변화의 도구로서의 교수개발: 전문직업성 교육에 관한 사례연구(Acad Med, 2007)

변화의 도구로서의 교수개발: 전문직업성 교육에 관한 사례연구(Acad Med, 2007)

Faculty Development as an Instrument of Change: A Case Study on Teaching Professionalism

Yvonne Steinert, PhD, Richard L. Cruess, MD, Sylvia R. Cruess, MD, J. Donald Boudreau, MD, and Abraham Fuks, MD

"전문직교육의 어려운 점은 어떻게 분석적사고/능숙한행동/현명한판단의 복잡한 조화를 가르치느냐는 것이다"

The challenge for professional education is how to teach the complex ensemble of analytic thinking, skillful practice, and wise judgment upon which each profession rests. 

—WilliamM. Sullivan, Work and Integrity: The Crisis and Promise of Professionalismin America, 2005

어떤 대규모 조직에서든 변화를 일으키는 것은 어려우며 의대도 마찬가지다.

Effecting change in any large organization is difficult, and faculties of medicine (i.e., medical schools) are no exception.

일부 관측자들은 '본질적으로 보수적인', '현재 상태에 매몰된' 등의 용어로 의료전문직에서 변화를 일으키는 것의 어려움에 대해 코멘트한 바 있다. 이들을 지지원하기 위하여 어떤 교수들은 외부의 컨설턴트를 고용해서 변화 프로세스에 공식적 관리테크닉을 도입하고자 했다.

Several observers have commented on the difficulty of implementing change within the medical profession and its institutions, which have been described as being inherently conservative and devoted to the status quo.1–4 To assist them, some faculties of medicine have used outside consultants to bring formalized management techniques into the change process.5,6

McGill 의과대학은 변화의 8단계 모델이 유용하다고 보았다.

We at the Faculty of Medicine at McGill University have found it useful to apply an eight-stage model for implementing change,7,8

 

교수개발은 컨센서스를 만들고, 열정과 지지를 끌어내고, 변화 이니셔티프를 도입하는데 도움이 된다. 또한 공식/비공식/잠재 교육과정을 바꿔서 조직의 문화를 변화시키는데 기여할 수 있다.

Faculty development can help to build consensus, generate support and enthusiasm, and implement a change initiative; it can also help to change the culture within the institution by altering the formal, informal, and hidden curricula.9,10

 

교수개발은 다음과 같이 정의.

Faculty development has been defined as

• that broad range of activities that institutions use to renew or assist faculty in their roles.11
• That is, faculty development is a planned program, or set of programs, designed to prepare institutions and faculty members for their various roles.12
• 점차 포괄적인 교수개발 프로그램이란 개인의 발전 뿐 아니라 점점 더 복잡해지는 조직(의 발전)에 대해서도 다뤄야 한다고 인정받고 있다.
  For some years, it has been recognized that comprehensive faculty development programs cannot focus solely on individual improvement; they must also address the increasingly complex institutions in which teaching and learning occur.13,14

프로페셔널리즘의 중요성

The Importance of Professionalism

지난 수십년간 의사와 환자 사이에 상당한 불편함이 있었다. 의사들은 그들의 환자에 대한 태도와 의료기술을 강조하는 것에서 '하지 말아야 할 것을 한 죄와 해야 할 것을 하지 않은 죄'에 모두 책임이 있는 것처럼 느꼈다. 동시에 환자들은 근대과학에 기반한 의료에 예전 의사들이 보여주던 compassion을 더한 진료를 원했다. 환자는 의사들로부터 자신들의 자율성/책무성/투명성을 모두 요구했고, 모든것보다도 '유능한 치유자'로서의 봉사service를 원했다.

The past few decades have witnessed the development of a profound sense of unease amongst physicians and patients. Physicians feel that they are being “held to account for sins of both commission and omission,”15 for their attitudes towards patients and for their emphasis on medical technology. At the same time, patients express a strong desire for care that is based on modern scientific medicine combined with the compassion of the physician of yesteryear. They wish respect for their own autonomy, accountability and transparency from their physicians, and, above all, the services of a competent healer.15

의료계는 이에 화답했다.

The medical profession has responded.18

이 문제를 해결하기 위해서 McGill의과대학은 일찍부터 프로페셔널리즘을 가르치는 것은 하나의 과목이나 포커스가 좁고 목표가 제한적인 특정 교육과정활동만으로는 해결되지 못할 것임을 인지하였다.

In addressing these issues, McGill’s Faculty of Medicine realized early on that the teaching of professionalism could not depend solely on the establishment of a single course or selected curricular activities with a narrow focus or limited objective.

프로페셔널리즘 교수-학습

Teaching and Learning Professionalism

프로페셔널리즘은 전통적으로 존경받는 롤모델을 통해서 한 세대에서 다음 세대로 전해진다. 이러한 방법은 부분적으로는 성공적이었는데, 왜냐하면 의료전문직은 상당히 균질한 집단이었고, 일부 세대차이가 있더라도 규범적으로 공통된 가치가 있었기 때문이다. 오늘날의 놀라울 정도의 복잡한 세상과 사회에서는 더 이상 '공통의 가치'라는 것을 가정할 수 없으며, 현대 보건의료시스템에 있어서 전통의 가치에 대한 도전은 생소한 것이었다. 따라서 롤모델링이 여전히 강력하고 필수적인 수단이긴 하나 더 이상 충분하지는않았다. 프로페셔널리즘은 명시적으로 교육되어야 했다. 더 나아가서 교육기관의 환경이 프로페셔널리즘에 심대한 영향을 준다는 인식이 늘어났다.

Professionalism was traditionally transmitted from one generation to the next by respected role models.32–34 It is believed that this method was successful, in part, because the medical profession was fairly homogeneous and, despite some generational differences, shared values were the norm. In today’s wonderfully complex and diverse society, one can no longer assume shared values, and the challenges to the traditional values of the medical profession posed by modern health care systems are new. It has therefore been concluded that role modeling, while remaining a powerful and essential tool, is no longer sufficient.24,34 Professionalism must be taught explicitly. Furthermore, there has been increased recognition that the environment within the teaching institution has a significant effect on the teaching of professionalism and must be addressed.9,10,35,36

프로페셔널리즘을 효과적으로 가르치고 학생들에게 내면화하기 위한 몇 가지 접근법이 있었다. 또한 프로페셔널리즘을 명시적으로 가릋야 한다고 강조한 사람들도 있었다. 이 때 조작적 정의를 사용할 수도 있고, 특성이나 성격의 목록으로 개념을 개요적으로 서술하기도 했다. 어떤 사람들은 프로페셔널리즘 교육이 '도덕적 노력moral endeavor''로서 접근해야 한다고 하면서, 이타성과 봉사정신을 강조했다. 우리와 다른 사람들은 두 가지 접근법이 모두 필수적이라고 생각했다. 인지적 기반을 반드시 정의해야 하며, 이것을 의사들이 프로페셔널리즘의 본질을 이해하고, 의료의 사회적 계약과 무슨 관계인지 알아야 하고, 프로페셔널리즘이 생존하려면 충족되어야 하는 의무가 무엇인지를 이해하게끔 소통해야 한다고 생각했다. 추가적으로, 정기적regular basis으로 '자기성찰'과 'mindfulness'를 촉진하기 위하여 경험학습의 기회가 제공되어야 함, 이를 통해 프로페셔널리즘이 단순히 이론이나 동떨어진marginal개념으로 남게 하지 말아야 한다고 보았다. 따라서 의학교육에서는 경험을 쌓고/성찰하고/프로페셔널리즘의 개념과 원칙을 습득하기 위한 다수의, 단계적 접근법을 제공해야 했다.

The literature indicates several approaches that must be considered if professionalism is to be taught effectively and internalized by students. There are those who have emphasized that professionalism needs to be taught explicitly, using either operational definitions or outlining the concept as a list of traits or characteristics.19,20,22 Others have stated that the teaching of professionalism should be approached as a moral endeavor, emphasizing altruism and service.29,30 We, and others,24,35,36 believe strongly that both approaches are essential. The cognitive base must be defined and communicated so that physicians understand the nature of professionalism, its relation to medicine’s social contract, and the obligations that must be met if professionalism is to survive. In addition, opportunities for experiential learning must be provided on a regular basis to promote self-reflection37 and “mindfulness,”23 so that professionalism will not remain a theoretical or marginal concept. Professional identity arises from a combination of experience and informed reflection on experience.38 Therefore, a major objective of medical education should be to provide multiple, stage- appropriate opportunities for gaining experience in, and reflecting on, the concepts and principles of professionalism.25,29,30

전문직은 동료간의 협력collegiality을 공통의 목표를 향한 합의를 도출하고, 그들간의 추종compliance를 장려하기 위한 수단으로 사용한다. 존경받는 롤모델로서 동료가 주는 압박은 강력한 수단이다. 반대로 합당한 기준을 충족시키지 못하는 롤모델의 부정적인 효과도 강력하다. 롤모델들이 그들이 보여줘야 하는 역할과 가치관에 대해서 명확히 이해했을 때에야 롤모델이 효과적인 수단이 될 수 있다. 우리에게, 이것은 프로페셔널리즘 교수학습을 촉진기 위한 FDP를 설계하고 도입하기 위해 가장 설득력있는 주장이었다. 추가적으로 우리는 교수들의 자기성찰을 촉진하고 프로페셔널리즘이 중요하다는 강력한 메시지를 던짐으로서 공식 교육과정과 잠재 교육과정에 모두 영향을 주고 싶었다.

Professions use collegiality as a means of obtaining agreement on common goals and encouraging compliance with them.39 The peer pressure of respected role models remains an enormously powerful tool. Conversely, the destructive effects of role models who fail to meet acceptable standards can be equally strong.29,30,40 To be effective, it seems axiomatic that role models must understand and be able to articulate the roles and values that they are expected to demonstrate. To us, this was the most cogent argument for creating and implementing a faculty development program designed to promote the teaching and evaluation of professionalism. In addition, we hoped that it would positively influence both the informal and hidden curricula9,10 by promoting self-reflection in faculty members and sending a strong message that professionalism is important.

변화의 Context

The Context for Change

 

McGill 의과대학는 4년제, 통합, 시스템-기반 학부 프로그램을 운영한다.

The Faculty of Medicine at McGill University offers a four-year, integrated, systems-based undergraduate program.

프로페셔널리즘에 대한 인식은 거의 없었고, 매우 소수의 교수들만이 교육 프로그램에 참여 가능한 수준이었다. 따라서 교수들의 지지buy-in을 위해서는 포괄적이고 체계적인 교수개발 이니셔티브가 필요했다. 교육의 목표와 내용에 대한 컨센서스를 쌓고, 교수들이 프로페셔널리즘을 더 효과적으로 가르치고 평가할 수 있도록 훈련해야 했다.

there was little faculty awareness of professionalism, and few faculty members were knowledgeable enough to participate in an expanded teaching program. It was therefore decided that a comprehensive and systematic faculty development initiative was needed to promote faculty “buy-in,” to develop consensus on educational goals and content, and to train faculty members to teach and evaluate professionalismmore effectively.

'변화주도'의 사례로서의 교수개발

Faculty Development as an Example of “Leading Change”

우리가 비록 FDP를 계획하는데 있어서 Kotter의 모델을 사용한 것은 아니나, 우리는 곧 이 모델의 단계를 따르고 있다는 것을 인식했다.

Although we did not use the Kotter model in planning this faculty development program, we soon realized that we had followed the steps recommended by Kotter for transforming organizations.8

긴박함 인식

Establish a sense of urgency

Kotter는 긴박함을 인식하게 하는 것이 변화에 필요한 협조cooperation을 얻는데 매우 중요하다고 보았는데, 왜냐하면 현 상태에 만족하는 수준이 높을수록 목표를 달성하기 위한 변화노력이 실패할 가능성이 높기 때문이다. 더 나아가서 긴박함에 대한 인식을 높이기 위해서는 현 상태에 만족하게 만드는 요인을 제거하거나 그 효과를 최소화해야 한다. 내부의 system of measurement를 바꾸거나 더 높은 기준을 설정함으로써 후자가 다성될 수 있다.

Kotter states that establishing a sense of urgency is critical to gaining needed cooperation, because transformation efforts fail to achieve their objectives when complacency levels are high.7,8 Moreover, establishing urgency demands that the sources of complacency be removed or their impact minimized; the latter can be achieved by setting higher standards or changing the internal systems of measurement.

 

 

McGill의 사례

• In our own setting, and indeed in most medical schools, this sense of urgency was provided by the widespread belief that medicine’s professionalism and professional status were being threatened by contemporary health care systems, whose values are difficult to reconcile with those traditionally associated with medicine.1,4,16,17
• Without question, the actions of licensing and accrediting bodies reinforced the sense of urgency felt by the faculty and provided a potent stimulus for change.
• The recognition of professionalism as an essential competency by the Royal College of Physicians and Surgeons of Canada,45 the American Board of Medical Specialties,46 the Accreditation Council for Graduate Medical Education,47 as well as the support of the Association of American Medical Colleges48 and the American Board of Internal Medicine,49 created a need for timely action on the part of medicine’s educational institutions.
• However, the knowledge, attitudes, and skills to do this effectively were not readily apparent.
• In our own context, this sense of urgency was communicated to our faculty members through the leadership of the faculty of medicine as well as through a series of educational activities sponsored by the faculty development office, starting with medical education rounds in 1997.

강력한 지도연합체 형성

Form a powerful guiding coalition

Kotter 는 "major change를 달성하기는 너무나 어렵기 때문에, 그 프로세스를 지속시키기 위해서는 강력한 힘이 필요하다"라고 했다. 또한 '변화 이니셔티브'를 관장할 팀의 특성을 강조했는데, 여기에는 지위/권력/전문성/신뢰성/리더십(position, power, expertise, credibility, and leadership)이 포함된다.

Kotter eloquently states that “because major change is so difficult to accomplish, a powerful force is required to sustain the process.”8 (p51) He also highlights the key characteristics of a teamthat can direct a change initiative. These characteristics include position, power, expertise, credibility, and leadership.

 

 

 

McGill의 사례

 

누가

In our own setting, in June 1999, the dean initiated the process of creating a powerful guiding coalition by inviting 25 educational leaders, consisting of the associate deans responsible for undergraduate and postgraduate medical education, members of the faculty development team, key departmental chairs, program directors at the undergraduate and postgraduate levels, and local content experts, to a half-day “think tank.”

 

무엇을 목표로

The goal of this session was

• to highlight the importance of professionalism,
• to begin to develop consensus among diverse educational leaders, and
• to discuss ways of reaching out to faculty members across the basic science and clinical teaching sites.

 

무엇을 하였나

To achieve its objectives, the think tank started with

• a brief overview of the core content of professionalism and
• a review of how professionalism was being taught at all levels of the undergraduate curriculum.

 

결과물

After a lively debate and exchange of ideas,

• consensus on the importance and content of teaching professionalism was reached.
• A plan for a faculty development workshop was also developed.

 

 

비전 창조

Create a vision

"비전이란 (왜 사람들이 그 미래를 창조하기 위해 노력해야 하는가에 대한 묵시적/명시적 코멘터리가 더해진) 미래에 대한 그림이다" 더 나아가 비전은 변화의 방향을 명확하게 해주고 사람들에게 동기를 부여해주며 핵심 플레이어key players를 정렬align해준다.

“Vision refers to a picture of the future with some implicit or explicit commentary on why people should strive to create that future.”8 (p68) Moreover, vision clarifies the direction of the change and helps to both motivate and align key players.

 

 

McGill의 사례

 

싱크탱크가 비전을 창조

At McGill, the think tank described above helped to create the vision for teaching and evaluating professionalism.

 

More importantly, however, an invitational half-day workshop, which grew out of this first session and focused on teaching professionalism, led to the creation of a vision that we could then articulate faculty-wide.

 

모든 과의 과장과 전공의교육프로그램 디렉터들 워크숍 수행. 워크숍은 세 가지 파트로 구성

In December 1999, the dean invited all department chairs and undergraduate and postgraduate program directors to a half-day workshop designed to examine the working definition of professionalism and its attributes and to determine the strengths and weaknesses of diverse teaching methods. More specifically, the workshop was organized into three parts:

• 프로페셔널리즘의 핵심 내용 the core content of professionalism,
• 참여자들의 관점과 신념 the participants’ personal views and beliefs, and
• 교육 전략 strategies for teaching.44

 

워크숍의 성과(1)

By the end of this session, we had

• developed a broad agreement regarding the importance of professionalism and its core content,
• discussed ways of implementing the teaching of professionalism in specific departments and sites, and
• developed a plan for a faculty-wide workshop.

 

워크숍의 성과(2)

We had also

• prepared a cohort of small- group facilitators for future workshops and teaching sessions and
• devised a series of recommendations regarding the teaching of professionalism that were presented to the undergraduate and postgraduate curriculum committees.

 

이 워크숍의 핵심 메시지: (1)프로페셔널리즘 교육을 명시적으로 해야 한다 (2)롤모델이 중요하다.

The two key messages of this workshop were

(1) the need to make the teaching of professionalism explicit, and

(2) the importance of role modeling.

비전의 소통

Communicate the vision

Kotter 는 "비전의 진정한 힘은 (변화활동에) 관계된 대부분의 사람이 목표와 방향에 대한 공통된 이해를 가지고 있을 때 드러난다"

Kotter states that “the real power of a vision is unleashed only when most of those involved in an activity have a common understanding of its goals and direction.”8 (p85)

 

 

McGill의 사례

 

전체교수대상 워크숍 진행

The vision for teaching and evaluating professionalismat McGill was communicated through the support given by the dean and the associate deans. It was also promulgated by another faculty-wide workshop on teaching professionalism that accommodated 65 health care professionals representing the basic sciences and all major medical specialties. This workshop, which was held in December 2000, was designed

• 프로페셔널리즘의 중요성을 강조하고 to highlight the importance of teaching professionalism and
• (다음을 토대로) 교육을 향상시키기 위함 to improve such teaching by
• transmitting core content,
• discussing effective teaching strategies, and
• developing an action plan for each department.

 

워크숍의 성과

This workshop resulted in

• increased buy-in among the educational leaders who participated, and it led to the
• development of new content experts and an array of educational resources that could be used for teaching purposes.

 

 

비전을 공유하기 위한 추가적인 활동으로 이어졌음

It also led to a number of other activities designed to communicate the vision for change, including

• educational sessions for residents,
• hospital grand rounds,
• departmental workshops, and
• high-profile activities outside McGill such as peer-reviewed publications and presentations at national and international meetings.

 

다른 사람들이 비전을 따라 행동할 수 있는 권한 부여

Empower others to act on the vision

Kotter 는 다른 사람들이 변화를 가져올 수 있게effect change 하는데 필수적인 요소 다섯가지 중 하나로 '트레이닝 제공provision of training'을 꼽았다.

Kotter specifically identifies the provision of training as one of the five essential ingredients to empower people to effect change.7

 

 

 

McGill의 사례

 

 

교수개발이 변화를 위한 주된 vehicle중 하나였음

In our context, faculty development has been one of the major vehicles for empowering others to lead the change initiative.

 

해당 이슈의 중요성이 널리 퍼짐

Knowledge of the importance of the issues became widely recognized as a result of the think tanks and workshops, during which workable solutions appropriate to McGill’s culture and environment were developed.

 

 

워크숍에 다양한 방법 활용

Methods used in the workshops, which included case vignettes, organizing frameworks for matching content to methods, and opportunities for experiential learning and reflection, empowered our educational leaders and colleagues.

 

 

교수들이 다음에 대한 합의를 가지게 됨

In many ways, the faculty development program allowed our faculty members to agree on

• the cognitive base of professionalism,
• the attributes and characteristics of the professional, and
• the behaviors to be encouraged among students, residents and faculty.

 

어떻게 'healing'이라는 개념이 교육 프로그램에 통합될 수 잇는가

It also provided us an opportunity to explore further how healing, a concept that is essential to the medical mandate, could be integrated into our teaching program.19

 

교수들이 다음을 인식하게 됨

Faculty members came to realize

• 학생들과 cognitive base를 소통해야 한다 that the cognitive base of professionalism and healing must be communicated to students, and
• 다양한 교육법, 평가법이 활용되어야 한다 that diverse teaching and evaluation strategies should be used.

 

의사의 두 가지 역할(전문직 and 치유자)에 기반한 학부교육과정의 리뉴얼을 위한 비전

This reflection and discussion also led to a vision for renewal of the undergraduate medical curriculum based on the dual roles of the physician: professional and healer

단기 성공의 성취

Generate short-term wins

Kotter 는 단기 성공이 다음에 중요하다고 강조함

Kotter highlights the importance of short-term wins in

• 변화 촉진 promoting change,
• 노력에 대한 강화(더 노력하게끔) providing reinforcement for the efforts taken,
• 비전과 전략의 미세한 조정 helping to fine-tune the vision and strategies implemented, and
• 모멘텀 수립 building momentum.7,8

 

 

McGill의 사례

In our context, we experienced the following short-term gains:

• 학생 교육과정 The design and implementation of small-group teaching sessions on professionalism in the first, second, and fourth years of the undergraduate curriculum 
• 레지던트 프로그램 The development of a faculty-wide residency teaching program on professionalism 
• 병원에서 Grand Round Departmental grand rounds in local hospitals, reaching out to the departments of medicine, pediatrics, surgery, obstetrics and gynecology, orthopedic surgery, cardiac surgery, thoracic surgery, anesthesia, and emergency medicine 
• 장소-특이적site-specific 워크숍 The delivery of site-specific workshops in diverse hospital departments (e.g., anesthesia, medicine, obstetrics/ gynecology, ophthalmology, surgery)

프로페셔널리즘 평가로 초점을 옮겨감

Our early efforts to promote the teaching of professionalism also led to the need to focus on the evaluation of professionalism.

• 비록 평가를 하고 있지만 개선되어야 함 Although aspects of professionalism were being assessed routinely on in-training evaluations, improvement was needed.
• 또 다른 싱크탱크 Thus, several years after this change initiative started, we held another think tank, this time on evaluating professionalism. It was clear to us that for teaching to be successful, professionalism would need to be evaluated in a more systematic way.
• 20명의 리더와 내용전문가와 함께 워크숍 Thus, we invited 20 educational leaders and content experts to examine methods of evaluating professionalism and to develop the content and methodology of a workshop in this area. At the time, we

• 전문직으로서의 의사와 치유자로서의 의사의 특성이 통합되어야 함 realized that the attributes of a physician as professional and healer had to be integrated for evaluations to be comprehensive; we therefore
• 정의의 수정 added a definition of healing, including the attributes of the physician as healer, which had been developed and agreed on by a work group on healing (as outlined in List 1 and List 2).

 

• 워크숍의 결과로 또 다른 전체교수 워크숍의 세부 계획이 나옴 The outcome was a detailed plan for a faculty-wide workshop, called Evaluating the Physician as Healer and Professional, in May 2002.

전체교수 워크숍. 다음을 수행함 

This workshop was attended by 95 faculty members and focused on developing methods for evaluating the physician as healer and professional at the undergraduate and postgraduate levels by

• defining specific, observable behaviors for each attribute,
• examining different approaches to evaluating professionalism,26,27,50 and
• assessing the benefits and limitations of different evaluation methods (e.g., global rating scales; portfolios; critical incidents).

 

Organizing frameworks 을 활용함.

Organizing frameworks were also used to guide the identification of desirable and undesirable behaviors, the “matching” of methods to behaviors, and the feasibility of different assessment approaches.

 

워크숍의 성과

This workshop

• 평가개선에 대한 합의 led to a consensus on the need to improve the evaluation of professionalism at McGill, and it
• 권고안 resulted in a series of recommendations that were presented to the Faculty of Medicine.

 

 

Kotter가 말한 단기성공의 세 가지 특징: 눈에 보이는 성공, 모호하지 않은 성공, 변화 이니셔티브와 명확히 관련된 성공

According to Kotter, short-term wins usually have three characteristics:

• they are visible,
• they are unambiguous, and
• they are clearly related to the change initiative.

 

 

이 특징을 만족하였다.

In our own setting, these characteristics were achieved. The short-term wins also helped to demonstrate the value of our early efforts, gave us the opportunity to celebrate early successes, and brought additional players into the fold.

성취를 굳히고 더 많은 변화를 만들어내기

Consolidate gains and produce more change

Kotter는 "너무 빠르게 성공을 선언하는 것"이 초반의 성공을 훼손시킬 수 있다고 보았다. 따라서 성취를 굳히고 더 많은 변화를 만들어내는 것이 중요하다. 새로운 프로젝트, 주제, 변화에이전트가 이 과정에 힘을 실어줄 수reinvigorate 있다.

Kotter states that the declaration of “early victory” and resistance to change can undermine early success.8 It is therefore critical to consolidate gains and, often, to produce more change. New projects, themes and change agents can reinvigorate the process.

 

McGill의 사례

 

성취 굳히기의 방법

In our setting, the consolidation of gains occurred in a number of ways.

 

첫번째 워크숍 후 디브리핑 세션이 있었음. 추가적인 활동이 필요하다는 컨센서스가 생김

After the first faculty development workshop on teaching professionalism, a debriefing session took place that involved the workshop planners, the associate deans, and the small-group facilitators. In addition to discussing the workshop process, a consensus emerged that further faculty action was required to ensure that students understood professionalism and behaved according to its precepts.

 

학장단에 보고서가 전달되고, physicianship이라는 용어를 통해서 서로 분리되었지만 상호보완적인 접근법을 갖춘 (교육)프로그랭미 필요함을 권고함.

Thus, a report to this effect was sent to the dean and the associate dean responsible for undergraduate education, emphasizing the need to teach the principle that the physician fulfills two roles: that of healer and professional. This report, which used the word physicianship—a term already used by Cassell51 and Papadakis and colleagues52 to refer to these dual roles— recommended that a distinct program on physicianship be established, based on separate, but complementary, approaches to the healer and the professional. It also included numerous detailed suggestions for teaching strategies across all four years of the curriculum.

보고서는 교육과정 위원회가 검토함. 세 개의 working group을 설립함.

This report was reviewed by the curriculum committee, which is chaired by the associate dean responsible for undergraduate education. This committee chose to establish three working groups consisting largely (but not entirely) of individuals who had been involved in the faculty development program on professionalism.

• The mandate of the first was to recommend a curriculum on teaching professionalism.
• The second working group focused on the teaching of the healer role.
• The third was established to look at new ways of evaluating the physician as healer and professional, as it was recognized that a system of evaluating students had to be linked to the teaching of physicianship.

이 working grup의 권고안은 이후 교수개발활동의 근간을 이룸. 권고안의 주요 내용은 다음과 같음.

The recommendations of these working groups, some of which evolved directly from the faculty development workshops, and all of which enjoyed the strong support of the dean, formed the basis of subsequent faculty development activities aimed at supporting and informing curricular change. Briefly, these recommendations suggested that we should:

• establish a longitudinal four-year program on physicianship that would include specific activities devoted to teaching the roles of the healer and the professional; 
• create new learning experiences and regroup existing successful activities under the umbrella of physicianship; and 
• revise McGill’s evaluation system.53

이 권고안에서 강조한 것들은.. 

These recommendations also stressed

• Physicianship의 인지적 토대를 명시적으로 교육할 것 that the cognitive base of physicianship be taught explicitly and
• Physicianship에 대해서 성찰할 기회를 교육과정 전반에 걸쳐 제공하기 that opportunities for reflection on physicianship be provided throughout the curriculum.
• 치유자와 전문직의 두 가지 역할을 모두 하기 위한 의사소통기술의 중요성 The importance of communication skills to the dual roles of healer and professional was also recognized,

 

의사소통기술에 대한 전체교수 워크숍. Calgary–Cambridge model을 도입함

and a faculty-wide workshop on teaching communication skills was organized in February 2004.

The goal of this workshop, which welcomed 80 faculty members, was to introduce and explore different models of teaching communication skills, and after the workshop, a newly established committee recommended that we implement the Calgary–Cambridge model,54,55 a successful model of teaching communication skills, at McGill.

 

교육과정 개편을 위한 구체적이고 세부적인 권고안 작성을 위한 task force 설립

Finally, the recommendations of the three working groups, as well as the committee on teaching communication skills, were discussed by a special task force mandated to make specific, detailed recommendations for curricular renewal. The task force report56 was approved by the curriculum committee, the dean, and the faculty executive; it was also endorsed by the entire faculty leadership, including departmental chairs, at a retreat specifically devoted to curricular change.

(조직)문화에 새로운 접근법을 고정시키기

Anchor new approaches in the culture

 

Kotter에 따르면 조직을 변화시키기 위한 마지막 단계는 새로운 접근법을 조직의 문화에 institutionalize하는 것(institutionalize the new approaches in the culture of the institution)이다. 새로운 행동과 문화적 규범을 연결(connections between new behaviors and cultural norms)시키고, 리더십 개발과 연속성을 확고하게 하는 것(ensure leadership development and succession)을 말한다

According to Kotter,7 the final step in transforming an organization is to institutionalize the new approaches in the culture of the institution. This refers to articulating the connections between new behaviors and cultural norms and developing the means to ensure leadership development and succession.

 

 

부분적으로는 FD워크숍에서 나온 제안들을 바탕으로 학부교육과정의 major revision이 이뤄짐

New approaches are being anchored in the culture of the Faculty of Medicine at McGill University by implementing a major revision to the undergraduate curriculum based, in part, on the different suggestions made during the faculty development workshops. Moreover, endorsement of curricular renewal at the Faculty of Medicine retreat led to the following recommendations, all of which have now been implemented.

▪ The overall organization of the scientific and clinical aspects of the systems-based curriculum should remain unchanged.

▪ A longitudinal four-year course, addressing the role of the healer and the professional, should be established under the umbrella of physicianship.

▪ There should be separate activities devoted to teaching the roles of the physician as healer and professional.

▪ There should be class-wide “flagship activities” devoted to physicianship on a regular basis throughout the four years of instruction; these would include the body donor service and the white coat ceremony.

▪ Existing and successful learning experiences should be regrouped under a series of courses on physicianship; this would include the teaching of ethics, spirituality, and palliative care medicine.

▪ Emphasis should be placed on providing a cognitive basis for the role of the healer and the professional and creating regular, stage-appropriate opportunities for experiential learning and reflection on the two roles throughout the four years of undergraduate education.

 

▪ A mentorship program, using respected role models, should be established. The mentors, called Osler Fellows, would work with six medical students, who would remain with themfor four years. A separate series of faculty development workshops, specifically designed for the Osler Fellows, would help to build a sense of community, ensure understanding of the objectives and methods of the proposed program, and foster the acquisition of new skills such as narrative medicine57 and reflective practice.38

 

▪ The mentors should supervise the creation of a physicianship portfolio for each student. The portfolio,58 which would include material relevant to the roles of the healer and the professional, should be paper based, designed to promote self-reflection, and not used for summative evaluation.

▪ Each student should be required to pass the physicianship course before proceeding to the next year.

▪ It would be important to establish a revised system of evaluating professional behaviors. A pilot study of a new method, the Professionalism Mini-Evaluation Exercise (P-MEX),59 a modification of the mini-CEX60 that grew directly out of the workshop called Evaluating the Physician as Healer and Professional, has been completed. A revised global assessment form, using the behaviors identified in the workshop, has been designed and is now being used in the undergraduate program. We are also considering the implementation of a system for student evaluation of faculty professionalism.

▪ The associate dean responsible for undergraduate medical education should complete his term and become the director of the office of curriculum development. Several faculty members would be chosen to serve as directors of different aspects of the new physicianship program.

▪ A review of many of the elements of the clinical method (e.g., the template for the written case report; the physical examination) should be undertaken by the Faculty of Medicine.

▪ A revised and expanded course on communication skills should be instituted, based on the Calgary– Cambridge guides to the medical interview.54,55

▪ External consultants, including Drs. Eric Cassell and Rita Charon, should assist in the implementation of the new curriculum and the evaluation of its impact.

고찰

Discussion

중요한 점들

Clearly, a number of factors, including strong support from the dean and other educational leaders, have played a critical role in this change initiative. It must also be stressed that the curriculum has evolved during the past 10 years, and many of the flagship activities had been in place for several years and were functioning well.

 

평가는 이르다

It is also too early to assess the results of our curriculum, which is still a “work in progress.” Although the educational blueprint is in place, additional activities need to be planned and implemented, and, as is true with any curriculum, there will undoubtedly be unforeseen events requiring adjustments.

 

앞으로 할 일

In the short term, we need to introduce activities into each major academic unit of the curriculum to allow for experiential learning of the roles of healer and professional. Also, the importance of residents in the learning experience of medical students has led us to recognize that further education of residents as role models is required.

 

The identification of behaviors indicative of professional values and the development of the P-MEX has allowed us to begin to address the issue of evaluation, but we, along with most of the profession, must still do better, and we must begin to evaluate the professionalismof our faculty members.

54 Kurtz S, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching: enhancing the Calgary– Cambridge guides. Acad Med. 2003;78: 802–809.

56 Faculty of Medicine, McGill University. Report of Task Force on MDCMCurriculum Renewal. Available at: (http://www.medicine. mcgill.ca/physicianship/reports.htm). Accessed July 26, 2007.

59 Cruess R, McIlroy JH, Cruess S, Ginsburg S, Steinert Y. The professionalismmini- evaluation exercise: a preliminary investigation. Acad Med. 2006;81:S74–S78.

60 Cruess SR, Johnston S, Cruess RL. “Profession”: a working definition for medical educators. Teach Learn Med. 2004; 16:74–76.

 

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Acad Med. 2007 Nov;82(11):1057-64.

Faculty development as an instrument of change: a case study on teaching professionalism.

Steinert Y1, Cruess RL, Cruess SR, Boudreau JD, Fuks A.

Author information

• 1Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. yvonne.steinert@mcgill.ca

Abstract

Faculty development includes those activities that are designed to renew or assist faculty in their different roles. As such, it encompasses a wide variety of interventions to help individual faculty members improve their skills. However, it can also be used as a tool to engage faculty in the process of institutional change. The Faculty of Medicine at McGill University determined that such a change was necessary to effectively teach and evaluate professionalism at the undergraduate level, and a faculty development program on professionalism helped to bring about the desired curricular change. The authors describe that program to illustrate how faculty development can serve as a useful instrument in the process ofchange. The ongoing program, established in 1997, consists of medical education rounds and "think tanks" to promote faculty consensus and buy-in, and diverse faculty-wide and departmental workshops to convey core content, examine teaching and evaluation strategies, and promote reflection and self-awareness. To analyze the approach used and the results achieved, the authors applied a well-known model by J.P. Kotter for implementingchange that consists of the following phases: establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, generating short-term wins, consolidating gains and producing more change, and anchoring new approaches in the culture. The authors hope that their school's experience will be useful to others who seek institutional change via facultydevelopment.

PMID:

 

17971692

 

[PubMed - indexed for MEDLINE]