching earlier ranked by others in a teaching pyramid, starting from

• ‘teacher’, i.e. participating in teaching, to

• ‘master teacher’ and

• ‘educator’ to

• ‘master educator’, i.e. being a recognized leader in education

(Sachdeva et al. 1999; Sherertz 2000; Collins 2004).

마지막으로, 역량을 교사의 자격qualification시스템으로 만들고 이것을 조직에 요구에 따라 도입하는 것에 대해서 말하고자 한다. 교사에게 필요한 기본 자격은 여기서 micro 수준에 해당하는 것이다. 그러나 더 자세하게 만들어야 할 필요가 있다. 같은 원칙이 senior 혹은 더 고위자격에 대해서도 적용된다. 스펙트럼의 반대 끝에는 의과대학생을 위한 'junior' teaching qualification이 있을 수 있다. 이러한 교육자격 도입은 의학교육의 사회에 대한 책무성을 강화해주고, 교사와 교육을 인정하고 그 지위를 높여줄 것이다.

Finally, the translation of competencies to a teacher qualification system and its implementation in the organization need to be mentioned. It is likely that the criteria for a basic teacher qualification will largely coincide with those here described for the micro-level. However, further detailing is needed, such as the required extent of competencies and the distribution over the teaching domains. The same holds even more for the definition of senior or other higher level qualifications. At the other end of the spectrum, the require-ments for a ‘junior’ teaching qualification for medical students can also be derived from the framework (Cate 2007).Implementation of teacher qualifications may enhance the accountability of medical education to society and help to raise the status and recognition of teaching and teachers (Benor2000;Purcell & Lloyd-Jones 2003). 

Conclusion

Cate OT. 2007. A teaching rotation and a student teaching qualification forsenior medical students. Med Teach 29:1–6. 

Collins J. 2004. Teacher or educational scholar? They aren’t the same. J AmColl Radiol 1(2):135–139. 

Purcell N, Lloyd-Jones G. 2003. Standards for medical educators. Med educ37(2):149–154. 

Sherertz EF. 2000. ‘Criteria of the ‘‘educators’ pyramid’’ fulfilled by medicalschool faculty promoted on a teaching pathway’. Acad Med75(9):954–956. 

Tigelaar CPM. DEH, 2004. Dolmans DHJM, Wolfhagen IHAP, Van der Vleuten The development and validation of a framework forteaching competencies in higher education. Higher Educ48(2):253–268. 

Sutkin G, Wagner E, Harris I, Schiffer R. 2008. What makes a good clinicalteacher in medicine? A review of the literature. Acad Med83(5):452–466. 

 

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Med Teach. 2009 May;31(5):390-6.

A framework of teaching competencies across the medical education continuum.

Molenaar WM1, Zanting A, van Beukelen P, de Grave W, Baane JA, Bustraan JA, Engbers R, Fick TE, Jacobs JC, Vervoorn JM.

Author information

• 1Center for Professional Development of Teachers, Institute of Medical Education, University Medical Center Groningen, Amsterdam, The Netherlands. w.m.molenaar@med.umcg.nl

Abstract

BACKGROUND:

The quality of teachers in higher education is subject of increasing attention, as exemplified by the development and implementation of guidelines for teacher qualifications at Universities in The Netherlands.

AIM:

Because medical education takes a special position in higher education the Council of Deans of Medical Schools in The Netherlands installed a national task force to explore a method to weigh criteria for teacher qualifications of medical teachers.

METHODS:

A framework was developed covering competencies of teachers throughout the medical education continuum and including medicine, dentistry and veterinary medicine.

RESULTS:

The framework distinguishes 3 dimensions: (a) six domains of teaching (development - organization - execution - coaching - assessment - evaluation); (b) three levels in the organization at which teachers perform (micro, meso and macro level) and (c) competencies as integration of knowledge, skills and attitude and described as behaviour in specific context. The current framework is the result of several cycles of descriptions, feedback from the field and adaptations. It is meant as a guideline, leaving room for local detailing.

CONCLUSION:

The framework provides a common language that may be used not only by teachers and teacher trainers, but also by quality assurance committees, human resource managers and institutional boards.

Comment in

• Mapping the teacher's role: the value of defining core competencies for teaching. [Med Teach. 2009]

PMID:

 

19811129

 

[PubMed - indexed for MEDLINE]