프로페셔널리즘 교육과 평가를 위한 교수개발: 프로그램 설계에서 교육과정 변화까지 (Med Educ, 2005)

프로페셔널리즘 교육과 평가를 위한 교수개발: 프로그램 설계에서 교육과정 변화까지 (Med Educ, 2005)

Faculty development for teaching and evaluating professionalism: from programme design to curriculum change

Yvonne Steinert, Sylvia Cruess, Richard Cruess & Linda Snell

도입

INTRODUCTION

의사들은 전통적으로 치유자healer와 전문직professional에게 부여된 가치가 위협받고 있음을 느꼈으며, 의료에 대한 불만이 늘어났다는 것도 느꼈다. 이 도전에 반응하여 프로페셔널리즘의 중요성이 대두되기 시작했다.

Doctors have felt that the values traditionally associated with healers and professionals have come under threat, and their dissatisfaction with the practice of medicine has increased. In response to this challenge, the importance of professionalism – for doctors and society – has been recognised.1–3

그러나 이 이니셔티브를 도입해야 할 의무가 있는 많은 교수들은 '전문직으로서의 의사'가 갖추어야 할 행동과 특성을 설명하는 것 조차 힘들어한다.

However, many of the faculty members who must implement these new initiatives are unable to arti- culate the attributes and behaviours characteristic of the doctor as a professional,

대부분의 의사는 자신을 전문직이라고 믿으며, 전문직업성을 가르치는 것은 직관적으로 가능하다고 생각한다. 사회와 전문직(집단)이 균질했을 때는 그들 사이에 (중요하다고 여겨지는)가치가 공유되었고, 효과적으로 롤모델링을 통해서 전달될 수 있었다. 그러나 의료행위가 복잡해지고, 의사들이 겪게 외는 윤리적 딜레마가 늘어나고, 사회와 의료전문직이 다양해질수록 더 이상 과거와 같지 않았다.

Most doctors believe that they are  professional  and that teaching professionalismis intuitive. When both society and the profession itself were reasonably homogeneous, values were shared and could be transmitted effectively through role modelling.10,14 The increasing complexity of the practice of medicine, the ethical dilemmas faced by contemporary doctors and the diversity of the med- ical profession and of society make this no longer true.

프로그램 설명

PROGRAMME DESCRIPTION

우리의 교수개발프로그램은 두 섹션으로 나뉜다: 지도원칙guiding principle과 프로세스(내용과 방법)

The description of our faculty development pro- gramme will be divided into 2 sections: guiding principles and process, which includes content and methods.

지도원칙

Guiding principles

이 이니셔티브의 설계는 핵심 지식을 전달하고, 내용을 교육행위로 실현하고, 평가에 앞서 '가르침'에 초점을 두고, 컨센서스를 이루고, 지지buy-in을 얻는 것이었다

The design of this initiative was guided by the need to transmit core knowledge, translate content into practice, focus on teaching before evaluation, and promote consensus and  buy-in .

핵심 지식의 전달

Transmission of core knowledge

프로페셔널리즘의 정의, 그것을 구분짓는 특성, 전문직에게 기대되는 행동에 대한 공통의 이해가 필요했음. 다양한 정의가 존재하기에 이 과정은 반드시 필요했으며, 교수들은 종종 프로페셔널리즘을 인지적 토대 없기 모호한 개념으로 보고 있었다. 추가적으로 교사들은 교육과 평가가 가능한 조작적 정의를 필요로 했으며 암묵적인 것을 명시적으로 만들어줘야 했다.

In order to teach and evaluate professionalism, faculty members need to develop a common understanding of the definition of professionalism, the characteris- tics that distinguish it, and the behaviours expected of a professional. This is essential, as diverse definitions exist,1–3,18 and teachers often see professionalism as a vague concept lacking a cognitive base. In addition, teachers need operational definitions that can be taught and evaluated, making the implicit explicit. We cannot tell students simply to  be like us .19

내용을 교육 행위로 실현

Translation of content into practice

의사들은 핵심 내용을 교육행위로 실현해야 하며, 적용가능성과 (직무)연관성을 알아야 한다. 우리는 전문직업성과 그것의 특징을 정의하고, 사례를 활용하고, 참여자들이 행동계획action plan을 작성하게 함으로써 후자의 목표를 실현했다. 또한 강력한 교육방법이자 전문직의 가치를 소통하는 수단으로 롤모델role modelling이 중요하다고 생각했다. 

Accordingly, clinicians need to translate the core content into practice and see its applicability and relevance. We chose to promote the latter by defining professionalism and its attributes, using case examples, and asking participants to complete action plans. We also believed that it was critical to conceptualise role modelling as a powerful teaching method14,20 and strategy for communicating professional values.

가르침에 대한 초점

A focus on teaching

거의 모든 인증, 면허, 자격부여 기관은 학생과 레지던트의 professional behavior를 평가할 것을 요구한다. 그러나 프로페셔널리즘을 평가하기 위해서는 먼저 그것을 가르쳐야 한다. 우리는 내부 전문성in-house expertise를 개발해서 교사와 학생들에게 전파시켰다. '전문직다워라being professional'라는 것에 초점을 두넌 것보다 '전문직업성을 가르치자teaching professionalism'에 초점을 두는 것이 덜 위협적일 것이라고 생각했다.

Virtually every accrediting, licensing and certifying body2,4–8 requires that professional behaviours in students and residents be evaluated. However, if professionalism is to be evaluated, it must be taught. We had also developed in-house expertise1,10,18 that needed to be transmitted to teachers and students, and we believed that a focus on teaching profession- alism would be less threatening to health care professionals than a focus on being professional.

컨센서스를 이루고 지지를 끌어냄

Promotion of consensus and buy-in

우리는 중요도, 가치, 정의에 대한 합의가 부족했기 때문에 전문직업성의 개념에 대한 저항이 있을 것으로 예상했다. 따라서 체계적인 접근법(씽크탱크/핵심 교육법 워크숍)을 선택하여 지지를 끌어내고자 했다. 참여자로부터 자신의 가치와 신념을 탐색하게 하고, 핵심 내용과 스킬을 습득하게 하고, 이 (교육)내용에 대한 ownership을 갖게 만들려고 했다.

We had expected some resistance to the concept of professionalism as a consensus on its importance, values and definitions was lacking. We therefore chose a systematic approach, consisting of think tanks and workshops as key educational methods, to promote buy-in. Both methods allowed participants to explore their values and beliefs, acquire core content and skills, and begin to take  ownership  of this content area.

프로세스

Process

 

 

 

프로페셔널리즘 교육을 위한 씽크탱크

Think tank on teaching professionalism

반나절, 25인 교육리더 워크숍

To initiate the discussion about teaching profession- alism, the dean invited 25 educational leaders in our medical school to a half-day session, to highlight the importance of this issue, develop consensus and discuss outreach to faculty members.

 

진행과정

The think tank started with

• a brief overview of the core content of professionalism and proceeded

• to examine how professionalism was being taught at all levels of the curriculum. By the end of the session,

• a plan for a faculty development workshop had been developed.

 

기타 성과로는..

Other outcomes included

• a consensus on the importance of teaching professionalism,

• a review of how professionalism was being taught, and

• agree- ment on content. 

 

프로페셔널리즘 교육을 위한 초청워크숍

Invitational workshop on teaching professionalism

모든 교실의 주임교수와 프로그램디렉터 워크숍. 35명의 참가자. 다양한 교육법의 장단점을 논의하고 피드백을 받음.

Following the think tank, all departmental chairs and undergraduate and postgraduate programme direc- tors were invited to a half-day workshop called  The Teaching of Professionalism . This workshop was limited to 35 participants so that we could test out the working definitions of the attributes of professional- ism, examine the strengths and weaknesses of diverse teaching methods, and receive immediate feedback.

세 부분으로 구성됨

The workshop was organised into 3 parts:

• 핵심내용 the core content of professionalism;

• 개인적 관점과 신념 personal views and beliefs, and

• 교육전략 strategies for teaching.

워크숍 성과

The workshop concluded with

• 각 교실의 행동계획 the completion of an action plan for each department. By the end of the workshop, we had

• 프로페셔널리즘의 중요성과 핵심 내용에 대한 컨센서스 broadened consensus regarding the importance of professionalism and its core content, and

• 전체 교수 대상 워크숍 계획 developed a plan for a faculty-wide workshop. We had also

• 소그룹 퍼실레테이터 코호트 prepared a cohort of small group facilitators for future workshops and teaching sessions, and

• 프로페셔널리즘 교육에 대한 권고안의 개요 outlined a series of recommendations regarding the teaching of professionalism that would be presented to the undergraduate and postgraduate curriculum committees.

 

워크숍의 두 가지 핵심 메시지: 롤모델링의 중요성, 프로페셔널리즘 교육을 명시적으로 만들 필요성

The 2 key messages of this workshop were the importance of role modelling and the need to make the teaching of professionalism explicit.

프로페셔널리즘 교육에 대한 전체 교수 워크숍

Faculty-wide workshop on teaching professionalism

 

The faculty-wide workshop accommodated 65 health care professionals, representing all major specialties.

 

워크숍의 목적 The workshop’s goals were to

• 중요성 강조 highlight the import- ance of teaching professionalism in the Faculty of Medicine and to

• 핵심 내용 전달을 통한 교육의 향상 improve the teaching of this content area by transmitting core content,

• 핵심 교육전략 논의 discussing key teaching strategies and

• 각 교실의 행동계획 개발 developing an action plan for each department.

 

각각의 특성에 맞는 방법론을 매칭시키기 위한 표(Fig 2)

A written matrix, designed to facilitate the  matching  of methods to attributes, was developed to guide the discussion and highlight the value of examining the strengths and limitations of diverse approaches (Fig. 2).

 

워크숍 성과: 교수들 사이에서 지지를 끌어냈으며, 새로운 내용전문가가 생겼고, 교육에 사용가능한 교육리소스가 생겼다.

The outcome of this workshop was increased buy-in among the faculty members present, new content experts, and an array of educational resources that could be used for teaching purposes.

 

 

프로페셔널리즘 평가에 관한 씽크탱크

Think tank on evaluating professionalism

착수단계에서부터 평가가 더 체계적으로 이뤄져야 할 필요성을 느낌. 

We realised at the outset that, for teaching to be successful, professionalism would need to be evalu- ated in a more systematic way.

20명의 교육리더로 구성된 또 다른 씽크탱그를 구성하여 프로페셔널리즘 평가를 위한 방법을 조사하였음.

We therefore held another think tank with 20 educational leaders and content experts to examine methods for evaluating professionalism and develop the content and method of a workshop in this area. The outcome of this session was a detailed plan for a faculty-wide workshop.

'치유자이자 전문직으로서의 의사' 평가를 위한 전체 교수 워크숍

Faculty-wide workshop on evaluating the doctor as healer and professional

By the end of the workshop, we had developed consensus on the need to improve our evaluation of professional- ism, identified behaviours that described the attrib- utes, and developed a series of recommendations that were presented to the Faculty of Medicine (e.g. each attribute must be evaluated on a regular basis).

 

 

프로그램 평가

Programme evaluation

맥락

Context evaluation

(평가대상과 관련된) 교육환경의 다양한 요소들을 개념화하고, 그 교육맥락 속에 존재하는 문제/니즈/기회를 밝히기 위한 자료를 수집하는 것. 우리가 생각하기에, 사회적 요구와 교육적 불가피성으로 인해서 우리의 동료와 우리의 맥락은 프로페셔널리즘 교육과 평가에 대한 교수개발에 준비가 되어있는 상태였다. 학장과 부학장들도 서포트 해주었다.

Context evaluation involves an analytic effort to conceptualise the relevant elements of an educa- tional environment and gather empirical data that help identify the problems, needs and opportunities present in an educational context.22 In our estima- tion, and that of our colleagues, our context was ready for a faculty development effort on teaching and evaluating professionalism as a result of a renewed interest prompted by societal needs and educational imperatives. The dean and associate deans also supported the effort and our in-house expertise needed to be shared.

투입

Input evaluation

맥락 평가의 결과로서 드러난 목적을 달성하기 위하여 해당 교육시스템이 이용가능한 역량을 확인하기 위한 작업. 이 단계에서 학습자의 특성(역할과 책임)도 파악하게 됨.

Input evaluation ascertains the available capabilities of the instructional system for achieving the objec- tives identified as a result of the context evaluation.22 It also assesses learner characteristics (e.g. roles and responsibilities).

 

우리는 잘 갖추고 있었음.

From our perspective, we had the necessary resources to conduct this initiative, inclu- ding

• a well functioning faculty development office that supported professional development in this area,

• local expertise,1,10,18 and

• influential participants with key educational responsibilities.

 

The choice of think tanks followed by workshops was also deemed appropriate as the initial faculty development metho- dology.

프로세스

Process evaluation

프로세스 평가는 교육프로세스의 모니터링과 평가이다. 참여자들로부터 워크숍 사후 평가를 받았으며, 워크숍의 형식과 유용성, 기대효과 등을 평가했다.

Process evaluation aims to monitor and assess the instructional procedures.22 We conducted a process evaluation by asking participants to complete a post- workshop evaluation that assessed their perceptions of the workshop’s format, usefulness and anticipated benefit.

주관식 응답은 세 부분으로

Narrative comments on the evaluation form were divided into 3 categories:

• 유용성에 대한 전반적 인식 overall perceptions of the workshop’s usefulness;

• 가장 유용한(무용한) 내용 identification of the most (and least) useful components, and

• 변화의 의지 intent to change.

 

가장 유용한(무용한) 내용: 무엇이 가장 유용했느냐에 대한 응답은 워크숍 방법론과 내용으로 구분되었음

Participants’ responses to what was most useful about the workshop could be grouped into workshop meth- odology and content.

• 워크숍 방법: 소그룹토론이 가장 좋았다. Regarding the former, the participants most valued the small group discussions as an opportunity to reflect, discuss this topic with their colleagues, and apply the content to their settings.

• 내용: 핵심개념/교육과 평가를 위한 프레임워크/케이스 분석 Their comments regarding content supported the value of

• defining core concepts,

• providing a structured framework for teaching and evaluating professional- ism, and

• analysing case vignettes.

변화의 의지: 미래에 어떻게 가르치겠냐는 질문에 대해서..

In response to the question of how the participants might teach professionalism in the future, the majority noted that they would try to incorporate these concepts into their clinical teaching and that role modelling would be their method of choice. Many commented that they would try to make their teaching more explicit and insert professional content into ongoing teaching.

 

 

 

산출

Product evaluation

산출 평가는 교육프로그램으로부터 얻은 성과attainments를 측정하기 위한 목적이 있으며, 도출된 성과가 무엇인지를 특히 강조한다. 교수개발프로그램 뒤에 나타난 교육활동과 교육이니셔티브를 모니터링하였고, 워크숍 18개월 후에 워크숍 참석자로부터 개념과 스킬의 활용에 대해서 상찰하게끔 했다.

Product evaluation aims to measure the attainments yielded by an instructional programme, with a clear emphasis on the outcomes produced.22 We carried out a product evaluation by monitoring the educa- tional activities and initiatives that followed the delivery of our faculty development programme, and by asking workshop participants to reflect on their use of the concepts and skills, 18 months after the last faculty-wide initiative.

Table 2 summarises the formal educational activities and initiatives that took place after the workshop.

추가적으로 3문항짜리 후속 설문을 시행하였다.

In addition, a 3-item, follow-up questionnaire was sent to all the workshop participants in the autumn of 2003. A total of 67 individuals responded (45% response rate). Of these,

• 배운 것을 자신의 진료활동에 사용했다. 61% said they had used what they had learned in their clinical practice,

• 학생, 전공의 교육에 워크숍 자료를 활용했다 70% said they had used the workshop material in their clinical teaching with students or residents,

• 공식 교육에 워크숍 자료를 적용했다 44% had applied the material in formal teaching, and

• 프로페셔널리즘에 대한 CME나 FDP를 했다. 25% had conducted a continuing medical education or faculty development activity on professionalism.

 

 

 

고찰

DISCUSSION

첫째, 장기적 FDP를 설계하고 도입하는 것, 그리고 그것의 효과를 보는 것(가르치는 것 뿐만 아니라 교수들이 진료하는 것에까지)이 가능하다. 교수들은 프로페셔널리즘의 기반이 되는 인지적 토대가 무엇인지 알게 되고, 이것을 가르치고 평가하기 위한 전략을 알게 되면서 프로페셔널리즘 교육을 더 확장시킬 수 있게 되었다.

Firstly, it seems possible to plan and implement a longitudinal faculty development programme and have an impact, not only on what and how faculty members say they teach, but also on how they practise. Based on our preliminary results, it appears that our faculty mem- bers were able to expand their teaching of profes- sionalism, in part because they had become more knowledgeable about the cognitive base underlying professionalism, strategies for teaching this subject matter, and methods of evaluation.

둘째, 이 이니셔티브를 통해서 우리 의과대학은 프로페셔널리즘의 인지적토대cognitive base에 합의를 보았다(전문직의 특성과 자질, 학생과 전문의가 해야 할 행동). Whitcomb가 말한 바와 같이, (이러한 합의)는 프로페셔널리즘을 가르치기 위해서 필수적이다. 또한 이러한 인지적 토대가 학생과 공유communicated되어야 하며, 다양한 교수, 평가법을 고려해야 한다.

Secondly, this initiative allowed our medical school to agree on the cognitive base of professionalism, the attributes and characteristics of a professional, and the behaviours to be encouraged in students, residents and faculty. As Whitcomb23 said, this is key in order for professionalism to be taught. The faculty also came to realise that this cognitive base must be communicated to students and that diverse teaching and evaluation strategies should be con- sidered.

셋째, 이 이니셔티브는 교수개발이 교육과정변화를 시작하고 정착시키는 강력한 수단이 될 수 있음을 보여준다. Lanphear and Cardiff는 교육과정변화를 위한 교수개발의 필요성을 논의한 바 있다. 우리의 결과는 한 사례이다. 의심의 여지 없이, 인증, 면허, 허가(accrediting, licensing and certifying)기관이 주요 동기부여요인이었지만, 내부적으로는 이 이니셔티브가 교수들의 인식을 일깨워주었고 교수들이 이 쪽에 더 노력하게 해주었다. 많은 교육 이니셔티브가 현재 진행중이며, 이 프로그램의 자극과 방향제시가 없었다면 이렇게 빨리 진행되지 않았을 것이다. 이러한 결과는 Rubeck and Witzke이 말한 '교육과정변화를 촉진하기 위해서는 교수개발이 필요하다'는 것과도 비슷하다. Wilkerson and Irby도 조직변화를 시작하기 위해서는 교수개발이 필요함을 강조했다.

Thirdly, this initiative demonstrated that faculty development can be a powerful tool in initiating and setting the direction for curricular change. Lanphear and Cardiff24 talked about the need for faculty development to support curriculum change; this initiative is an example of faculty development leading to change. With- out question, the demands of accrediting, licensing and certifying bodies were major motivating factors, but within the local context, this initiative raised awareness and channelled the faculty’s efforts. Many of the educational initiatives currently underway (outlined in Table 2) would probably not have occurred as rapidly, or in their current form, without both the stimulus and the direction of this programme. This observation is in line with that of Rubeck and Witzke,25 who spoke of the need to develop teachers to facilitate curricular change. It also touches on the beliefs of Wilkerson and Irby,26 who highlighted the need for faculty development toinitiate organisational change.

 

우리의 결과를 뒤돌아보면 다음을 제안할 수 있다.

Upon reflection, we would suggest the continued use of

• 컨센서스와 지지를 끌어내기 위한 싱크탱크의 활용 think tanks to promote consensus and buy-in, and

• 인지적 기반을 전파하고(적용가능성, 전략, 흔한 문제에 대한) 토론를 위한 워크숍 활용 workshops to transmit a cognitive base and stimulate discussion around applicability, strategies and commonly encountered problems.

 

However, we would also suggest the use of

• 더 많은 교수들에게 닿기 위한 교실-기반 활동 more department-based activities to reach larger numbers of faculty members, as well as

• 지금까지 잘 활용되어오지 않은 피어코칭, 자기주도학습 이니셔티브의 활용 peer coaching28 and self-directed learning initiatives which, to date, have been underutilised educational strategies.

우리가 얻은 교훈들

In conclusion, we hope that some of the lessons we have learned can be applied to other contexts.

• 개인 수준: 학습을 위한 동기부여, 저항을 극복하는 것, 암묵적인 것을 명시적으로 만드는 것의 중요성
  At the individual level, we need to remember the importance of building motivation for learning, overcoming resistance, and making the implicit explicit.

• 프로그램 수준: 교육과 평가를 위한 내용과 방법에 초점. 적절한 교수개발 전략 활용, 개념적 프레임워크를 활용하여 특정 맥락에 성찰과 적용이 가능하게. 후속 과제와 활동 도입. 학습이 (실제 현실과) 관련되고 즐겁게 만들기
  At the programme level, we need to develop programmes that focus on content and methods, for teaching and evaluation. Appropriate faculty development strat- egies29 must be utilised, and conceptual frameworks must be provided to promote reflection and appli- cation to specific contexts. We should also incorpor- ate follow-up tasks and activities, and above all, make learning relevant and enjoyable.

• 시스템 수준: 교수들의 지지 끌어내기, 조직문화와 환경 고려하기, 교수-학습의 기회 발견하기, 교육자교육 시키기, 전파를 촉진하기
   At the systems level, we need to promote buy-in, address the organisa- tional climate and culture, identify opportunities for teaching and learning, and train the trainers, thus facilitating dissemination.

교수개발활동은 단순히 교육의 향상을 넘어서서 개인/프로그램/시스템을 모두 타겟으로 해야 함

It has been said that faculty develop- ment activities should move beyond instructional improvement and target 3 levels: the individual, the programme and the system.27 This initiative has attempted to target all 3 levels.

 

 

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Med Educ. 2005 Feb;39(2):127-36.

Faculty development for teaching and evaluating professionalism: from programme design to curriculumchange.

Steinert Y1, Cruess S, Cruess R, Snell L.

Author information

• 1Centre for Medical Education, Faculty of Medicine, McGill University, Lady Meredith House, 1110 Pine Avenue West, Montreal, Quebec H3A 1A3, Canada. yvonne.steinert@mcgill.ca

Abstract

INTRODUCTION:

The recent emphasis on the teaching and evaluation of professionalism for medical students and residents has placed significant demands on medicine's educational institutions. The traditional method of transmitting professional values by role modelling is no longer adequate, and professionalism must be taught explicitly and evaluated effectively. However, many faculty members do not possess the requisite knowledge and skills to teach this content area and faculty development is therefore required.

PROGRAMME DESCRIPTION:

A systematic, integrated faculty development programme was designed to support the teaching and evaluation ofprofessionalism at our institution. The programme consisted of think tanks to promote consensus and "buy-in", and workshops to convey core content, examine teaching strategies and evaluation methods, and promote reflection and self-awareness.

PROGRAMME EVALUATION:

The programme was evaluated using a CIPP (context, input, process, product) analysis. The institution supported this initiative and local expertise was available. A total of 152 faculty members, with key educational responsibilities, attended 1 or more facultydevelopment activities. Faculty participation resulted in agreement on the cognitive base and attributes of professionalism, consensus on the importance of teaching and evaluating professionalism, and self-reported changes in teaching practices. This initiative also led to the development of new methods of evaluation, site-specific activities and curriculum change.

DISCUSSION:

A faculty development programme designed to support the teaching and evaluation of professionalism can lead to self-reported changes in teaching and practice as well as new educational initiatives. It can also help to develop more knowledgeable faculty members, who will, it is hoped, become more effective role models.

PMID:

 

15679679

 

[PubMed - indexed for MEDLINE]