논문 프로포잘 양식(질적 논문)

1. 연구제목 혹은 주제

2. 연구의 필요성과 목적

3. 연구 맥락을 이해하기 위한 문헌고찰 / 선행연구의 개관

4. 연구문제 / 연구 질문

5. 연구방법: 방법, 참여자, 표집, 자료수집방법, 분석방법, 연구의 윤리

6. 연구의 타당성

7. 예비결과

8. 연구의 의의

9. 참고문헌

10. 부록

※ 프로포잘 작성의 구체적인 예는 다음 자료를 참고하시기 바랍니다.

합의적 질적 연구법(Consensual Qualitative Research)을 사용하는 논문계획서 작성기준

● Przeworski와 Salomon(1988)은 모든 논문계획서를 심사하는 사람들이 다음 세 가지 질문에 대한 해답을 찾는다고 한다. 

1) 제안된 계획서의 결과로서, 지금까지 알고 있지 못했던 어떤 것을 우리는 알 수 있게 되는가? 

2) 왜 그것은 알만한 가치가 있는가? 

3) 그 결과가 타당하다는 것을 우리는 어떻게 알 수 있는가?

첫 번째와 두 번째 질문에 대한 해답은 연구자들이 자신이 연구하려고 하는 주제 에 대해 기존의 이론이나 선행연구들을 충실하게 검토하면 할수록 더 명확하게 전 달될 수 있다. 연구자들은 선행연구들을 존중하면서도 한편, 비판적인 안목을 갖고 그것의 한계와 문제점을 인식할 수 있어야 한다. 질적 연구에서는 선행연구 뿐 아 니라 연구자 자신의 개인적 경험에 대한 반성과 실천적 목적에 대한 고려도 중요하 다. 이러한 과정을 통해 나온 연구 질문이라야 자신의 연구의 정당성과 가치를 방 어하고 입증하기 쉬울 것이다. 또한, 연구는 어떤 현상에 대한 새로운 지식이나 통찰 그리고 가치와 의미를 제시할 수 있어야 한다.

세 번째 질문에 대한 해답은 질적 연구에서 특별한 의미를 갖는다. 연구의 타당 성을 확보하는 질적 방법론의 절차를 심사자들에게 이해시키기 위해서, 연구자는 양적 연구방법과 질적 연구방법의 철학적, 방법론적 차이를 명확히 이해하고 있어 야 한다. 타당성과 관련된 문제는 뒤에서 다룰 것이다.

● 논문계획서에는 연구자 자신의 아이디어를 논리적으로 전개해야 한다. 기존이론 이나 선행연구들, 연구방법론에 대한 지식을 백화점식으로 나열해서는 안 된다. 자 신의 연구문제를 도출해내게 된 개인적 경험, 실천적 이유, 그리고 기존이론 및 선 행연구들의 모순이나 한계를 보여주는 것이 더 설득력 있을 것이다.

● CQR은 비교적 협소한 특정현상(예로, 상담관계에서 일어나는 전이현상)을 경험 한 소수의 참여자들을 집중적으로 연구하는데 적합한 질적 연구방법이다. 분석 데 이타는 대개의 경우 참여자들의 언어적 자료이며, 다수의 공동 평정자 및 감사들을 활용함으로써 연구의 타당성을 확보하려고 한다. 연구자는 자신의 연구목적을 달성 하는데 CQR이 적당한 방법인지 검토해야한다.

1. 서론 / 연구의 목적과 필요성

서론에는 연구자가 어떤 현상을, 왜 연구하고 싶은가에 대해 개요를 기술한다. 여기에서는 연구의 목적이 명확히 제시되어야 한다. 질적 연구의 목적은 연구적 목 적과 더불어 개인적 목적이 포함될 수 있다. 

• 연구적 목적에는 특정한 경험을 가진 참여자들의 경험에 대한 의미의 이해, 그러한 경험을 발생시키는 맥락에 대한 포괄 적인 이해, 특정사건이 발생하는 과정에 대한 이해 등이 포함된다. 

• 개인적 목적에는 연구자들이 이 연구를 하도록 동기화시키는 사적경험들, 실천적 이유들이 포함될 수 있다.

또한 연구의 필요성 혹은 정당성에 대해 설명하여야 한다. 기존의 이론이나 연구들의 한계(기존 연구의 부족도 포함) 혹은 기존 연구자들의 추후 연구를 위한 제안 사항, 개인적 경험 등이 연구의 필요성을 설명하기 위해 언급될 수 있다. 이 연구를 통해 얻을 수 있는 새로운 지식과 이해가 가치 있는 것인가? 누구를 위해 그리고 어떤 방식으로 유익한가에 대한 설득력 있는 논리를 개발하는 것이 필요하다.

2. 연구맥락 / 선행연구의 개관 및 문제점

자신이 연구하고자 하는 현상 혹은 문제에 대한 선행연구와 이론들을 논의한다. 그러나 이론이나 선행연구를 단지 요약하거나 제시해서는 안 되며, 자신의 연구에 대한 토대와 정당성을 확보하기 위한 근거로서 이들을 활용해야 한다. 질적 연구에 서 연구자는 문헌을 무비판적으로 따르기 보다는 비판적인 주관성을 갖고 문헌으로 부터 쟁점과 한계를 읽는 눈을 계발해야한다. 이를 위해 연구자는 연구현상에 대한 자신의 개인적 경험과 지식을 적절히 활용할 필요가 있다.

3. 연구문제 / 연구질문

연구 질문은 연구계획서의 가장 핵심적인 부분이다. 연구 질문은 연구의 목적이 나 필요성과 논리적으로 연결되어야한다. 즉, 이러한 연구 질문이 연구의 목적을 달 성할 수 있는 응답을 이끌어 낼 수 있는가 계속해서 질문해야 한다.

좋은 연구 질문은 명확하게 초점이 있어야 한다. 특히 CQR은 비교적 좁은 범위 의 현상을 집중적으로 연구하는 방법이므로 주제에 대한 물음들을 미리 만들어 보 는 것이 좋다. 그러나 명확하게 초점이 있는 질문과 지나치게 구체적인 질문 혹은 연구자의 의도를 이끌어내는 질문을 잘 구분해야한다. 질문은 개방적이어야 하지만 연구의 초점에 대한 일관성 없이 마구잡이식의 자료 수집은 곤란하다.

연구계획서에 포함될 초기 질문은 대략 3-5개 정도가 적당하다. 초심연구자들이 라면 초기질문에 대한 하위질문들을 미리 만들어보는 것이 좋다. 연구 질문은 인터 뷰가 진행됨에 따라 달라질 수 있으나, 초기 질문은 연구하려는 현상에 대해 연구 목적과 관계된 대답을 이끌어 낼 수 있도록 중요한 초점들을 담고 있어야 한다. 예비연구를 수행하고 있다면, 인터뷰 전과 후에 연구자가 생각한 질문내용이 어떻게 변화했는지를 계획서에 제시하면 더 설득력이 있을 것이다. 이 밖에 연구 질문과 관련된 주의사항은 질적 연구 방법론 책들을 참고하기 바란다.

4. 연구방법 / CQR소개, 연구참여자, 표집, 자료수집방법, 분석방법, 연구의 윤리.

연구방법에는 우선 자신의 연구목적을 이루기 위해 왜 질적 연구를 그 중에서도 CQR을 선택했는가를 설명한다. 어떤 방법론을 선택할 것인가는 연구의 목적 그리 고 질문과 논리적인 연결이 이루어져야 한다.

연구 참여자들과 연구자간의 관계에 대해 제시한다. 만약, 이중적 관계(예를 들 어,연구자와 상담자 혹은 치료자)에 놓여있다면, 그로인한 윤리적 문제나 연구타당 성 문제를 어떻게 해결할 수 있는지 방안이 제시되어야 한다.

CQR에서 연구 참여자의 표집은 목적적 표본 추출 방법을 사용한다. 이것은 특정 한 기준에 부합되는 사람들을 연구 참여자로서 선정하는 것을 말한다. 연구 참여자 는 연구하려는 현상을 경험했어야 하며 그것을 적절히 표현할 수 있는 사람이어야 한다. 연구현상에 대한 경험이 최근이어야 한다(예로 3개월 이내)는 기준을 정할 수 도 있다. 중요한 점은 연구 참여자는 연구자가 연구 질문에 대한 대답 을 얻을 수 있는 사람이어야 한다는 것이다. 연구 참여자의 대표성 혹은 전형성은 연구의 타당성이나 일반화 가능성(물론 질적 연구에서 일반화가능성은 그리 중요한 이슈가 아니다)을 높일 수 있다. 계획서에는 왜 이 사람들을 특정한 세팅에서 인터 뷰하려고 하는지를 설명한다.

CQR에서 자료수집 방법은 대개 언어적 자료에 의존한다. 인터뷰를 통한 녹음, 메모 등이 주요도구가 된다. 그러나 자료수집에서 삼각검증(triangulation)으로 알려 진 다층적 자료 수집을 할 수 있다면, 결과의 타당성을 확보하는데 좋은 근거가 된 다. 예를 들어, 명상경험에 대한 질적 분석에서 참여자 뿐 아니라 지도자로부터도 자료를 모은다면 더 타당성 있는 결과를 얻을 수 있을 것이다.

CQR의 자료분석 방법은 체계적인 절차를 제공해주고 있으므로 초심자들도 비교 적 손쉽게 따라할 수 있을 것이다. 공동 평정자 팀 및 감사의 구성을 어떻게 할 것 인지 기술한다. 영역설정, 중심개념, 범주생성, 교차 타당화, 감사과정, 데이터의 패 턴 발견하기(예를 들어 영역들 간의 경로생성) 등의 자료 분석 절차를 간단히 제시 한다.

5. 연구의 타당성

연구자는 자신의 연구에서 타당성을 훼손할 수 있는 요소들을 제거하는데 최선의 노력을 해야 한다. 연구 설계 단계에서 타당성 위협요소를 통제하려는 양적 연구와 달리, 질적 연구에서 결과의 타당성과 관련된 가장 중요한 문제는 자료로부터 도출 된 연구결과(연구자의 해석, 설명, 도출한 패턴 등)와는 다른 대안적인 가설들을 어 떻게 배제시킬 것인가이다. 연구자는 우선 데이터를 분석하여 결론을 도출한 후, 도 출된 결론을 반증하는 데이터가 있는지를 면밀히 재검토해야 한다. CQR에서 이러 한 작업은 연구자, 공동 평정자 그리고 감사의 공동과업이기도 하다.

질적 연구의 타당성을 위협하는 가장 큰 문제는 연구자의 편견과 반응성이다. 연 구자들(공동 평정자와 감사를 포함한)은 연구하려는 현상(혹은 연구 참여자들)에 대 한 각자의 이론이나 선입관을 충분히 인지해야 하며(하나의 방법으로 자료 분석전 메모를 활용하여 편견들을 적고 함께 논의할 수 있다), 연구자가 연구 참여자에게 미치는 영향인 반응성에 대해서도 고려해야 한다. 질적 연구에서는 연구자가 연구 참여자에게 미치는 영향을 최소화하려는 노력을 하는 대신, 이를 이해하고 생산적 으로 활용하는 것이 중요하다(예를 들어 연구문제가 사회적 혹은 도덕적으로 민감 한 문제라면 면접에서 나온 결과보다는 질문지를 활용하는 것이 더 나을 수 있다).

이 밖에 질적 연구의 타당성을 확보하는 방법으로 삼각검증(자료수집의 다양화), 참여자선정에서 엄격한 기준제시, 다수평정자의 사용, 참여자 확인(도출된 결과를 참여자에게 확인하는 것), 양적인 자료들의 활용 등이 있다.

6. 예비결과

연구자가 이미 연구를 시작했다면, 지금까지의 연구과정과 잠정적인 연구결과 그 리고 본 연구를 위한 제안사항 등을 제시할 수 있다. 예비연구는 연구의 실행가능 성을 증가시키고, 연구 질문을 정교화하며, 연구의 필요성과 가치를 부각시킬 수 있 다는 점에서 적극 추천한다. 질적 연구에서는 1-2명 정도의 참여자를 대상으로 자 료를 모으는 것으로도 자신의 연구전반에 걸친 훌륭한 통찰을 얻어낼 수 있을 것이 다.

7. 연구의 의의

여기서는 앞에서 논의된 연구의 목적, 필요성, 그리고 연구의 예상되는 공헌 사항 들을 제시한다. 이와 같은 연구를 해서 무엇을 하자는 것인가? 에 대한 답변들이 있어야 한다.

8. 참고문헌

9. 부록

부록에는 연구 진행 계획표, 연구참여동의서, 설문지(참여자들의 인구통계학적 자 료수집을 위한), 인터뷰 질문항목들, 예비연구가 있다면 참여자 정보, 메모노트 등 이 포함된다.

160517 국문참고문헌 2. 논문 프로포잘 양식(질적연구 CQR).pdf

의학교육의 변화: CBME가 옳은 접근법인가? (Acad Med, 2016)

Transforming Medical Education: Is Competency-Based Medical Education the Right Approach?

Michael E. Whitcomb, MD

지난 15년간 미국 뿐 아니라 전 세계의 대학의학 커뮤니티의 많은 사람들이 CBME를 지지해왔다. 이 움직임은 1999년 ACGME가 새로운 GME프로그램 개발/시행/평가를 위한 여섯 개의 general competencies를 제안하면서 시작되었다.

During the past 15 years, various individuals within the academic medicine community have advocated for the development of a competency-based approach for reforming medical education in the United States, and around the world. The movement had its formal beginning in 1999 when the Accreditation Council for Graduate Medical Education proposed a set of six general competencies that were to be used in establishing a new framework for designing, conducting, and evaluating graduate medical education programs.1

동시에, 의학교육계의 여러 사람들이 CBME는 ill-conceived하며 의학교육의 질을 저하시킨다고 주장했다.

At the same time, other members of the medical education community have argued that the CBME movement is ill conceived and actually threatens to undermine the quality of medical education.2

이번 호에서 ICBME Collaborators는 헌장charter를 제안하며 "CBME가 널리 도입되고 전세계 의학교육계가 이 여정과 함께할 수 있는 길을 구축하는 데" 도움이 되기를 바란다고 하였다.

In an article appearing in this month’s issue of the journal, a group of International Competency-Based Medical Education (ICBME) Collaborators have proposed a charter that they hope will help them “forge a path toward the goal of widespread implementation of CBME and to invite the worldwide medical education community to travel with [them] on this journey.”3

의학교육에서 CBME란 무엇인가?

What Does This Mean for Medical Education?

우선, 나는 의학교육을 변화시켜야 할 강력한 요구가 존재함에 동의한다.

To begin, I agree that there is a compelling need to transform medical education in this country to better prepare new physicians for the practice of medicine.

의학교육프로그램은 새롭게 양성되는 의사들이 진료를 시작했을 때 임상적 역량을 갖추었을 수 있게 설계되어야 한다고 믿는다. CBME를 도입하는 rationale이 "새롭게 양성되는 의사들이 진료practice에 준비될 수 있게 한다"라는 점은 말이 된다.

I believe that medical education programs should be designed and conducted in ways that aim to ensure that new physicians are clinically competent whenthey enter practice. Thus, the rationale for employing CBME in preparing new doctors for practice makes good sense.

내 관점에서, 의학교육계는 CBME지지자들이 말하는 것, 즉 임상역량의 결정은 졸업이나 수련을 마칠 당시에 한 차례의 총괄평가에만 기반해서는 안 되며, 각각의 역량 영역 - milestone - 에 대한 발전과정을 지속적으로 평가해야 한다는 것, 을 반드시 address해야 한다. 이러한 권고가 특히 문제가 있는 지점은, 각각의 역량을 individually 평가할 수 있다는 확실한 근거가 없다는 데 있다.

From my perspective, the medical education community must address the position advanced by CBME advocates that the determination of clinical competence may not be based solely on a summative assessment of a trainee’s ability to provide high-quality care at the time the trainee completes his/her training, but that indicators of progress in each of the competency domains—the milestones—must be continuously evaluated as the trainee progresses through each stage of the educational process. The approach recommended is particularly problematic because there is no convincing evidence that it is possible to assess each of the competencies individually.4

CBME가 완전히 도입된다고 했을 때 생길 문제도 있다. 실제로 2010년 ICBME Collaborators는 CBME 시스템을 도입하기 위해서 극복되어야 할 "CBME의 일곱개의 주요 위험과 과제"를 제시한 바 있다. 이들은 의학교육계가 이 문제를 슬기롭게 해결하기 위한 노력에 동참해주기를 요청했다. 5년 이상이 지났지만, 여전히 그 문제는 해결되지 않고 있으며, 심지어 ICBME Collaborators는 이번 문헌에서 CBME가 더 나은 의사를 양성한다는 근거가 하직까지 없음을 명확히 밝히고 있다.

The reality that institutions will face a major challenge if a CBME system is fully adopted is well recognized. In fact, in 2010, the ICBME Collaborators presented a list of seven major “potential perils and challenges of CBME” that would have to be overcome to implement a CBME system, and they called on the medical education community to engage in efforts to determine how best to resolve the issues of concern.5 Now, more than five years later, those issues have not been resolved, and even more important, the Collaborators state clearly in their current article that there is currently no proof that the implementation of CBME would produce better doctors.

CBME를 지지하는 사람들의 주장의 타당성을 검증하는 것이 규제기구와 전문직기구가 CBME system의 도입을 강제하기 전에 이루어져야 한다. 왜냐하면 이를 위해서 엄청난 자원이 요구사항을 맞추기 위해서 투입될 것이기 때문이다. 그러나 현실에서 CBME시스템 도입을 지지하는 사람들의 입장은 theoretical construct에 머물고 있다.

I believe the claims being made by CBME advocates should be verified before steps are taken by regulatory and professional bodies to mandate the implementation of a CBME system that will require that substantial resources be committed to implement and conduct the system requirements. In reality, the position taken by those advocating for the implementation of a CBME system is so far based solely on a theoretical construct.

CBME가 더 나은 의사를 양성한다는 것을 보여줄 수 있는더 자세한 연구 아젠다가 필요하다.

A detailed research agenda that will provide a clear understanding of the value of CBME in producing better doctors is clearly needed.6

진정한 도전

The Real Challenge

나는 의료의 퀄리티가 낮은 것은 현재 진료중인 의사가 임상역량을 유지하는데 실패해서 생기는 경우가 더 흔하며, 학생이나 전공의가 그들의 교육과 수련을 마칠 때 임상적으로 충분한 역량을 갖추지 못했기 때문이라고 생각하지 않는다. 현재 진료중인 의사들의 의료행태를 모니터링하는 접근법은 매우 부족하다. certification과 relicensure에 필요한 프로세스는 의료의 질에 대한 진정으로 유의미한 그 어떤 척도도 포함하지 않고 있다.

I believe that medical care that is of poor quality is more often caused by practicing physicians who have failed to maintain their clinical competence, rather than by physicians who were not clinically competent when they completed their residency training and entered practice. The fact is that the approaches now in place for monitoring physicians’ practice behaviors are grossly inadequate. The fact is that the processes employed to grant maintenance of certification and relicensure do not include any truly meaningful measures of the quality of care being provided by physicians.7 At

4 Lurie SJ, Mooney CJ, Lyness JM. Commentary: Pitfalls in assessment of competency-based educational objectives. Acad Med. 2011;86:412–414.

5 Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: Theory to practice. Med Teach. 2010;32:638–645.

Transforming Medical Education: Is Competency-Based Medical Education the Right Approach?

CBME 진보: 임상가-교육자를 위한 헌장(Acad Med, 2016)

Advancing Competency-Based Medical Education: A Charter for Clinician–Educators

Carol Carraccio, MD, MA, Robert Englander, MD, MPH, Elaine Van Melle, PhD, Olle ten Cate, PhD, Jocelyn Lockyer, PhD, Ming-Ka Chan, MD, MHPE, Jason R. Frank, MD, MA(Ed), and Linda S. Snell, MD, on behalf of the International Competency-Based Medical Education Collaborators

Background

국제적으로 CBME는 다양한 프레임워크로 도입되었음

Internationally, CBME is being adopted under a variety of frameworks, including

• CanMEDS,3

• the Accreditation Council for Graduate Medical Education competencies,4

• the Scottish Doctor Outcomes,5 and

• the Australian Curriculum Framework for Junior Doctors.6

이 헌장에서는 ten Cate의 CBME정의를 적용함: 하나 혹은 그 이상의 의료역량medical competencies에 해당하는 적절한 수준의 능력을 목표로 하는 의료전문직을 위한 교육

For the purposes of this charter, we adapt a definition of CBME recently proposed by ten Cate7: education for the medical professional that is targeted at a necessary level of ability in one or more medical competencies.

CBME가 도입된 이후, resource-intensive한 교육시스템을 도입하는 것에 대한 우려가 많았으며, 그것이 정말 더 나은 의사를 만드는 것인가도 증명되지 않았다. 그러나 CBME의 효과성에 대한 공식적 근거가 부족하더라도 우리는 이 모델을 지향해야 할 두 지식체bodies of knowledge를 가지고 있다. 첫 번째는 CBME의 building block이라 할 수 있는 교육이론이다.

Since the introduction of CBME, many concerns have been raised about implementing a resource-intensive system of education and training that is as yet unproven as a means of producing better doctors.8 However, if formal evidence of the effectiveness of CBME is lacking, we do have two bodies of knowledge that support the move to this model. First are sound advances in education theory that serve as the building blocks of CBME:

• 명확하게 정의된 성과 the importance of clearly defined outcomes,

• 학습자가 authentic setting에서 능동적 역할을 담당 learners taking an active role in their education and assessment within an authentic clinical setting, and

• 다수의 평가자와 다수의 방법을 이용한 형성적, 집중 피드백 formative and focused feedback from multiple assessors using multiple methods.9,10

두 번째는 우리는 우리의 현재 시스템이 최선의 의사를 양성하기에 부족하다는 근거가 충분하다. 의료과오에 대한 여러 문헌들.

Second, we have ample proof that our current system falls short of producing the best possible doctors:

• An Institute of Medicine (IOM) report,11

• the Canadian adverse events study,12 and

• adverse events and near-miss reporting in the United Kingdom13

...have documented high rates of preventable medical errors.

현재까지 CBME 도입에 대한 여러 장애물이 있어왔다.

Major barriers to CBME implementation to date have included

• (1) the time- and resource-intensive nature of competence assessment, which requires direct observation by multiple assessors in multiple settings;

• (2) the need for faculty development in teaching and assessing the competencies;

• (3) a misalignment between learning environments and learners’ chosen practice environments;

• (4) the logistical challenges of introducing competency- based advancement into a traditionally time-based system (where advancement is primarily based on satisfactory completion of medical school and prescribed number of years of specialty training); and

• (5) limited investment in health professions education, which accounts for less than 2% of expenditures globally in the health care industry.8,14,15

기본 원칙 Fundamental principles

교육은 반드시 serve하는 인구집단의 건강요구에 기반해야 한다.

Education must be based on the health needs of the populations served.

학부의학교육의 플렉스너적 전통에서는 quality gap과 의료 과오를 낳았다. CBME는 반대로 "해결되어야 할 건강 문제를 정의하고, 건강시스템의 퍼포먼스를 위하여 졸업생에게 필요한 역량을 밝히고, 교육과정이 역량을 달성하고, 성취와 부족한 점을 평가하도록 tailor되어야 한다"

Flexnerian tradition17 for undergraduate medical education (UME), The deficiencies that resulted from this education and training experience were explicitly brought to light by reports on quality gaps and medical errors.11–13,19 CBME, by contrast, “is a disciplined approach to specify the health problems to be addressed, identify the requisite competencies required of graduates for health-system performance, tailor the curriculum to achieve competencies, and assess achievements and shortfalls.”14

이 원칙의 중요성은 Berwick이 말한 "세 가지 목표"에 의해서 지지되며, '더 나은 건강, 더 나은 헬스케어, 그리고 낮은 가격'이다.

The importance of this principle is supported by the “triple aim” of Berwick et al21, which espouses better health, better health care, and lower cost.

CBME는 강조점을 학습자가 어떤 지식을 적용할 수 있는 능력을 보여주게끔 하는데 둔다. CBME는 '기본 역량' 을 다양한 스펙트럼에서 요구하는데, 특정 역량은 직업 궤적에 따라서 선택되며, 학습자는 다음 단계로 나아가기 전에 반드시 역량을 보여주어야 한다. 이 원칙, 즉 "학습성과의 표준화와 학습 프로세스의 개별화" 는 최근 UME와 GME 개혁을 위하여 카네기 재단에서 발간한 보고서에 실린 네 가지 목표 중 하나이다. 또한 CBME에서 발달advancement한다는 것은 전문직정체성형성PIF 에도 근거를 두는데, 이것은 시간에 걸친 성숙 과정으로서 전문직업적 역량 개발의 핵심 요소이다.

CBME shifts the emphasis to the learner’s ability to demonstrate the application of that knowledge. CBME defines a broad spectrum of basic competencies, along with specific competencies aligned with chosen career trajectories, that learners must demonstrate before they advance to the next stage. This principle—“standardization of learning outcomes and individualization of the learning process”—is one of the four goals of the recent Carnegie Foundation report on reforming medical school and residency education.23 It is important to emphasize, that advancement in CBME predicated also on professional identity formation, a maturational process that occurs over time, is an integral component of the development of professional competence.24,25

의사의 양성은 교육, 훈련, 실천의 seamless 연속체에 있어야 한다.

The formation of a physician should be seamless across the continuum of education, training, and practice.

"종점을 염두에 두고 시작하라beginning with the end in mind"는 교육, 훈련, 실천의 전체 연속체가 "좋은 의사란 무엇인가"라는 질문의 공동의 비전으로서 informed될 수 있게 해준다. 이러한 shift는 입학시점부터 시작되어야 하며, 우리로 하여금 premedical candidate가 바람직하게 갖추어야 할 것이 무엇인지를 다시 검토하게 한다. 연속체의 정신을 떠올렸을 때, 이것은 기초의학을 전체 교육 훈련과정에 걸쳐서 통합시키는 것을 말하며, 환자 진료에 어떻게 적용되는지를 명시적으로 연결시켜야 한다.

Adopting a strategy of “beginning with the end in mind” will allow the entire continuum of education, training, and practice to be informed by a shared vision of what it means to be a good doctor. This shift must begin at the point of admission, requiring us to reexamine what we consider to be the desirable attributes of premedical candidates. In the spirit of the continuum, it also means focusing and integrating core basic science knowledge throughout education and training, and explicitly linking its application to patient care.23

교육과정과 평가의 연속성이 연속체에 걸친 학습을 더 효과적, 효율적, 의미있게 해줄 것이다.

Continuity of both curriculum and assessment across the continuum will make learning effective, efficient, and meaningful.

도출된 넓은 범위의 역량을 포괄하는 교육, 평가, 롤모델링에 대한 헌신

Commitment to teaching, assessing, and role modeling the broad range of identified competencies.

Reaching beyond the traditional goals and objectives related to patient care and medical knowledge, these competencies include communication, professionalism, advocacy, scholarship, leadership, and practice and system improvement.3–6,28 For learners to embrace these compe- tencies as part of their professional formation, they must be made explicit in our curricula.

환자 안전과 학습자의 전문직업적 성장의 균형을 맞추는 supervision에 대한 헌신

Commitment to supervision that balances patient safety with the professional development of learners.

There is a basic core of knowledge and skills that faculty must learn to practice effective supervision Faculty must provide the structure and support to learners to facilitate their progression toward unsupervised practice.

모든 이해관계자들에게 투명성을 갖출 헌신

Commitment to transparency with all stakeholders.

환자. 학습자는 형성적, 건설적, 구체적 피드백을 환자/타 의료직종/동료/교수에게 받아야 하며, 학습자의 발달에 투자되는 모든 이해관계자와 협력해야 한다.

The voice of the patient—collectively and individually—must be attended In turn, the numerous stakeholders in health care deserve transparency regarding achievement of the targeted outcomes. To be able to improve their performance, learners need formative, constructive, and specific performance feedback from patients, other health care professionals, peers, and faculty, requiring collaboration with all stakeholders invested in learner development.

학습자를 empowerment해야 할 헌신

Commitment to the empowerment of learners.

학습자가 다른 것처럼 그들의 교육적 궤적도 모두 다르다. 이 원칙을 적용하기 위해서 우리는 '학습환경'을 '근무환경'까지 확장시켜서 학습자가 궁극적으로 근무할 곳에서 더 많은 시간을 보내게 해야 한다.

The expectation of CBME is that the teacher, the learner, and the learning environment will foster a learner-centered approach that includes individualized learning experiences, feedback, and guided reflection at every step along the career trajectory.30 As all learners differ, so should their educational trajectories. Applying this principle requires that we extend our notion of the learning environment to apply to the workplace, allowing learners to spend more time in the types of settings in which they will ultimately practice.

평가전략과 도구의 효과성과 효율성을 위한 헌신

Commitment to the effectiveness and efficiency of assessment strategies and tools.

다수의 평가자가 필요하다. 첫째, 다양한 이해관계자가 환자 진료에 관여되며 이들은 모두 서로 다양한 관점에서 중요한 기여를 한다. 둘째, 신뢰도를 높이는데는 샘플링이 많아져야 한다.

Multiple assessors are critical for two major reasons. First, many stakeholders are involved with patient care, and they each bring an important and different perspective. Second, reliability is dependent on broad sampling.32

Crossley and Jolly가 말한 바와 같이, 높은 수준의 평가는 '판단'의 문제이고, 이는 '옳은 질문'을 '옳은 방식'으로, '옳은 것'에 대해서, '옳은 사람'이 했을 때 더 가능하다. 즉, 우리의 평가 전략은 우리가 측정할는 construct와 잘 align되어 있어야 한다. 예컨대 팀워크를 평가하기 위해서 우리는 근무지에서의 협력적 행동을 구체적으로 평가할 수 있는 도구가 있어야 한다. construct alignment가 평가자간 일치도를 향상시키고, 저성과자와 고성과자를 구분하는데 도움이 된다는 근거가 있으며, 신뢰도있는 평가를 위해서 필요한 관측의 숫자도 줄여준다.

As Crossley and Jolly33 state, “Because high-level assessment is a matter of judgment, it works better if the right questions are asked, in the right way, about the right things, of the right people.” In other words, our assessment strategies must be closely aligned with the constructs (i.e., the behaviors in health care) we are attempting to measure. For example, if we want to assess teamwork, we need a tool that specifically addresses collaborative behaviors in the workplace.34 There is some evidence that this quality of construct alignment increases rater agreement around learner performance and the ability to discriminate between low and high performers while reducing the number of observations required for reliable learner assessments.35,36

우리가 사용하는 도구는 구조화된 평가 프로그램의 한 부분이 되어야 하며, 그 '효용성'에 의해서 정해져야 한다. van der Vleuten and Schuwirth32이 말한 바와 같이 “multiplicative product of their reliability, validity, cost-effectiveness, feasibility, and educational impact.”을 고려해야 한다.

The tools that we use should be part of a structured program of assessment37 and be guided by their “utility,” which is defined by van der Vleuten and Schuwirth32 as the “multiplicative product of their reliability, validity, cost-effectiveness, feasibility, and educational impact.”

시간이 아니라 역량에 따라서 이행여부가 결정되어야 할 헌신

Commitment to basing transition decisions on competence rather than time.

근무지 평가, 프로그램 평가, 연구를 통한 CBME 발전을 이룰 헌신

Commitment to advancing CBME through workplace assessment, program evaluation, and research.

학습자를 개개인 수준에서 평가하는 것은 역량-기반 발달에 필수적이다. 그러나 집단의 역량collective competence가 평가의 중요한 단위로 떠오르고 있으며, '팀'에 대한 연구는 앞으로 이어질 연구에서 매우 중요한 영역이다. 따라서 우리는 CBME의 복잡성을 잡아내기 위하여 다양한 렌즈를 통하여 관점을 확장시켜야 한다. 교육 연구는 기존의 교육이론을 기반으로 해야 하며, 새로운 이론의 발달에 기여해야 하고, 무엇이 성공했으며, 무엇이 그러지 못하였고, 왜 그랬는지를 보여주어야 한다. 이에 따르면 이 연구는 가설 검증에만 집중해서는 안되며 어떻게 CBME가 adopted and adapted했는지에 대한 우리의 이해를 정교화시켜주어야 한다.

Assessment of learners at the individual level is critical to their competency-based advancement. However, collective competence is emerging as a critical unit of assessment, and the study of teams is an increasingly important area of continued research.39 Accordingly, we must expand our view, using a range of lenses—including multisite case studies41 and developmental42 and realist evaluation40—to capture the complexity of CBME. Education research must draw from and build on existing theories of education, as well as contribute to the development of new ones, in illuminatingwhat worked, what did not work, and why. 43 Accordingly, this research should not focus solely on hypothesis testing but should also elaborate our understanding of how CBME is adopted and adapted as an educational innovation over time.44 

교수개발에 대한 헌신

Commitment to faculty development.

최근에 졸업한 교수를 빼면, 다른 교수들은 자신이 배우거나 평가받지 않은 역량을 가르치게끔 요구받는다. 더 문제를 복잡하게 만드는 것은 20세기 모델에 뿌리를 둔 교육과 21세기 의사에게 필요한 역량의 격차이다.

Unless faculty are recent graduates themselves, they are being asked to teach about competencies that were not formally taught or assessed during their own training. Compounding the problem is the gap between practices rooted in 20th- century models and the required abilities of 21st-century physicians;

두 층위에서의 헌신이 필요하다.

Our commitment must be twofold:

(1) to provide faculty development in teaching and assessing the competencies required of learners, and

(2) to work with those responsible to transform care systems to models that align with our teaching about best practices.15,45

협력에 대한 헌신

Commitment to collaboration.

This collaboration should encompass all the international communities interested or involved in implementing CBME.

Advancing Competency-Based Medical Education: A Charter for Clinician-Educators.

과거를 되돌아보고 미래로: 새로운 세대의 의학교육자에게 보내는 메시지(Med Educ, 2011)

Looking back to the future: a message for a new generation of medical educators

Ronald M Harden

INTRODUCTION

내 삶을 세 가지 시기로 나눠서 볼 것이다.

I will look at my journey in three phases.

• The first 12 years, from 1960 to 1972, I spent in Glasgow, where I developed an interest in medical education that evolved alongside my training as an endocrinologist and my work in research in iodine metabolism and thyroid disease.

• The second phase represents the 30 years from 1972 to 2002, spent in Dundee, where, while continuing to practise as a clinician and a clinical teacher, my interest and commitment increasingly turned to medical educa- tion.

• The final phase of the journey covers the period from 2002 to the present, following my retirement from my post at the University of Dundee, when new opportunities arose.

This was a point made by Christopher Lawrence,2 medical historian to the Wellcome Museum, in a review of the book Retro- spectroscope: Insights into Medical Discovery by Julius H Comroe. Lawrence wrote: ‘His retrospectroscope (a barbarous neologism history) is not the finely honed tool he thinks, but a blunt instrument for bludgeoning the doubtful.’2

제1기: 글래스고에서 의학교육에 대한 관심을 품다

PHASE 1: 1960–1972. DEVELOPING AN INTEREST IN MEDICAL EDUCATION IN GLASGOW

제2기: 던디에서 의학교육을 전공으로 삼다

PHASE 2: 1972–2002. MEDICAL EDUCATION AS A SPECIALTY IN DUNDEE

효과적 학습을 위한 CRISIS 준거(Convenience, Relevance, Individualisation, Self-assessment, Independent learning, Systematic approach) 는 CME분야의 대규모 연구의 결과로부터 유도되었다. 비록 CME영역에서는 편의성, 관련성, 개별성, 자기평가, 관심과 동기, 시스템적 접근(convenience, relevance, individualisation, self-assessment, interest and motiva- tion and a systematic approach)이 확립되어 있었지만, 이러한 아이디어가 학부교육에도 동등하게 적용가능하다.

The CRISIS (Convenience, Relevance, Individualisation, Self-assessment, Independent learning, Systematic approach) criteria for effective learning were derived fromthe findings of large-scale implementation stud- ies inthe fieldof continuing medical education(CME) involving in excess of 50 000 general practitioners.20 Although the concepts of convenience, relevance, individualisation, self-assessment, interest and motiva- tion and a systematic approach were established in the context of CME, these ideas were found to be equally applicableinundergraduate education.

제3기: 지평을 넓히다.

PHASE 3: 2002 TO THE PRESENT. EXPANDING HORIZONS

교훈

LESSONS LEARNED

Ian Stronach는 "승리의 서사"라고 부르는 것에서 성공의 중요성을 지나치게 강조하고, 그럼으로써 불가능한 선례만을 남겨놓고 후계자들에게 잘못된 선로를 놓는 것을 지적했다. 찬양성 글은 교육학적으로 막다른 길이다.

Ian Stronach23 attacked what he called ‘victory narratives’ for their over- emphasis of the importance of success, their laying of false trails and for the impossible exemplars they leave to those who follow. Departure eulogies, he argued, offer a pedagogic dead end for those who remain. I hope this account is not read as such a narrative of victory and I would be dismayed if it was.

교훈1: 사람이 중요하다

Lesson 1: people are important

교훈2: 의학교육의 혁신은 복잡하다.

Lesson 2: innovation in medical education is complex

교훈3: 넛지가 중요하다.

Lesson 3: nudges are important

넛지란 특정 행동을 강요하기보다는 장려하는 방식의 정책 개입을 말한다. 비근한 예로 남자 소변기에 파리를 그려놓은 것과 같은 것이다. 의학교육은 본질적으로 과학적 토대를 둔 social discipline이라는 점을 잊어서는 안된다.

Nudges are defined as policy interventions that encourage rather than mandate certain types of behaviour. The authors cite, as a classic example, the painting of a fly on urinals at Amsterdam airport.24 The use of the pilot OSCE in Dundee to gain its acceptance for use as a formal part of the Dundee final examination is another example of a nudge. Medical education is essentially a social discipline with scientific underpinnings and we should not forget this. Nudges can be important.

교훈4: 학생도 중요한 플레이어이다.

Lesson 4: students are important players

교육과정에 대한 학생의 잠대력을 과소평가해서는 안된다. 이들은 중요한 이해관계자이며 교육과정을 계획하는데 중요한 기여를 할 수 있고, 변화의 동력이 될 수 있다.

It is important not to underestimate students’ poten- tial input to the curriculum. They are important stakeholders; they can make important contributions to curriculum planning and they can be drivers for change.

학생-중심 학습, 독립적 학습에 대해서 논할 때, self-directed learning보다는 directed self-learning을 목적으로 삼는 것이 중요하다. Jon Dron은 교사의 중요한 과제 중 하나는 학생의 발달 단계에 맞춰 학생에게 스스로의 학습에 대해 얼마나 많은 통제권을 부여할 것인가를 결정하는 일이라고 하였다.

When thinking about student-centred and indepen- dent learning, it is important to have as the aim directed self-learning rather than self-directed learning. In his book Control and Constraint in E-Learning, Jon Dron25 made the important point that one of the main challenges for the teacher is to decide at the different stages in students’ development how much control students should be given over their own learning.

학생에 대해 논할 때, 오늘날의 학생은 과거의 학생과 매우 다르다는 것을 인식해야 한다. 우리가 digital immigrants라면 지금의 학생은 digital native이다. 또 다른 점은 학생은 균일한 집단이 아니며 각자가 다른 니즈를 가지고 있다는 점이다. 미래의 핵심 트렌드는 개별 학생의 니즈에 맞는 adaptive learning을 개발하는 것이 될 것이다. 학교의 수월성의 척도 중 하나는 극단에 있는 학생을 어떻게 다루느냐가 될 것이며, 여기에는 고성취 학생과 struggler를 모두 포함한다.

When thinking of students, we need to recognise that students today are very different from the students with whom we studied medicine. We may be ‘digital immigrants’, but contemporary students, as described by Prensky,26 are ‘digital natives’. Another point worth remembering is that students are not homogeneous, They each have different needs. A key trend in the future will be the development of more adaptive learning that is customised to meet the needs of individual students. One measure of excellence of a school should reflect how well it deals with the extremes among its students, including both the high achievers and those who are struggling or in difficulty.

교훈5: 현실적인 해결책을 제공하라.

Lesson 5: offer practical solutions to problems

의과대학의 학장, 교사, 행정가들은 현실적 문제에 대한 답을 원한다.

The dean, teachers and administrators in the medical school expect answers to practical problems.

교훈6: 자기가 하고 있는 것 바깥에서 배울 점이 늘 있다.

Lesson 6: there is always something to learn outside one’s practice

교육자로서 우리는 같은 분야의 저널을 읽고, 학회에 참석하고, 사람들을 만난다. 미국의 교육학자 Royal van Horn은 일 년에 한 번은 관심 분야 외의 교육 컨퍼런스에 참여할 것을 권했다.

As educators, we have a tendency to read journals, attend conferences and communicate with people working in our own area. Royal van Horn, an eminent American educationalist, argued that, once per year, teachers should attend an education conference out- side their own immediate area of interest. I have tried to do just that.

만약 우리가 의학교육에서 진정한 진보를 이루고 새로운 패러다임을 개발하기 위해서는 내용전문가, 교육과정 개발자, 교육학자, 교육공학자, 교육설계가, 심리학자 등의 더 많은 협력이 필요하다. '메디치 이펙트'에서 강조한 것처럼 여러 학문의 교차점에서 진보가 이뤄질 것이다.

I argued that if we are to make real progress in medical education and develop new paradigms, we need to ensure greater collaboration between content experts, curriculum planners, educationists, learning technol- ogists, instructional designers and psychologists. As Frans Johansson27 highlighted in his book The Medici Effect, it is at the intersections between different disciplines that progress will be made.

교훈7: 출판하라.

Lesson 7: publish

내가 다시 산다 해도 내가 한 일을 기록하고 출판하는데 더 큰 우선순위를 둘 것이다. 오늘날에는 더욱 중ㅇ해졌다.

Although I have published well in excess of 400 papers in-peer reviewed journals, if I had to live my life again I would place greater priority on documenting what I did and publishing it. Publishing is even more important today, when professionalismand scholarship in medical education are crucial. As editor of Medical Teacher, however, I see how badly many authors approach the publishing challenge.

교훈8: 역사에서 배우라

Lesson 8: learn from history

Paul Saffo는 '우리의 역사적 거울을 미래를 예측하는 강력한 도구로 사용할 것이며, 과거 사건의 결texture이 현재의 지표가, 그리고 미래의 궤적의 신뢰성 있는 지도가 될 것이다. 다만, 충분이 과거를 돌아봤을 때 말이다'라고 했다.

Paul Saffo, writing in the Harvard Business Review, suggested that, when making a decision, we should look back twice as far as we look forward.28 He argued: ‘…used properly, our historical review mirror is an extraordinary powerful forecasting tool and the texture of past events can be used to connect the dots of present indicators and thus reliably map the future’s trajectory – providing one looks back far enough.’28

교훈9: 독립적인 펀딩을 확보하라

Lesson 9: obtain independent funding

Convincing commercial organisations, professional bodies, philanthropists, patient organisations and governmental funding agencies that they should fund research and development work in medical education was and remains challenging. Arguing the case for funding to the respective body was itself a challenge, but proved to be a useful exercise as it helped to ensure clarity of thinking. It should be recognised, however, that, at a time of financial constraint, the funding of work in medical education is not easy.

교훈10: 즐겨라!

Lesson 10: have fun!

결론

CONCLUSIONS

비록 나에게 훌륭한 동료들이 있지만, 의학교육 혁신에 대한 나의 접근이 언제나 인정받았던 것은 아니며, 모든 사람이 편안해하는 것도 아니라는 사실을 받아들여야 했다. 내 철학은 Ian Stronach의 스펙트럼과 정반대에 있었던 듯 하다. 그는 "이끌지 않음으로써 이끌고, 통제하기보다는 동기를 부여하고, 주도권을 쥐기보다는 주도권을 만들어내고, 공간을 채우기보다는 공간을 만들고, 지시하기보다는 멘토링을 하고, 협력적이고 상대적으로 민주적인 기풍을 만든다'고 했다. 나는 사실 동제하려는 성향이 강하고 진행과정을 막는 사람에 대해서는 참아내지 않았다. 그러나 나를 이끌어준 것은 의학교육의 역할을 통해서 세계world를 도우려는 것이었다. 만약 내가 epitaph를 고른다면, 다음이 딱 적당할 것 같다.

Although I have had many wonderful colleagues, my hands-on approach to innovation in medical education has not always been appreciated and I have had to accept that not everyone is comfortable with it. I suppose that my own philosophy could be defined as located at the opposite end of the spectrum to that of Ian Stronach, who describes his view as one of ‘leading by not-leading, motivating rather than controlling, making rather than taking initiatives, creating spaces rather than filling them, mentoring rather than directing and developing a collaborative and relatively democratic ethos’.23 I have to confess to a more controlling tendency and an impatience with anyone who seems to obstruct progress. What has driven me, however, is more a desire to help to shape the world in so far as this is possible through a role in medical education, rather than to document what has been done in the field. If I had to choose an epitaph, I could think of nothing better than the following West Point Military Academy cadet maxim:

안전보다는 위험을 감수하라. 현명함보다 케어care에 신경쓰라. 현실적인 것을 넘어서 꿈을 꾸라. 가능한 것 이상을 상상하라

‘Risk more than others think is safe. Care more than others think is wise. Dream more than others think is practical. Expect more than others think is possible.’

Appendix S1 Looking Back to the Future: A message for a new generation of medial educators.

Looking back to the future: a message for a new generation of medical educators.

보건의료 "제3의 커브"에 있어서 대학의학의 중요한 역할 (Acad Med, 2016)

Academic Medicine’s Critical Role in the “Third Curve” of Health Care

Harold L. Paz, MD, MS

With more than two decades of experience leading academic health systems and practices, I have watched the world of academic medicine steadily evolve against the backdrop of an enormous and unprecedented structural transformation of U.S. health care.

From the public health movement in the early part of the 19th century,

• to the definition of health by the World Health Organization,2

• the rise of community-based medical schools,

• the conceptualization of the biopsychosocial model of health, and

• measurement of social determinants of health, all in the latter part of the 20th century,

the core elements of this transformation in our health system have been in place for years. The convergence of this work with new payment models distinct from fee-for- service medicine has brought us to a post-Flexner era of population health.

Plotting the Curve of the U.S. Health System

보건의료전달체계 모델은 하나의 모델이 널리 받아들여지면서 성장했다가, 다른 모델이 그 자리를 대체하면서 감소taper하는 양상을 띈다. 커브I (fee-for-service)로부터 커브II (population health)로 옮겨왔으며, 우리는 이제 커브III (소비자-주도 보건의료consumer-directed health care)에 이르렀다. 첫 두 개의 커브가 건강을 제공자와 사업의 관점에서 보는 것이라면, 세 번째 커브는 개개인을 curated health ecosystem의 중심으로 본다.

Health care delivery models can be seen as graphed curves that rise as they are widely adopted and then taper off as another model begins to take their place.3 As quickly as we have moved from Curve I (fee-for-service) to Curve II (population health), we are now crossing over to a new form of consumer-directed health care, or what I call the third curve of health care (Curve III). While the first two curves look at health from a provider and business perspective, the third curve places the individual in the center of a curated health ecosystem.

의사가 아니라 환자가 그들 스스로의 건강을 소유own하고 있다는 인식이 확산되면서, 새로운 자원과 도구가 각 개개인의 소유권을 더 강화시키게끔 해 주었고, care plan에 더욱 adhere하게, 그리고 자신의 웰-빙에 더 책임을 갖는다고 느끼게끔 해주었다. 우리는 이 새로운 도구와 자원을 포용해야 한다(모바일 어플, 원격의료, 가정의료, urgicare 센터, 기타 등등) 의사와 보건의료시스템은 양보다는 질에 더 관심을 두어야 하며reward, 신체의 건강이 행동적 건강과 사회적 건강과 상호의존적임을 설명할 수 있어야 한다.

Recognizing that patients, not physicians, own their health, new resources and tools will enable each individual to take more ownership, become more likely to adhere to care plans, and feel more empowered to take charge of his or her well-being. We must embrace these new tools and resources, such as mobile apps, telemedicine, home health, “urgicare” centers, and other technologies to improve the health of our patients. Physicians and health systems must be rewarded for quality over volume and must be able to address the interdependencies of behavioral and social health on physical well- being.

커브III는 인터넷이나 소셜미디어 등을 통한 경험에 의해서 형성되는 소비자의 기대의 모든 변화에 면역immune이 될 수 없다는 인식으로부터 만들어졌다. 의심할 여지 없이 모든 세 개의 커브가 한동안은 공존할 것이지만, 대규모 데이터와 유전체 분석과 건강정보 분석이 환자-중심의 의료로 갈 것을 보여주고 있으며 우리는 이제 고작 막 상상을 할 뿐이다.

Curve III is shaped by the recognition that health care is not immune to overall changes in consumer expectations driven by experiences with the Internet, social media, and information transparency in other sectors of the economy. Undoubtedly, all three curves will, for a time, coexist, but the convergence of large data sets and analytics with genomics and health information will certainly make good on the promise of patient- centered care in ways we can only begin to imagine.

적응하여 살아남을 수 있는 의사 기르기

Training Physicians Who Can Adapt and Thrive

미래의 의사는?

What will the physicians of the future look like, and how will they operate?

컴퓨터는 공감능력이 없고, 이는 academic medical institutions들이 기술에 의해 남겨진 영역인 인성과 스킬 세트를 개발시키는 것에 중점look for을 둬야 한다는 압박을 주고 있다.

Computers do not offer compassion, and this will increase the pressure on academic medical institutions to look for and develop the personality and skill sets necessary to fill the void left by technology.

의사를 양성함에 있어서 이들이 전문직으로 이뤄진 팀의 리더 역할을 할 수 있게 준비되어야 하며, 보건의료 데이터 분석과 기술을 접목하여 개개인의 건강과 웰니스 경험을 만들어줄 수 있어야 한다. 리더십의 특성(공감, 신뢰, 의사소통, 의지determination, 용기, 진실성, 비전)은 다른 분야와 다르지 않다.

there must be an emphasis on preparing physicians to serve as leaders of teams of professionals that create a health and wellness experience for individuals that combines health care with data analytics and technology. The attributes of leadership, including empathy, trust,  communication, determination, courage, integrity, and vision, are no different in medicine than in any other field.

협력은 우리를 미래로 이끄는 핵심이다. 환자-의사 관계가 유지되기 위해서는 의사는 반드시 가능한 최대한 리더로서 역할을 할 수 있게 훈련되어야 한다.

Collaboration will be the key to leading us into the future. If the doctor–patient relationship is to be preserved, physicians must be trained to serve as leaders to the greatest extent possible.

Academic Medicine's Critical Role in the "Third Curve" of Health Care.

초심자부터 교육전문가까지: 교육자를 위한 TSP (Acad Med, 2006)

From Novice to Informed Educator: The Teaching Scholars Program for Educators in the Health Sciences

Yvonne Steinert, PhD, and Peter J. McLeod, MD

TSP는 흥미롭고 가치로운 여정의 시작일 뿐이다.

The Teaching Scholars Program is but a start on an interesting and worthwhile voyage—from novice to informed educator.

TSP는 Faculty of Medicine at McGill University, in Montreal, Quebec의 프로그램. 교육프로그램의 개발 및 도입과 관련된 교수들의 전문성을 향상시키고, 교육 리더십을 맡을 수 있도록

The Teaching Scholars Program for Educators in the Health Sciences was designed to promote the professional development of health science educators in the Faculty of Medicine at McGill University, in Montreal, Quebec, by increasing faculty members’ expertise in developing and implementing educational programs and taking on leadership roles in education.

1년 프로그램. 주요 주제는 아래 다섯 가지.

The Teaching Scholars Program(TSP), which has been previously described,1 is a year-long program that focuses on five major themes:

• curriculum design and innovation,

• effective teaching methods and evaluation strategies,

• educational program evaluation,

• research in medical/ health sciences education, and

• educational leadership.

University of North Carolina2의 TSP에 inspired되어 시작하였으며, Faculty of Medicine(의학, 간호학, 물리-직업치료, 커뮤니케이션과학 등)의 교수들이 교육 관련 지식과 스킬을 강화할 수 있도록 만든 프로그램. 교육적 원칙과 교육방법에 대해서 배우고, 의학교육의 scholarship울 추구하고, 교육리더로서의 역할에 준비되게 도와줌.

This program was inspired by the Teaching Scholars Program at the University of North Carolina2 and was designed to enable faculty members in the Faculty of Medicine (which includes the schools of medicine, nursing, physical and occupational therapy, and communication sciences and disorders) to enhance their educational knowledge and skills while maintaining their clinical, teaching, and research responsibilities. More specifically, the TSP aims to respond to faculty members’ needs by helping them to learn more about educational principles and methods, pursue scholarship in medical education (through curriculum development, program evaluation, and educational research), and prepare for educational leadership roles.

TSP 개요

The Teaching Scholars Program

매년 3~6명의 펠로우. 1997년부터 총 34명 마침. 대부분은 주로 clinician이다.

The TSP accepts three to six faculty members annually. Since 1997, 34 faculty members from the following disciplines have graduated from this program:

• The majority of teaching scholars have been clinicians, involved in teaching undergraduate, graduate, and postgraduate students.

• Two have been basic scientists.

• At the time of entry, eight of the scholars held an administrative position in medical education (eg, undergraduate or postgraduate program director).

펠로우 모집

• 대상자: 대학 및 협력 교육병원의 모든 보건전문직을 대상으로 함.
  Recruitment for the TSP targets individuals from all health professions in the university and affiliated teaching hospital.

• 대상자: 소속 및 전공 
  Educators from all of the medical specialties, basic science departments, and schools of nursing, physical and occupational therapy, and communication sciences and disorders can apply.

• 프로그램 홍보
  We circulate program descriptions to departmental chairs and divisional directors, undergraduate and postgraduate program directors, and faculty members involved in medical education.

• 제출서류: 자기소개서
  We ask potential applicants to provide a letter outlining their anticipated goals for the program, a description of their proposed educational project, and an explanation of how their involvement in the program will benefit their division or department.

• 제출서류: 추천서 (주임교수의 letter of support 포함)
  We also require two letters of reference, including a letter of support from the applicant’s departmental chair.

• 선발위원회 구성
  The TSP selection committee includes the authors, members of the Faculty Development Office, and a representative from a basic science department, nominated by the dean.

• 모든 지원자를 면접함. 면접 내용
  We interview all applicants and choose the teaching scholars based on

• their stated interest in medical education,

• their previous educational experience,

• the potential value of their educational project to both their department and the Faculty of Medicine, and

• the feasibility of the applicant acquiring “protected time” for the program.

• 프로그램을 이수하기까지 필요한 서포트에 대한 과장 혹은 분과장의 written support 요구함.
  We also require written support from the departmental chair or divisional chief in order to ensure successful completion of the program.

펠로우들이 해야 하는 것: 최소 주당 하루, 1년간. 대부분은 1년 이상 소요됨. "보장된 시간"을 확보하는 것이 늘 문제인데, 그래서 18개월이 넘어가면 graduation을 hold함.

The teaching scholars are expected to devote a minimum of one day a week, for the duration of one year, to complete the program. Although all of the scholars have completed the program requirements, most of them require more than a year to achieve the program objectives; “protecting” time for their course work and independent study is an ongoing challenge. As a result, we hold the TSP “graduation,” which consists of individual presentations and a celebration of excellence, 18 months after the start of the program.

프로그램 참여를 위해서 돈을 내지 않으며, 임상 수입에 대한 손실을 보전받지도 않음. course work와 교육관련 미팅 참석은 지원받음. Annual cost는 약 25000달러.

The teaching scholars do not pay to participate in the program, nor do they receive a stipend for lost clinical income. However, their course work and travel to an educational meeting (or educational site of interest) are paid for by a private donation made to the Faculty of Medicine. The annual cost of this program, which includes course work, travel, and program administration by the Faculty Development Office, is approximately $25,000.

• 대학원 과목 두 개 ▪ two university courses, primarily in the Faculty of Education;

• 월간 세미나  ▪ a monthly seminar, specifically designed for the teaching scholars;

• 교육 프로젝트  ▪ an educational project, which typically consists of curriculum design and evaluation or a research study; and

• 전체교수대상 FD활동 ▪ faculty-wide faculty development activities, which include workshops, seminars, and medical education rounds.

대학원 과목 두 개

University courses

Each scholar participates in two graduate courses in the Faculty of Education or another department at McGill University. Students in these three-credit courses typically meet once a week for three hours over the course of a semester. To date, the majority of scholars have taken courses in the Faculty of Education. These courses have included:

• Teaching and Learning in Higher Education;

• Instructional Design;

• Cognition and Instruction;

• Theories of Teaching and Learning;

• Educational Evaluation;

• Educational Research Methods;

• Qualitative Research; and

• Learning and Technology.

이론적 과목도 있고, 실용적 과목도 있음

A number of these courses address the theoretical underpinnings of teaching and learning and introduce the scholars to the foundations of pedagogy. Other courses are more practical in nature and help the scholars to develop a new course or educational program. For example, the course entitled Teaching and Learning in Higher Education systematically guides the scholars through the steps of course design, from the articulation of goals and objectives to the choice of content and teaching methods and the development of appropriate evaluation tools.1

자신만의 니즈와 교육 프로젝트에 관련된 것을 듣기를 권장함

At the same time, we encourage the scholars to choose courses that address their own educational needs and pertain to their educational project. Thus, they have also taken courses in the departments of

• English (eg, The Meaning of Literacy),

• philosophy (eg, Epistemology; Phenomenology),

• music (eg, The History of Jazz),

• epidemiology (eg, Randomized Clinical Trials), and

• management (eg, Cross Cultural Management; The Art of Leadership).

The scholars appreciate the diversity of courses available to themas well as the flexibility in course selection.

(대학원 과목 이수에 대한) 피드백은 지속적으로 긍정적이다. 새로운 용어 익히고, 배운 내용을 적용시킴

Feedback on the university courses has been consistently positive. When scholars first return from their educational courses, they often report that they are overwhelmed by the “jargon” of pedagogy. However, in no time they are using a different “language” themselves and quickly impress their departmental colleagues with their new vocabulary (eg, concept maps; formative and summative evaluation). They also report that the pedagogical content applies directly to their own courses and projects and provides them with the foundation to pursue new educational initiatives from an informed perspective.

월간 세미나

Monthly seminar

We meet on a monthly basis with the teaching scholars as a group, to review their educational projects, to discuss issues of common interest (eg, methods of student evaluation; qualitative research methods), and to examine topics that arise from the university courses (eg, theories of teaching and learning). These two-hour meetings also facilitate the development of a “community of practice” among the scholars3 and help to promote reflection on educational issues and problems.

• Once a year, we hold a teaching scholars “alumni meeting” and current scholars have an opportunity to hear what previous scholars have achieved. They also learn how the graduates’ educational projects and responsibilities have evolved over time.

• In addition, we have incorporated educational journal clubs (where scholars review an educational article of interest to the group) and discussions with visiting speakers into the monthly seminars. Most meetings also provide opportunities for individual mentorship and peer support.

Feedback from the scholars has indicated that they appreciate the opportunity to sit behind closed doors with one another and reflect on teaching and learning, their educational projects, and their ongoing teaching encounters.

이러한 미팅의 장점

The scholars seem to particularly welcome

• the mutually respectful nature of the meetings,

• the time away from other professional responsibilities, and

• the support they receive from their peers.

교육 프로젝트

Educational projects

처음에는 전체 펠로우에게 프로젝트를 요구하였으나, 현실적으로 가능하지 않아서, (1)교육 연구 프로젝트 (2)교육과정 개발과 평가 중 하나를 선택하는 것으로 바꿈.

Independent study is a key component of the TSP. Originally, we expected all scholars to design and conduct a research study in medical education. However, we quickly realized that many of the scholars wanted to design a new course or curriculum for their students, residents, or peers, and that a completed research project was not feasible within the constraints of a one-year program. Thus, we modified the parameters of independent study to include an educational research project or the development and evaluation of a curricular initiative To date, 22 (62%) of the scholars have focused on curriculum design and evaluation during the TSP.

프로젝트의 목적

The overriding goals of the educational projects are

• to encourage the scholars to focus on a departmental need,

• to buttress the principles discussed in the university courses, and

• to promote scholarly activity in education.

개념과 경험의 통합 기회

they all value the opportunity to focus on a subject that is relevant to them and their department, that enables the integration of course concepts and educational experiences, and that promotes “learning by doing.” For many, their educational project is also a critical factor in their understanding of the value of research in medical education.

교수개발 프로그램

Faculty development activities

The Faculty Development Office in the Faculty of Medicine at McGill University sponsors a variety of activities designed to assist faculty members in their multiple roles (eg, educators, researchers, administrators) and to promote excellence in teaching and learning. Faculty-wide workshops and seminars form an important component of the TSP year, and teaching scholars are encouraged to participate as facilitators or participants.

3~4개 워크숍에 참여. 처음에는 소그룹의 구성원으로 참여. 나중에는 코-퍼실리테이터로 참여

All of the scholars participate in these activities, with each scholar averaging attendance at three or four workshops during the TSP year.

• At the beginning of the program, the scholars generally participate as small-group members;

• by the end of the year, the majority function as co-facilitators and participate in the design and delivery of the educational session.

펠로우의 피드백. 좋았던 점은...

Feedback on this activity has demonstrated the value of

• 무대 뒤에서 일어나는 일을 보게 됨 witnessing what goes on behind the scenes,

• 실제로 활동in action하는 전문가를 보게 됨 observing experts in action,

• 새로운 스킬 습득 acquiring new skills, and

• FD워크숍 설계 프로세스에 대한 이해 better understanding the process of designing a faculty development workshop.

The CV analysis of 26 scholars who participated in the program between 1997 and 2003 showed that 15 of the teaching scholars (60%) have taken on new roles and responsibilities in medical education since completing the TSP. Two former scholars (8%) became associate deans in the Faculty of Medicine, seven (27%) became program directors at the undergraduate or postgraduate level, six (23%) were named directors of major curricular initiatives, and one (4%) took on a major leadership role in a national organization.

Nine of the scholars (35%) became members of our renewed Centre for Medical Education, with two involved as Core Faculty (devoting one day a week to medical education activities at the Centre) and seven as Centre Members (devoting at least one day a month to Centre activities).

In addition to these new roles and responsibilities, 24 of the scholars (92%) who participated in the program between 1997 and 2003 became involved in new educational committees at multiple levels,

새로운 교육적 역할과 책임

New educational roles and responsibilities

Follow-up data indicated that the majority of teaching scholars continued their involvement in teaching

All of the scholars who had developed a course or program during the TSP continued to deliver their curricular initiative, with ongoing refinements and modifications. In addition, 20 scholars (80%) developed new courses, and 13 (50%) designed faculty development activities for their own departments. The majority also continued to participate in faculty-wide faculty development activities, as participants or facilitators. Sixteen scholars (62%) reported that they had become an important resource for their colleagues and were viewed as educational leaders in their own departments,

Twenty-three scholars (90%) have presented aspects of their TSP educational project at a national or international educational meeting. In addition, many became regular attendees of such meetings (eg, the annual meeting of the Canadian Association for Medical Education) and continued to present their scholarly work in these settings.

Eight of the scholars (31%) applied successfully for educationally related grants during the TSP. Six (23%) received additional grants after the completion of the program, and 13 (50%) continued their involvement in educational research. Nine individuals (35%) have published their teaching scholars’ projects in peer-reviewed journals, for a total of 18 publications. Five of the scholars (19%) have pursued advanced studies following their year as a teaching scholar. One completed a masters in education, one received a masters in business administration, and another concluded a masters in public administration. One scholar registered for our newly formed masters in educational and counselling psychology, with a focus on health professions education, and one is a PhDstudent in philosophy. In many ways, the TSP laid the foundation for further learning and professional growth for these scholars.

이득 혹은 성과라고 느낀 것들

Perceived benefits and outcomes

In reviewing the scholars’ year-end and follow-up questionnaires, we noted three major areas of perceived impact:

• 지식과 스킬 향상 increased knowledge and skills,

• 실천공동체에 들어옴 introduction to a “community of practice,” and

• 새로운 커리어 기회 new career paths and opportunities.

Many also commented on the fact that the TSP “allowed” them to focus on developing these skills and characterized the TSP as a “transformational opportunity.”

Most of the scholars remarked upon the benefit of meeting “like-minded colleagues” and being introduced to a network of medical educators.

A growing awareness of a community of educators, and an increasing sense of belonging to this community, was noted by most of our teaching scholars.

Eighteen of the scholars (70%) observed that the TSP helped them to embark upon a new career path and develop new domains of academic activity.

기대하지 않았던 성과

Unanticipated consequences

The TSP has also had several unanticipated consequences at an organizational level. For example, interest in the TSP among residents and fellows has led to the development of a Postgraduate Fellowship in Health Sciences Education.

The TSP scholars’ participation in university courses, given by members of the Faculty of Education, has also opened channels of communication that have led to the development of a masters in educational and counselling psychology, with a focus on health professions education.

결론

Conclusion

프로그램의 주된 제약사항은 '시간'이었고, 프로그램의 시간(기간)과 펠로우들의 시간 모두를 포함함. "이제 막 본격적으로 해보려고 할 때쯤 프로램이 끝났다"

The program’s major limitation is time, both in terms of the scholars’ time and the length of the program. As one scholar commented, “The program was over just as we were getting into our stride.”

Sir William Osler 는 "가르치는 시점에 학생의 입장에 있지 않은 자는 제대로 가르칠 수 없다"라고 하였다.

Sir William Osler once observed, “It goes without saying that no man can teach successfully who is not at the same time a student.” In many ways, this is the strength of our program.

From novice to informed educator: the teaching scholars program for educators in the health sciences.

교수개발을 위한 온라인교육: 문헌 리뷰(Med Teach, 2013)

Online learning for faculty development: A review of the literature

DAVID A. COOK1 & YVONNE STEINERT2

1Mayo Clinic College of Medicine, USA, 2McGill University, Canada

도입

Introduction

교수들이 그들의 다양한 역할을 잘 수행하게끔 준비시켜주고 renew시켜주는 FD이니셔티브는 여러가지 형태가 있을 수 있다. 그러나 다양한 방법들은 로지스틱한 문제, 사회적으로 고립social disconectedness된 느낌, 바쁜 임상 및 연구업무 등으로 제한이 되기도 한다

Designed to prepare – and renew – faculty members for their multiple roles (Bland et al. 1990), faculty development initiatives can take many forms. However, such approaches have been limited by logistical issues (scheduling and physical location), perceptions of social disconnectedness, and the workload of a busy clinical or academic practice (Steinert et al. 2009).

온라인 학습은 하나의 혁신이다.

Online learning may constitute one such innovation. (Sherer et al. 2003).

우리의 personal and professional lives에 컴퓨터와 인터넷 기술이 발달하면서 온라인학습이 지난 10년간 드라마틱한 성장을 한 것은 놀랄 일이 아니다. 한 연구결과를 보면 온라인 CME가 모든 CME활동의 절반을 차지할 것을 예상했다.

With the growing presence of computers and Internet technologies in our personal and professional lives, it is no surprise that online learning has shown dramatic growth over the past decade (Cook et al. 2010a). One study suggests that online continuing medical education (CME) may dominate over half of all CME activities by 2017 (Harris et al. 2010).

온라인 학습의 개요

A brief review of online learning

그러나 이러한 장점에도 불구하고 해결해야 할 문제들도 있다.

However, with these advantages come many challenges.

• 개발하는데 시간과 돈의 투자가 많이 필요하다. 작은 수의 학습자들을 대상으로는 비효율적.
  Online tutorials and simulations typically require a large investment of time and money for development, making them relatively inefficient for small groups of learners (Cook 2007).

• 온라인 토론은 교수자의 시간이 학습자가 늘어날수록 더 많이 필요해지므로 규모의 경제에 해당되지 않는다.
  Economies of scale are also less apparent in online discus- sions, in which demands on instructor time usually increase with each added learner.

• 한 번 만들어진 것은, 기술적인 문제나 교수설계와 같은 것을 온라인에서는 쉽게 바꿀수가 없다irreversibly derail.
  Technical problems or deficient instructional designs can irreversibly derail an online activity, by contrast with a face-to-face course in which a talented instructor can, if needed, improvise and recover.

• 학습자가 자신의 속도에 맞춰서 볼 수 있다고는 하나, 학습의 개별화는 이 정도를 넘지 못한다. Computer-adaptive instruction은 사실상 실현되지 않았으며, 근거도 부족하다.
  While learners can often govern the pace of progress through the course, individualization in an online course rarely goes beyond this; computer-adaptive instruction thus remains at present a largely unrealized possibility, with only sparse evidence evaluating its benefits (Cook et al. 2008a; Landsberg et al. 2012).

• 면대면 접촉이 적어서 고립된 느낌이 있을 수 있다. '온라인 협력'을 포함하다고 해도, 면대면 접촉보다 더 만족socially fulfilling하지는 않을 것이며, 결국 이때문에 engagement와 satisfaction이 낮아진다.
  Finally, the lack of face-to-face interaction can create a sense of isolation, particularly for courses comprised of independent-learning tutorials and simulations. Even in courses involving online collaboration, some learners may find this less socially fulfilling than face-to-face interactions, and this in turn can impair engagement and satisfaction. Several authors have noted this to be an issue with faculty members as learners (Steinert et al. 2002; Dyrbye et al. 2009; Wearne et al. 2011).

이러한 잠재적 장점과 한계에도 불구하고 여러 연구자들은 온라인 학습이 전통적 방법에 비해서 어떤지를 연구해왔다. 이번 연구로부터 얻은 결과는, 평균적으로 보자면, 유의한 차이는 없다는 것이다. 일부 연구는 온라인이 더 낫다고 하고, 어떤 연구는 전통적 방법이 더 낫다고 하나, 평균적으로 보면 기본적으로 형식 간 거의 차이가 없다. 현재까지의 근거를 보면 온라인과 면대면 방식 중에서의 선택은 하나가 다른 하나보다 inherently 우월하기 때문이 아니라, 상대적인 장점 때문이다. 이것은 교육자들에게는 좋은 소식인데, 왜냐하면 우리가 각각의 접근법을 자신감있게 사용할 수 있음을 뜻하기 때문이다.

Given these potential advantages and challenges, numer- ous educators and researchers have attempted to determine whether online learning is better or worse than traditional approaches. The bottom line from this research is that there is, on average, no significant difference. Some studies favored online, others favored traditional, but on average outcomes were essentially the same between formats. Current evidence suggests that the choice between online and face-to-face approaches depends primarily on the relative advantages and disadvantages of each approach rather than an inherent superiority of one over the other (Cook & McDonald 2008). This is good news for educators, because it means that we can confidently use either approach (or both together in a blended learning course), depending on the needs of the situation.

교수개발의 온라인학습

Online learning for faculty development

온라인학습은 교수개발에 특히 잘 맞는다.

Online learning may be particularly well-suited for faculty development.

• 교수들은 시간과 장소의 제약을 많이 받음
  Faculty members are affected by issues of time and location (Steinert et al. 2009).

• 인터넷에 기반한 수단을 활용해 물리적, 시간적 거리separation를 초월한 실천공동체를 형성할 수 있다.
  Moreover, by bridging physical and temporal separations Internet-based tools can facilitate online communities of practice that would otherwise be impossible (Sherer et al. 2003).

• 필요한 때에just-in-time제공, 규모의 경제 실현, 이수증 서류 등
  Other features such as just-in-time availability of resources, economies of scale, and documentation of completion are also helpful for faculty members (just as they are for other learners).

문헌 고찰

Literature review

온라인FD는 어떤 형태로 도입되어있는가?

How has faculty development been implemented online?

다음과 같은 형태

We identified 20 reports of online learning for faculty development These studies employed a wide variety of online modalities and instructional designs (Table 1), including

• 튜토리얼 tutorials;

• 온라인 토론 online discussion via discussion board, chat, and e-mail listserv;

• 컴퓨터 시뮬레이션 computer simulations;

• 비디오 클립 video clips; and

• 원거리에서의 실시간 평가 live assessment of a training subject at a distance.

일부 연구는 single location의 참여자를 대상으로 했지만, 대부분은 멀리 떨어진(도시, 주, 국가) 학습자들을 대상으로 했음.

A few studies included partici- pants at a single location, but most enrolled learners separated by large distances – different cities, different provinces, and even different countries.

온라인FD 연구에서 배운 점은?

What do we learn from studies of online faculty development?

종합적으로, 온라인FD에 대한 근거는 흩어져있고 insubstantial하다. 그럼에도 불구하고 몇 가지 눈에 띄는 주제들이 있다.

In sum, the evidence base for online faculty development is sparse and insubstantial. Nonetheless, several salient themes emerge from this literature.

첫째, 온라인FD는 적어도 전통적인 방식과 비견될 만은 하다. 두 가지 연구가 있었는데, 하나는 작지만 유의하지 않은 차이를, 다른 하나는 유의한 지식의 향상을 보고함.

First, online faculty development appears to be at least comparable to traditional training.

• Two studies made com- parison with traditional classroom training. One found small and non-significant differences (Coma del Corral et al. 2006); the other found significantly improved knowledge and skills for those trained online, perhaps due to increased intensity of the online training (Kobak et al. 2006).

둘째, 온라인FD는 아무런 intervention을 하지 않은 것보다 (늘 그런 것은 아니지만) 더 낫기도 하다. 한 연구에서는 no intervention보다 유의하게 나았다, 또 다른 연구는 전통적 방식에 virtual classroom을 더한 것이 유의한 향상을 가져왔다. 두 개에서는 차이가 없었다.

Second, online faculty development can be, but is not always, effective in comparison with no intervention. One study found that an online journal club was significantly more effective than no intervention (Macrae et al. 2004) while another found that adding a virtual classroom with online assignments to existing face-to-face lectures was associated with significantly improved scores (Dean et al. 2001). However, two studies evaluating the impact of a series of very brief e-mail messages (on topics of institutional review board guidelines [Kotzer & Milton 2007] and teaching effect- iveness [Pernar et al. 2012]) found only negligible differences.

셋째, 이들 비교연구로부터 떠오르는 질문이 있다. 온라인FD가 성공하기 위해서 중요한 특징은 무엇인가? 가장 눈에 띄는 것은 교수참여faculty engagement가 인터벤션간 차이가 크다는 것이다. 비록 일부 연구에서는 매우 효과적 방방법으로 참여를 장려했음에도, 많은 경우에 참여도가 매우 낮았다.

Third, the variability in these comparative studies raises the question: what features of the intervention, topic, and learners are critical to the success (or failure) of online faculty development? Most notably, faculty engagement varied widely for different interventions. Many courses were plagued by low participation, although some managed to effectively encourage faculty involvement.

• 어떤 연구자들은 교수들이 스스로 인지한 니즈need perceived by faculty가 온라인학습과 맞을 때에야만이 시간과 에너지를 온라인코스에 쏟을 것이라고 제안했다.
  Some authors suggested that only when courses successfully meet a need perceived by faculty members will they invest the necessary time and energy to participate in an online course (Steinert et al. 2002).

• 다른 연구자들은 기술적 문제를 잘 organization하고 assistant하는 것이 성공의 길이라고도 했다.
  Others felt that better organization and assistance with technical problems were keys to success (Langlois & Thach 2003; Dyrbye et al. 2009; Ladhani et al. 2011; Wearne et al. 2011).

• 코스를 마치는데 필요한 시간, 명확한 요구(기대), 가까운 미래의 (교육)활동에의 관련성 등이 중요하다
  Yet, others identified that time to complete course activities, clear expectations, and relevance to near-future academic activities (e.g. teaching) were essential (Steinert et al. 2002; Lewis & Baker 2005; Paulus et al. 2010; Wearne et al. 2011).

• FD일반에 대한 연구는 물론  온라인 CPD연구에서 보면, perceived professional need, immediate rele- vance, and institutional expectation and support 등이 중요하다.
  Research from the field of faculty development in general (i.e. not online-specific) confirms that meeting a perceived professional need, immediate rele- vance, and institutional expectation and support all encourage participation (Steinert et al. 2009, 2010) as does evidence from online clinical continuing professional development (Carroll et al. 2009).

커뮤니케이션과 사회적 상호작용social interactions 이 온라인FD의 장기적 성공에 중요하다. 여러 연구에서 사회적 사회작용을 핵심 주제로 도출했다. 온라인 커뮤니티는 (온라인 커뮤니티가 아니었으면 불가능했을) 상호작용을 강화하는 역할을 할 수 있으나, 만약에 온라인 상호작용이 면대면 상호작용을 대체해버리거나, 그 설계가 poorly structured 되어있다면, 오히려 역효과를 낳을 수도 있어서, 흥미나 참여가 떨어질 수도 있다.

Communication and social interactions also appear to be critical to the long-term success of online faculty development activities. Several studies identified social interaction and bonding as key themes: online communities can enhance such interactions if faculty members would not otherwise be able to meet, but if online interaction replaces face-to-face interaction or is poorly structured, it may meet with oppos- ition, disinterest, and lack of engagement (Steinert et al. 2002; Langlois & Thach 2003; Bramson et al. 2007; Anshu et al. 2008; Dyrbye et al. 2009; Anshu et al. 2010; Paulus et al. 2010).

토론그룹 사이에서 중재역할을 적극적으로 하는 것Active moderation of discussion groups 이 특히 중요하다. 한 연구에서 참여자들은 온라인토론이 포함된 집단에서 (비록 그것이 면대면 접촉을 대체하기에 매우 적합한 것은 아니었으나not adequately substitute) self-reported understanding이 더 향상되었음을 보고함.

Active moderation of discussion groups may be particularly important (Fox et al. 2001; Anshu et al. 2008; Wearne et al. 2011).

• One randomized trial evaluated an online tutorial with and without enhancement through an online discussion forum and found greater self-reported understanding (albeit statistic- ally non-significant) among the group with online discussion, although participants indicated this ‘‘did not adequately substitute for face-to-face contact.’’ (Fox et al. 2001).

커뮤니케이션과 관련된 문제를 지적한 연구가 있었는데, 목소리의 굴절이나 바디랭귀지가 없는 것 때문에 오해가 생기기도 한다. 비-온라인FD에서 연구들은 social connection과 실천공동체의 필요성을 지지한다.

Several studies noted problems with communication, such as the absence of voice inflection or body language, which leads to increased chance of misunderstanding. Again, research from non-online faculty development supports the need for social connections and communities of practice (Steinert et al. 2009, 2010).

마지막으로 (짧은 이메일 메시지, optional한 토론포럼 등과 같이) 매우 짧거나 단차원적인 인터벤션brief or uni-dimensional interventions 은 덜 효과적이다.

Finally, brief or uni-dimensional interventions, such as short e-mail messages (Kotzer & Milton 2007; Pernar et al. 2012) and optional discussion forums (Steinert et al. 2002) seem to be less effective.

미래 연구에 대한 함의

Implications for current practice and future research

온라인학습은 다른 방법보다 우월하지도 열등하지도 않고, 그저 어떤 challenges를 극복하기 위한 방법이다. 온라인과 면대면 학습의 구분은 점차 모호해지고 있다. 이미 교사들은 blended experience를 루틴하게 활용중이다.

Online learning in general is neither superior to nor inferior to other approaches, but simply a method that overcomes some challenges while creating others. We expect that the distinction between online and face-to-face learning will increasingly blur, as educators take advantage of the strengths of both approaches to create blended learning experiences. Teachers already routinely create blended experiences – for example, using lecture, PowerPoint, video, small groups, and self-study to optimize learning according to specific objectives. Online learning adds one more tool (or, more accurately, a collection of tools) to the educator’s toolbox.

온라인 실천공동체의 발달을 장려할 수 있을 것이다. 그러나 단순히 FD프로그램을 온라인으로 만드는 것 만으로 성공을 담보하지는 못한다. 최고의 계획과 가장 효과적인 프로그램조차 교수들이 능동적으로 학습프로세스에 참여하지 않는다면 실패로 끝날 것이다.

Online learning may be particularly effective in overcoming these barriers and encouraging the development of online communities of practice (Sherer et al. 2003). However, simply building a faculty development program or activity – online or otherwise – will not guarantee success. Even the best-laid plans and most highly-effective programs will come to naught if faculty members do not actively engage in the learning process. While online learning has the potential to overcome barriers results thus far are decidedly mixed.

Online learning for faculty development: a review of the literature.

교육펠로우십 프로그램: 공통의 주제와 이슈(Acad Med, 2006)

Educational Fellowship Programs: Common Themes and Overarching Issues

Larry D. Gruppen, PhD, Deborah Simpson, PhD, Nancy S. Searle, EdD,

Lynne Robins, PhD, David M. Irby, PhD, and Patricia B. Mullan, PhD

Searle 이 언급한 바와 같이, 교육스킬을 강화하고 교육자 공통체를 만들고, 교육 리더를 양성하기 위한 펠로우십 프로그램이 여러개 늘어나고 있다.

As Searle et al.1 note in the opening article, there is a growing number of fellowship programs designed to augment teaching skills, create communities of educators, and develop educational leaders.

이러한 트렌드를 촉진하는 요인으로는 교육에 있어서 scholarship의 정의가 확장되었다는 것을 인지한 것, 개별 기관과 인증기구 수준에서의 (교육과정, 교육teacching, 평가와 관련된 의사결정은 교육원칙과 근거에 기반해야 한다는) 요구사항이 늘어나는 것progressive expectation 등이 있다. ACGME는 “careful study of existing research on general competencies for physicians” 가 필요하며, 이것을 위해서는 “increasingly more useful, valid and reliable methods of assessing resident’s attainment” 가 필요하다고 하였다 .이들 요인은 교수들에게 (교육)원칙과 교육에서의 최선의 실천을 잘 수행할 것을 요구하기에 이르렀다.

Factors fostering this trend include the growing awareness of education within a broadened definition of scholarship2–4 and the progressive expectation, at both institutional and accreditation levels,5,6 that curricular, teaching, and learner assessment decisions should be informed by educational principles and evidence. The Accreditation Council for Graduate Medical Education derived its general competencies through a “careful study of existing research on general competencies for physicians” and requires “increasingly more useful, valid and reliable methods of assessing resident’s attainment” of these competencies.6 These factors have created a demand for faculty who are well versed in the principles and best practices in education.

교육과정 설계와 Educational Scholarship을 위한 포괄적 접근

A Systematic Approach to Curriculum Design and Educational Scholarship

이번 호에 실린 educational fellowship 프로그램을 본 독자들은 프로그램간 유사성에 매우 놀랄 것이다. 이와 관련된 요소들로는 다음이 있다.

A reader of the educational fellowship program descriptions in this issue will be struck by the similarities among the programs, which are derived from related elements:

• 기관 차원에서 극복해야 하는 (도전)과제들 a pervasive set of institutional challenges,

• 교육과정 설계를 위한 포괄적 접근 a systematic approach to curriculum design, and

• (도전)과제들을 해결하기 위한 교육전략 educational strategies to meet these challenges.

교육 혁신 평가를 위한 준거

Criteria for Evaluating Educational Innovation

우리는 Glassick의 준거를 사용하고자 함

We used Glassick’s criteria8 for evaluating educational innovations

유의한 결과와 효과적 의사소통

Significant results and effective communication

각 프로그램은 (효과를 보여주기 위해서) 각 목표와 관련된 증거를 제시하였다.

Each program report presents evidence associated with its specific objectives, including

• 지원 현황 enrollment data,

• 펠로우가 주도한 교육과정 이니셔티브 fellow- authored curriculum initiatives,

• 리더십 보직 leadership positions, and

• 학문 활동 scholarly activities (eg, numbers of peer-reviewed publications, presentations, acceptances of educational materials to peer-reviewed educational repositories).

대부분의 프로그램은 프로그램-특이적인 교육과정 구조와 교육자료와 교육성과를 disseminate하여 프로그램의 졸업생들에게 요구되는 scholarly approach를 modeling하고자 했다.

The majority of programs have also disseminated their program-specific curriculum structure, materials, and outcomes in professional presentations and publications thus modeling the scholarly approach expected of their graduates.

교육자 공동체 형성은 공통의 성과 중 하나였다. 초기의 공동체는 같이 트레이닝을 받는 집단으로만 구성되었으나 시간이 지남에 따라서 institution-wide한 효과가 나타났다.

A common outcome reported across all programs is the creation of a community of educators. Initially, this growth has occurred within training cohorts, but over time has evolved into an institution- wide effect.

정도의 차이는 있지만, 모든 프로그램은 interdisciplinary fellow cohorts가 있었다.

To varying degrees, all the programs have interdisciplinary fellow cohorts.

펠로우들의 status도 프로그램간 다양했다.

Variation in fellow status is also present across programs,

프로그램 차원의 interdisciplinary goals 은 교육 공동체 내에서의 connection 조성, 공동의 이니셔티브 촉진, 공동의 문제에 대한 해결책 제시 등이 있다. 실제로 이들 프로그램의 interdisciplinary한 특징은 참여 펠로우들로부터 가장 흔하게 언급되는 펠로우십 프로그램의 강점 중 하나이다. 이러한 결과는 Lenning and Ebbers12가 한 다음의 말과도 잘 부합한다. 프로그램 졸업생이 늘어남에 따라서 기관들은 교육자의 critical mass를 보유했음을 깨닫게 된다. 

The interdisciplinary goals of the programs represent an explicit effort to foster connections among members of the educational community and to stimulate shared initiatives and solutions to common problems. Indeed, the interdisciplinary nature of these programs is one of the strengths most frequently cited by participating fellows. This echoes the observation of Lenning and Ebbers12 that

“교수자들이 얻는 것은 faculty benefits (related to learning communities) include

• 고립에서의 탈피 diminished isolation,

• 교수 동료간 공동의 목표와 협력 a shared purpose and cooperation among faculty colleagues,

• 교육과정 통합이 늘어남 increased curricular integration,

• 개인의 전공학문에 대한 참신한 접근법 a fresh approach to one’s discipline, and

• 학생의 학습에 대한 만족도 향상 increased satisfaction with their students’ learning.”

As the number of program graduates increases, institutions recognize that they have a critical mass of educators

성찰적 비평

Reflective Critique to Improve Educational Fellowship Programs

목표의 명확성에 대하여..

Clear goals

적절한 준비와 적절한 방법에 대하여..

Adequate preparation and appropriate methods

평가 자료를 집합적으로 분석함으로써 프로그램이 성공적이었는지를 알 수 있을 것이다.

Aggregated analysis of the evaluation data across programs reveals that the programs are successful in promoting and advancing graduates as individuals.

대부분의 프로그램은 이제 막 기관 차원의 효과(학습 환경, 넓은 맥락에서의 교육 변화)를 살펴보기 시작하였다. 개별 학자scholar 수준에서 몇몇 프로그램은 졸업생이 교육 행정 관련한 참여presence가 늘어났음을 보여주었다.

Most of the evaluations have only begun to look at institutional impact, in terms of learning environment and the larger context of educational change. At the individual scholar level, several programs note an increased presence of program graduates in the school’s educational administration:

모든 프로그램이 공통적으로 당면한 평가 관련한 네 가지 문제가 있다.

Four common evaluation challenges remain to be addressed by all programs independent of their focus on individual or institutional outcomes.

• 첫째, 대조군의 부재
  First, the lack of a control or comparison group limits the scope of the conclusions.

• 둘째, 각 프로그램은 프로그램의 결과로 어느 정도의 변화가 일어났는가를 조사해야 한다. 비록 그 과정에 온갖 복잡성과 교란요인이 있지만 관심을 둘 만한 분야이다.
  Second, programs must examine the extent to which student learning has changed as a result of these programs. Although this particular outcome measure is fraught with all of the complexities and confounding factors that plague patient- outcomes research, it is an area that warrants attention.

• 셋째, 개인수준/기관수준/피훈련자수준에서 명확한 ROI를 보여주어야 한다. 교육평가에서 그러한 분석은 매우 드문데, 적어도 한프로그램에서는 노력은 하였다. 프로그램의 "비용"을 정량화하는 것은 복잡하며, 교수와 스텝의 시간, 공간활용, 리소스 분배에 대한 집중화와 공유, 임상 생산성의 저하 등등을 포함한다. 그럼에도 불구하고 교육 프로그램들은 여러 임상 프로그램과 연구 프로그램에서 시도하는 바와 유사하게 교육 프로그램에 대한 투자를 정당화할 수 있어야 한다.
  Third, programs need to demonstrate a clear return on the investment in the educational fellowship programs at the individual, institutional, and ultimately trainee levels. Such analyses are very rare in educational evaluation, but at least one program has made such an effort.15 As the program descriptions demonstrate, quantifying the “cost” of these programs is complex and raises questions of faculty and staff time, space utilization, centralized or shared resource allocation, lost fellow clinical productivity, and the like. Similarly, the outcomes can be defined in various ways and quantification of these outcomes is challenging. Nonetheless, educational programs should be prepared to justify the investments made in them in ways that many clinical and research programs are beginning to address.

• 넷째, 프로그램 운영 기관들이 서로 고립isolation되어 있다. 프로그램 디렉터는 지역 또는 국가 수준의 교육미팅에서 비공식적으로 아이디어를 얻을지 모르겠지만, 이 프로그램의 효과성과 퀄리티를 향상시킬 수 있는 기회는 그것 말고도 많다. 예를 들면...
  The fourth evaluation challenge is associated with the isolation that exists between programs’ sponsoring institutions. Although program directors may share ideas informally at regional and national educational meetings, there are many opportunities for augmenting the effectiveness and quality of these programs. Possible strategies include

• 교육과정 혁신에 관한 협력 collaboration on curricular innovations,

• 내용 전문성과 세션 퍼실리테이터를 공유함 sharing content expertise and session facilitators, and

• 특정 청중 혹은 요구에 대해 특화된 프로그램 개발exploring specialized programs for particular audiences or needs.

• 추가적으로, 이들 프로그램은 다-기관 차원의 평가 연구 기회를 제공하며, 이를 통해서 효과적인 프로그램의 특성을 알게 될 수도 있다. 교육과정의 기간 또는 강도와 그 성취 사이에 dose-response relationship 가 있는가? 유의미한 성과를 얻기 위한 최소 수준의 교육instruction이 있는가? 등이 있다. 이 질문은 세심하게 다기관 연구를 설계하면 답을 얻을 수 있을지도 모른다. 아홉개 프로그램은 공통의 핵심 주제를 가지고 있었으며, 이는 리소스와 노력의 중복 투자를 의미하며, (공식적 경로이든 비공식적 경로이든) 실제 프로그램간 교육 내용의 공유는 별로 없을 것임을 시사한다. 대신, 각 프로그램이 "reinvents the wheel" 했을 것이다.
  In addition, these programs provide an opportunity for conducting multi-institutional evaluation studies, which might provide insights into program characteristics that are effective in attaining the desired outcomes. For example, is there a dose-response relationship between the duration or intensity of the curriculum and the program outcomes? Is there a minimal level of instruction that is necessary to obtain useful outcomes? These questions might be answered by carefully designed, multi- institutional studies of the programs. All of the nine programs we have analyzed have a common core of critical topics. This represents a duplication of resources and effort, but there is limited sharing of actual curricular content among the programs, either through formal or informal mechanisms. Instead, each program “reinvents the wheel” for numerous topics.

이후 발전을 위한 성찰적 비평

Reflective critique for future development

교육자 공동체를 형성하는 것은 일부 프로그램에서만 명시적으로 드러난 목표였지만, 결과적으로는 모든 프로그램에서 중요한 가치를 지니는 성과가 되었다. 그러한 공동체가 형성된 것은 기관의 전반적 환경에도 도움이 된다.

The development of a community of educators is an explicit goal for only some programs, but a clearly valued outcome for all. The development of such a community benefits the overall environment of the institution

여기서 중요한 질문이 남는다.

There remain important questions about sustaining and nurturing such a community:

• 공동체가 생산력을 가지기 위해 필요한 critical mass가 있는가?
  is there is a critical mass necessary for such a community to be productive?

• 어떤 이벤트나 이니셔티브가 공동체의 유지에 도움이 되는가?
  What events or initiatives help maintain the community?

• 효과적인 공동체와 관련된 인프라, 리더십, 리소스는?
  What are the infrastructure, leadership, and resource requirements associated with effective communities?

• 진료를 하는데 필요한 시간과 경쟁하는 가운데 어떻게 공동체가 유지될 수 있을 것인가?
  How can the community be sustained in the face of competing demands on faculty time from clinical responsibilities?

3 Fincher RE, Simpson DE, Mennin SP, et al. Scholarship in teaching: an imperative for the 21st century. Acad Med. 2000;75:887–894.

Educational fellowship programs: common themes and overarching issues.

성년이 된 AHC: 교수들이 더 나은 선생, 변화에이전트가 되게 돕기(Acad Med, 2006)

The Academic Health Center Coming of Age: Helping Faculty Become Better Teachers and Agents of Educational Change

Charles J. Hatem, MD, Beth A. Lown, MD, and Lori R. Newman, MA

의학교육을 위한 기관들은 전통적으로 교수들이 교사로서의 책임을 다할 수 있게 준비시키는 것에는 매우 적은 시간만을 할애해왔다.

Institutions committed to medical education have historically spent an inordinately small amount of time preparing their faculty members for their responsibilities as teachers.

선구자적인 예외는 the Shapiro Institute for Education and Research at Harvard Medical School (HMS) and Beth Israel Deaconess Medical Center (BIDMC)이다.

A pioneering exception to the historic indifference to medical teaching was the prescient formation of the Shapiro Institute for Education and Research at Harvard Medical School (HMS) and Beth Israel Deaconess Medical Center (BIDMC). As described by the founders:

HMS와 BIH는 교육병원과 의과대학이 clinical business과 더불어 공통의 academic mission에서도 최고 선두이자 중심적 위치를 더 효과적으로 유지하기 위하여 1996년에 joint venture를 설립하였다.

In an effort to organize a teaching hospital and a medical school in a manner that would position them to maintain more effectively their common academic mission front and center with the clinical business, HMS and the Beth Israel Hospital (BIH) created a joint venture in 1996.

The new nonprofit Institute for Education and Research has education and research as its top (and only) mission. It is designed to provide additional and specific academic leadership and to enable the joint venture to undertake strategic planning for the academic mission.1

1996년 BIH는 BIDMC가 되었다. 그리고 CareGroup이라는 새로운 헬스케어 독립체entity 아래에 join하였다.

In 1996, the BIHmerged with New England Deaconess Hospital to form BIDMC. Mount Auburn Hospital (MAH), another HMS teaching hospital, joined BIDMC under the umbrella of a new health care entity, CareGroup.

이 기관의 핵심적으로 집중하는 것 중 하나는 교수개발이다.

One of the Institute’s central commitments is faculty development.

Harvard Medical System 내에서의 의학교육 펠로우십

The Fellowships in Medical Education within the Harvard Medical System

1998년의 The Rabkin Fellowship in Medical Education

The Rabkin Fellowship in Medical Education was established in 1998 in honor of Mitchell T. Rabkin, MD, CEO emeritus of the BIH.

The Rabkin Fellowship은 하버드-협력 기관의 교수들에게 열려있음

The Rabkin Fellowship is open to faculty based at all Harvard-affiliated institutions and is designed to prepare future leaders in medical education.

교육과정 구조

Curriculum Structure

펠로우십 세미나는 세 장소에서 열림. (외부) 초청 전문가, 지원 인력

The fellowship seminars are conducted at three sites: the Center for Education at BIDMC, the MAH, and HMS. 

Invited experts ...

Staff support ...

진행 기간 및 주요 활동 내용

• The fellows at the BIDMC and MAH meet weekly for 10 months (September through June) at separate sites for two- hour seminars during the academic year.

• The program at HMS meets monthly for two-hour seminars also for 10 months of the academic year. The medical education curriculum was added to the existing Academy fellowships at HMS in 2004–05.

• Previously the Academy fellowships were designed to support junior faculty projects, but did not have a component dedicated to ongoing seminars in medical education.

• In 2004– 05 the fellowship directors began to meet monthly with the HMS Academy fellows using core elements of the Rabkin and Mount Auburn Fellowship curricula.

여러 개의 (의학교육 연구 관련) 세미나에 참석함

Fellows from all three programs come together for a number of seminars. A majority of these are dedicated to medical education research principles taught by local and national experts.

이전 펠로우와 현재 펠로우와의 만남

In addition, past and present fellows convene twice a year to reflect and discuss challenging issues in medical education. The past fellows also serve as project consultants for the current fellows.

교육과정 내용

Curriculum Content

•  ▪ the historic evolution and financing of medical education;

•  ▪ the skills needed for curriculum development, design, and evaluation;

•  ▪ the application of adult learning theories to the clinical setting;

•  ▪ the enhancement of teaching skills needed at the bedside, ambulatory, operating room, and classroom arenas, including exercises in peer review, lecturing, and small-group and case- based discussion;

•  ▪ mentoring;

•  ▪ the skills needed for educational administration and leadership;

•  ▪ the relevance of the humanities to medical education;

•  ▪ research in medical education;

•  ▪ writing for publication;

•  ▪ sources of educational funding;

•  ▪ the role of technology/simulation in medical education; and

•  ▪ the skills of self-reflection and self- renewal.

경험학습이 핵심 요소

Experiential learning is a key component of the fellowship. Fellows ....

• conduct and report on master clinician–teacher observations,

• are videotaped and given feedback on lecturing techniques,

• engage in role plays providing difficult feedback to learners,

• lead case-based discussions,

• conduct peer reviews, and

• submit written reports of memorable teaching and learning experiences.

서로 존중하는 분위기의 교수-학습 공동체를 만들기 위해서 노력함. 서로 피드백을 주고 받는 안전한 환경을 만들어줌.

We strive to create a respectful “learning and teaching community” committed to the goals of better teaching. The fellowship provides a safe environment in which the fellows give and receive feedback

HMS와 협력병원의 다른 교수개발 프로그램도 있지만, 주로 개별 강의, 워크숍, 3주과정, 멘토링 등으로 구성되어 있다. The Rabkin, Mount Auburn, and Academy fellowships은 HMS교수만을 위하여 설계된, 1년에 걸쳐 정기적으로 진행되며, 방대한 읽기reading과 계획된 교육활동, 교육 프로젝트 수행 등으로 구성된 독립적 프로그램

Other educational faculty development opportunities within HMS and its affiliated hospitals exist, but are predominately individual lectures, workshops, three-week courses, and mentoring. The Rabkin, Mount Auburn, and Academy fellowships, however, are the only stand-alone offerings designed solely for HMS faculty that meet regularly for the entire academic year and involve extensive readings, planned curricular activities, and completion of a required educational project.

교육과정 평가

Curricular Evaluation

• 펠로우십 디렉터들은 매 세션 이후 만나서 debrief하고 이후 진행될 세미나에 대해서 계획을 세우며, 세션간 연관성을 가지게 하는 개념을 찾고, 펠로우의 니즈에 따라 교수계획을 설계함
  The fellowship directors meet after each session to debrief and plan upcoming seminars with particular attention to identifying connecting concepts between the sessions and designing teaching plans that meet the needs of the fellows.

• 펠로우들에게 커리큘럼에 대한 피드백을 계속 요청하기도 하지만, 일년에 두 세션은 프로그램에 대한 심층적 성찰과 펠로우의 personal and professional development에 대한 영향을 논의함.
  In addition to soliciting ongoing feedback from the fellows about the curriculum, two sessions during the year are devoted to eliciting in-depth reflections about the program and its impact on the fellows’ personal and professional development.

• 각 펠로우와 정기적으로 미팅을 잡아서 펠로우십 경험에 대한 피드백을 받고, 추가적 성찰을 위한 시간을 가짐. 프로젝트에 대한 심층적 토론
  Regularly scheduled meetings with each fellow throughout the year afford additional opportunities to garner feedback on the fellowship experience, provide time for further reflection, and allow for in-depth discussion of the fellow’s project.

• 이 미팅들은 펠로우가 change agent가 되는 과정에서 겪는 어려움을 상담해주고 서포트해주는 기회이기도 함.
  These meetings are also natural opportunities to provide support and counsel to the fellow regarding the challenges of being a change agent in an academic environment.

프로그램 평가

Programmatic Evaluation

2004년부터 ongoing evaluation study를 수행

In 2004, the program directors began an ongoing evaluative study of the fellowship in medical education. The goal of the study is to examine the outcomes of the fellowship, including its personal and professional impact, using both qualitative and quantitative methods.

펠로우십 이후

After the Fellowship

기관 차원에서 교육과 관련된 중요한 역할을 맡게 되었으며, 트레이닝의 효과도 있을 것.

The fellows have assumed significant institutional educational roles after the completion of fellowship training, which we feel is due in part to that training.

Challenges

Acad Med. 2006 Nov;81(11):941-4.

The academic health center coming of age: helping faculty become better teachers and agents of educationalchange.

의학의 교수-학습에 관한 논란을 바라보며(Med Teach, 2007)

Looking forward – looking back: aspects of the contemporary debate about teaching and learning medicine

ALAN BLEAKLEY & JOHN BLIGH

Institute of Clinical Education, Peninsula Medical School, Plymouth, UK

가장 강한 종이 살아남는 것이 아니라, 변화에 가장 잘 반응하는 종이 살아남는다

‘It is not the strongest of the species that survives, but the one most responsive to change.’

Charles Darwin

Burns의 논문은 습관적 학습 패턴의 집합, 또는 되풀이되는 '신드롬'을 묘사하고 있다. Burns는 학생이 반복적으로 해부학을 assessment-driven 전략으로 공부하면서, 그 댓가로 생산적인 학습을 하지 못하고 있으며 '모든 것을 외우지만 이해하는 것은 거의 없는' 학습을 한다. 그는 (이를 극복하기 위해) 특정 주제에 관한 풍부한 컨텐츠에 국한하는 짧은, 집중적 학습시기를 교육에 포함시키는 전략을 활용하고자 했다.

Burns’ article describes a set of habitual learning patterns, or recurrent ‘syndromes’, Burns describes recurrent assessment-driven strategies in learning anatomy that students employ at the expense of more productive learning, such as ‘memorize everything – under- stand little’. He involve short, intense periods of learning of circum- scribed ‘rich’ content around specified themes, such as mitochondrial structure and function, under general narrative themes such as ‘Cell Biology’.

의학교육 펠로우십의 Personal and Professional Impact (Acad Med, 2009)

The Personal and Professional Impact of a Fellowship in Medical Education

Beth A. Lown, MD, Lori R. Newman, MEd, and Charles J. Hatem, MD

학계가 점차 "과학 내용, 연구 및 임상 기술을 마스터 했다는 것 자체mastery가 반드시 교육 전문성과 바람직한 학습 성과로 변환되는 것은 아니라는 사실"을 인식하면서 FD가 점점 더 중요 해지고 있습니다.

Faculty development has become increasingly important as academic communities recognize that amastery of scientific content, research, and clinical skills does not in itself necessarily translate into educational expertise and desired learning outcomes.1

의학교육의 The Rabkin and Mount Auburn fellowships 은 두 개의 하버드 교육병원에서 시작되었다. (Beth Israel Deaconess Medical Center in 1998 and Mount Auburn Hospital in 1999) 성인학습, 경험학습, 성찰적 실천, 인본주의적 철학humanistic philosophy에 기반을 두고 있다.

The Rabkin and Mount Auburn fellowships in medical education were established at two Harvard teaching hospitals—Beth Israel Deaconess Medical Center in 1998 and Mount Auburn Hospital in 1999—to prepare faculty foracademic careers in medical education. These fellowships, are grounded in the principles of adult and experiential learning, reflective practice, and humanistic philosophy.16–20

중요한 질문이 남아있다. Palmer25 는 "우리는 우리 자신을 가르친다.we teach who we are"라고 하였다. 만약 그것이 사실이라면, 프로그램의 성과와 프로그램을 이수한 교수가 무엇을 하느냐 뿐만 아니라, 그들이

• 하나의 인간으로서 어떻게 변하였으며, 교육자로서 자신을 어떻게 바라보고, 학생과 어떻게 상호작용하는가?

• FDP가 참여자의 자기-인식과 행동을 변화시켰는가?

• 학습공동체는 의학교육자의 발달에 어떠한 영향을 주었는가?

• Personal and professional change를 촉진하는 FDP의 핵심 요소는 무엇인가?

Important questions remain. Palmer25 suggests that “we teach who we are.” If so, what is the impact of faculty development, not only on outcomes and what graduates do, but on whom they become as persons and how they view themselves as educators and their interactions with their students? Do faculty development programs change participants’ self-perceptions and behaviors? How do learning communities affect the development of the medical educator? What are the key elements of faculty development programs that foster personal and professional change?

연구 참여자와 모집 단계

Study Participants and the Recruitment Process

A letter of invitation and description of the study were sent by postal mail to eligible faculty. We were unable to locate one former Fellow. A follow-up inquiry was e-mailed to nonresponders one month later. Forty-two Fellows consented to participate in a telephone interview, but two were unavailable at the time of the scheduled telephone interview. Therefore, 40 of the 43 fellowship graduates participated in the semistructured interviews, which were conducted between June 2005 and February 2006.

Faculty members affiliated with Harvard Medical School are selected for one of the fellowships through a competitive application process that attracts persons from a variety of disciplines.

Fifty-six percent of the 43 Fellows who graduated between 1999 and 2005 were women;

80% self-identified as Caucasian, 16% as Asian, 2% as Latino, and 2% as African American.

반구조 인터뷰 과정

Semistructured interview process

We developed nine questions (List 1). A trained research assistant conducted audiotaped, standardized, semistructured interviews; each interview took approximately 30 minutes. The audiotapes were transcribed and deidentified.

We used qualitative, grounded theory methods to analyze and code the data and to build a theory from the data.26 We undertook multiple cycles of reading the transcripts, using the constant comparative method to group concepts within themes and to clarify and rename each theme until the data were fully described and categorized. Each author then independently coded all transcripts. We discussed coding discrepancies and revised the themes and their descriptions to better represent the data. Two of us (B.A.L. and L.R.N.) then independently recoded, discussed, and reached consensus on all 40 transcripts. We then entered the data into a qualitative analysis software program (HyperRESEARCH, version 2.6.1; ResearchWare, Randolph, Mass) to generate reports and to performtheme frequency counts. The themes are described in the Results section.

연구의 신뢰성trustworthiness을 위해서 다음을 활용

We used three methods to ensure the trustworthiness of our research.27

• 우리는 의도적으로 각 주제에 대해서 긍정적인 측면과 부정적 측면을 모두 탐색하였으며, 이에 따라 코딩을 진행하였다. 예를 들면 롤모델과 멘토링에 대해서 "서포트와 모범(사례)를 인지함", "더 많은 멘토링 필요"가 있다.
  First, we conducted deliberate searches for positive and negative examples of each theme and coded these accordingly. For example, within the theme, “Role models and mentoring,” we identified 77 quotes in the transcripts that we coded as “Perceived support and examples” and 6 quotes that we coded as “Wished for more mentoring” (Table 1).

• 둘째, 무작위로 선정된 25%의 transcript를 가지고 external audit을 수행하였다. 펠로우십에 아무런 역할이 없었던 질적연구자가 이 것을 가지고 review and code하였다.
  Second, we conducted an external audit of the data by randomly selecting 25%of the transcripts for independent review. A qualitative researcher with no role in the fellowships reviewed and coded this subset by using the final list of described themes.

• 셋째, 문헌고찰을 통해서 연구의 주제와 다른 질적연구자들의 주제를 비교하였다. 최종 분석 단계에서 우리가 발견한 주제들간의 관계를 ㅈ사해보고, 우리의 주제를 기존의 것과 비교하였다.
  Third, we performed a literature review to compare our study’s themes with those of other qualitative researchers who had analyzed outcomes of faculty development in medical education. The search strategy and results are described in Appendix 1 and Appendix 2, respectively. During the final analysis process, we examined the relationships between our themes and compared our themes with those of previous investigators to build a grounded theory about the results.

결과

Results

일부 Fellow들은 배운 것들을 임상/행정/리더십 역할에까지 광범위하게 적용할 수 있었다고 말하였다.

Several Fellows commented that the lessons learned can be broadly applied, including in their clinical, administrative, and leadership roles.

동시에 어떤 펠로우들은 어떤 것이 펠로우십이 기여한 것이고 어떤 것이 다른 요인이 기여한 것인지 구분하기 어렵다고 했다.

At the same time, some Fellows had difficulty distinguishing between what was attributable to the fellowship and what was attributable to other significant faculty development activities.

정체성

Identity

대부분의 Fellow들은 펠로우십이 의학교육자로서의 정체성을 강화시켜주었다고 응답했다. 일부에게 있어서, 펠로우십은 초기 단계에 있었던 정체성 또는 기존의 교육자로서의 정체성을 명확히 해주었다고 하였으며, 또 일부는 전환transformation의 느낌을 이야기했는데, 펠로우십을 통헤서 불타오른kindle것이 시간이 지나면서 더 강해졌다고 하였다.

Most of the Fellows said that the fellowship enhanced their sense of identity as medical educators. For some, the fellowship clarified a nascent or preexisting identification as an educator. Others described a sense of transformation, kindled by the fellowship, that continued to evolve over time.

대부분의 펠로우는 목표(의식)과 헌신이 깊어deepened sense졌다고 했다. 자신의 역할에 대한 열정이 새로워졌고, 다른 사람을 inspire하고자 하는 열망이 생겼다.

Most Fellows described a deepened sense of purpose and commitment. They spoke of a renewed passion for their roles and a desire to inspire others.

Empowerment와 자기효능감을 새롭게 찾게 되었다. 일부는 자기자신을 변화에이전트change agent라고 하였으나, 어떤 펠로우는 자신의 역할을 리더/교육혁신가/협력가로 묘사하며, 이 용어에 대해서 양가감정을 보였다.

Many Fellows described a newfound sense of empowerment and self-efficacy. Several Fellows were willing to describe themselves as change agents. Others were ambivalent about the term“change agent,” describing their role instead as leader, educational innovator, and collaborator.

공동체

Community

펠로우십 내에서 공동체의식이 성장하였다. 다른 학문분야나 다른 기관에서 온, 정기적으로, 마음이 잘 맞는 사람들과 만나는 것에 가치를 두었다. 펠로우십이 진행되며 신뢰trust가 쌓였으며, 개인의 학습과 집단적 학습을 진전advance시켰다.

The Fellows developed a sense of community within the fellowship. They valued the opportunity to meet regularly with like-minded people from other disciplines and institutions. They developed a sense of trust in the fellowship group over time that advanced both their personal and collective learning.

펠로우들은 (같은 용어를 사용하고 흥미가 공유하는) 더 큰 의학교육자 커뮤니티에 대한 connection을 느꼈다고 하였다. 일부에게 펠로우십이란 locally 또는 nationally, academic career로 가는 '입학증'과 같은 것이었다.

The Fellows also described a sense of connection to the larger community of medical educators with whom they shared a common language and interests. For some, it was an “admission ticket” to an academic career and a stimulus to network both locally and nationally.

동료 펠로우들이 다른 기관에서 근무하고 있으며, 시간적으로 한계가 있어서 connect할 시간이 더 있었으면 좋겠다고 하였다.

The Fellows commented on their wish for more time to connect, noting the difficulties of time constraints and the fact that the other Fellows were working in different institutions.

일부는 펠로우십 이후에 의학교육을 하나의 가능한 커리어 패스로 고려하게 되었다.

Some described considering medical education as a viable academic career path for the first time after the fellowship.

펠로우십에서 (의학교육에) 노출되고, 인정을 받은 것이 새로운 커리어 기회에 기여한 요인이라고 보았다.

Many commented on the exposure and recognition resulting from the fellowship as a factor that contributed to new career opportunities.

롤모델과 멘토링

Role models and mentoring

많은 펠로우들이 (펠로우십 리더의) 멘토링 활동에 대해서 언급하였다. 펠로우십 리더가 continuous learning의 모범을 보여주고, 친절함과 긍정affirmation의 태도로서 모범을 보여준 것이 펠로우십의 주된 take-home lesson이었다.

Many Fellows described the mentoring activities of the fellowship leaders, including the establishment of expectations coupled with support. The fellowship leaders’ modeling of their own continuous learning and of attributes such as kindness and affirmation was also mentioned frequently as a primary take- home lesson of the fellowship.

펠로우십 리더들이 보여준 사례eaxmple은 의학교육 커리어가 가능하겠다는 믿음을 강화시켜 주었다.

The example set by the fellowship leaders strengthened Fellows’ belief that a career in which medical education was a significant component was feasible.

시간이 지나며, 펠로우들은 서로서로와 이전 펠로우들이 지지와 협력적 멘토링의 중요한 source임을 알게 되었다.

Over time, many of the Fellows came to regard each other and former Fellows as important sources of support and collaborative mentoring.

다른 사람의 인식

Perceptions of others

많은 펠로우들이 펠로우십을 이수한 증명서credential의 가치가 어떻게 인식되는지에 대해서 언급했다. 이 증명서로 인해서 펠로우들은 자신이 속한 과나 국가 단위에서 교육컨서턴트 혹은 교육전문가로 인정regarded 받게 된 것 같다고 하였다.

Many Fellows talked about the perceived value of the credential of having completed the fellowship, which they felt made them more widely regarded as education consultants and experts within their departments and nationally.

많은 펠로우들은 자신이 속한 조직에 변화를 촉발하고 유지하기가 어렵다고 말했다. 이러한 어려움에는 자신이 원래 계획한 프로젝트의 범위scope에 의한 문제도 있었고, 필요한 리소스에 접근이 어렵다는 문제도 있었다.

Many Fellows noted the difficulty of initiating and sustaining change in their institutions. Factors contributing to this difficulty included the scope of their project as originally conceived and the barriers to accessing necessary resources.

여러 펠로우들이 자신의 기관에서 새로운 교육과정을 도입하고 있었고, 그 프로젝트의 결과로 기관 차원의 변화가 생겼다고 말했다.

Several Fellows had implemented new curricula at their institutions and described institutional changes that had resulted from their fellowship projects,

일반적 코멘트

General comments or suggestions for change

프로그램 개선을 위한 의견을 주었다.

Fellows shared their general reflections and offered suggestions for change, such as

• implementing project benchmarks,

• allowing for additional skills practice,

• focusing more on medical education research design,

• assigning project mentors, and

• establishing writing and publication requirements.

이 의견 중 대부분은 이후에 펠로우십에 반영되었다. 어떤 펠로우들은 더 빡세rigor게 하길 바랐으나, 반면 기존의 펠로우십도 따라가기 벅차다는 의견도 있었다.

Most of these suggestions have since been incorporated into the fellowship. Some Fellows wanted more rigor, but others stated that they had difficulty in keeping up with the fellowship requirements, along with their other professional and personal responsibilities.

고찰

Discussion

이전 연구에서 교수개발의 효과로는 진로-변경, 진로-확인, 진로-확장, 진로-중립 등이 있었다(career-altering to career- affirming and -expanding and to career- neutral). 전환Transformation을 느낀sense of- 펠로우들은 펠로우십이 그들의 커리어에 있어 특별한 기회의 시간이었으며, 이 시간은 그들의 사고와 모습에thinking and being 새로운 길을 열어주었다.

Prior research also noted a range of faculty development effects, from career-altering to career- affirming and -expanding and to career- neutral.28 Those Fellows who described a sense of transformation remarked that the fellowship had come at a particularly opportune time in their careers, when they were open to new ways of thinking and being.

이 변화가 유의미한 이유는 (학생과 선생 모두에 있어) 자기효능감에 대한 신념이 동기부여와 수행능력의 강화에 강하게 연관되어 있기 때문이다.

This change is significant because self-efficacy beliefs have been shown to be strongly correlated with motivation and enhancement of the performance of both teachers and learners.29

펠로우들은 자신감의 향상은 진화적evolutionary이라고 묘사했고, 이 진화는 개인적맥락/지식/능력/배운 것을 적용할 기회 등에 기반하였다. 긍정적인 피드백과 local expert로서 주변에서 인식해주는 것도 자신감을 향상시켰다. 대조적으로, 일부 펠로우는 지식이 늘고 자기에 대한 기대self-expectation가 높아지면서 오히려 자신감이 저하되었다. 이러한 발전과정은 Adam이 말한 "미인지된 비숙련"에서 "인지된 비숙련"“unconsciously unskilled” to “consciously unskilled”으로의 변화와 같다.

Fellows described the development of their self-confidence as evolutionary, based on their personal context, knowledge, ability, and opportunities to apply the lessons of the fellowship. Positive feedback and others’ perceptions of them as local experts further enhanced self-confidence. In contrast, for some, self-confidence decreased as their knowledge and self-expectations increased. This progression fromwhat Adams30 called “unconsciously unskilled” to “consciously unskilled”

이 연구를 통틀어서 공통적으로 등장하는 theme은 의학교육 펠로우십 기간에, 그리고 그 후의 personal and professional development 에 기여하는 몇 가지 요인을 제시해준다.

Common themes across these studies and ours suggest several factors that contribute to personal and professional development during and after medical education fellowships.

• 확보된 시간과 지지적 학습환경이 교수개발을 촉진하는데 필요한 조건을 마련해create준다.
  Protected time and a supportive learning environment create the conditions necessary to foster faculty development.

• 정체성과 자신감의 변화에 영향을 주는 핵심 요인은 교육적 원칙과 관련 스킬applied skill에 대한 펠로우의 탄탄한 지식기반이다.
  Our analysis suggests that a key factor in changes in identity and confidence was a Fellow’s strong foundation of knowledge of educational principles and applied skills.

• (정체성과 자신감의 변화에 영향을 주는) 또 다른 중요한 요인은 자기효능감, 타인에 의해서 신뢰받는 것, 자기성찰, 자기인식, 동료와 멘토 커뮤니티로부터의 서포트 등이 있다.
  Other important factors were an enhanced sense of self-efficacy, greater credibility as perceived by others, self-reflection and self-awareness, and support from a community of peers and mentors.

• 정체성은 의학교육에 관심을 가진 소중한 동료들의 사회적 그룹의 구성원membership에 의해서 더 강화된다.
  Identity was further strengthened by membership in a social group of valued colleagues who are interested in medical education.

• 대부분의 펠로우에게 있어서 personal development는 전문직으로서의 성장professional growth으로 이어졌는데 이것을 가능하게 해준 것은...다응메 대해서 펠로우가 자신의 능력을 느끼고felt enabled 힘이 생기는 것empowered이다.
  For most Fellows, this personal development led to professional growth, as they felt enabled and empowered

• 새로운 도전과제를 맡는 것 to take on new challenges,

• 의학교육과 관련한 커리어 궤적을 추구하는 것 to pursue career trajectories in which medical education responsibilities occupied an expanded role, and,

• (가끔은) 조직의 변화에 영향을 주는 것 in some cases, to effect institutional change.

우리의 분석 결과는 위의 언급된 요소로부터 촉진된 정체성/자신감/자기효능감은 의학교육을 핵심으로 두는 커리어 궤적을 따르는 professional development를 촉진한다는 이론을 지지해준다.

Our analysis supports the theory that the evolution of personal identity, confidence, and self-efficacy fostered by the common themes mentioned above promotes professional development in a career trajectory that includes medical education as a central focus.

이 공통의 주제들이 교수개발 펠로우십의 '필수 요소'를 구성할 것이다.

We suggest that these common themes constitute “essential elements” in faculty development fellowships in medical education.

28 Armstrong EG, Barsion SJ. Using an outcomes-logic-model approach to evaluate a faculty development programfor medical educators. Acad Med. 2006;81:483–488.

Acad Med. 2009 Aug;84(8):1089-97. doi: 10.1097/ACM.0b013e3181ad1635.

The personal and professional impact of a fellowship in medical education.

오슬러 펠로우십: 의학교육자를 위한 견습(Acad Med, 2010)

The Osler Fellowship: An Apprenticeship for Medical Educators

Yvonne Steinert, PhD, J. Donald Boudreau, MD, Miriam Boillat, MD, Barry Slapcoff, MD, David Dawson, MD, Anne Briggs, and Mary Ellen Macdonald, PhD

우린느 멘토가 되고자 한다. 그리고 의과대학생들이 의학을 배우는 여정동안voyage 그들의 인간성를 유지하고 의료의 예술art적 측면에 대한 감각을 유지할 수 있게 이끌고자 한다.

We are trying to mentor, accompany, and guide medical students on a voyage that will preserve their humanity and their sense of appreciation of the art of medicine. (Osler Fellow, Class of 2009)

Physician Apprenticeship이라는 플래그쉽 과정은 학부교육 4년간 지속되며, 모든 학부생은 6그룹으로 나눠져서 정기적으로 시니어 학생과 Osler Fellow(이하 OF)라 불리는 의사를 만나야 한다. Sir William Osler는 McGill의과대학의 가장 저명한 졸업생이자 교수이다.

a flagship course, Physician Apprenticeship, which spans the four years of the undergraduate curriculum. all students (n  172) in each undergraduate class are divided into groups of six who meet regularly with two senior students and a practicing physician called an Osler Fellow, in honor of Sir William Osler, one of McGill University’s most prominent medical school graduates and faculty members.

오슬러 펠로우십 개요

Description of the Osler Fellowship

두 가지 핵심 요소

The Osler Fellowship consists of two key components:

(1) 4년간 정기적 미팅 regular meetings with students across the four years of their undergraduate education and

(2) OF를 서포트하기 위한 지속적 FDP a longitudinal faculty development program specifically designed to prepare and support the Osler Fellows in their role.

OFship의 핵심은 학생이 일반인layman에서 의사physician이 되기까지의 이행과정을 촉진facilitate하는 것이다.

The meetings with students, a vital aspect of the Osler Fellowship, help to facilitate each student’s transition from layman to physician.

표2에 11개 워크숍의 주제

Table 2 outlines the topics of the 11 half-day faculty development workshops,

방법

Method

디자인

Design

참가자 모집

Participant recruitment

인터뷰 스케줄

Interview schedule

A research assistant with experience in qualitative research who was not associated with the Osler Fellowship conducted all of the interviews. The interview questions were pilot tested with members of the Centre for Medical Education and tapped three major areas of inquiry:

Most questions were open-ended to enable participants to talk freely about the issues. Probes accompanied each question to stimulate thinking, to encourage detailed, expansive responses, and to solicit examples of more general observations. During the face-to-face interviews, which lasted 30 to 45 minutes, the interviewer took minimal field notes; he wrote more extensive field notes within 24 hours of the session to capture main themes and preliminary impressions. The interview questions evolved slightly as the process unfolded; when salient issues emerged in one interview, the interviewer reiterated them in subsequent conversations to test for relevancy.

데이터 분석

Data analysis

Following a recognized qualitative descriptive methodology,18 we transcribed all interviews using standard rules of transcription. We removed identifiers and names from the final transcripts and checked each transcript for accuracy. Thematic content analysis guided the data analysis.19 Two of us (Y.S. and D.B.) independently read all transcripts, identified recurrent themes through multiple, close readings, and agreed on the final themes by consensus. We noted similar themes across transcripts, assembling and analyzing these together. A third investigator (M.B.) read a third of the transcripts to contribute to the confirmation and refinement of the emerging themes; no new themes were added. The final step in the analysis included developing major themes and their component sub themes as well as identifying exemplar quotations to illustrate each theme.

결과

Results

A. 왜 clinical teachers들은 OF가 되어달라는 요청을 받아들였는가?

A. Why clinical teachers accepted the invitation to be Osler Fellows

선택되었다는 명예로움

The honor of being chosen.

Osler라는 이름의 명성cachet이 이러한 기분을 갖는데 중요한 역할을 했음

The cachet of Osler’s name also played a role in this sentiment of honor and recognition,

프로그램의 목표가 자신의 개인적/전문직업적 가치의 부합

The match between program goals and personal/professional values.

여기에 참여하는 것은...다음을 할 수 있는기회라 생각하였음

they saw their involvement as an opportunity

• 의과대학에 reconnect되고 to reconnect to the faculty of medicine,

• 학생을 알게되고 to get to know the students, and

• 의학교육에 변화를 가져오는 to make a difference in medical education

그리고 이 기회는 (기존 교육과정에서는 놓치고 있던 부분인) '치유자이자 전문직으로서의 의사'에 초점을 맞춤으로써 가능한 것이라고 보았다. 또한 어떤 사람은 새로운 교육과정이 그것을 무시하기에는 너무나 중대하였기에, 참여하는것은 자신의 의무obligation이라고 보았다.

by focusing on the physician as healer and professional, a value they considered missing from the previous curriculum. Others commented that it was their “obligation” to participate, especially as the direction of the renewed curriculumwas too important to ignore.

학생과의 connection

The connection with students.

학생을 성장시키고 멘토링을 해주고자 하는 열망

학생들의 "이상주의에 대한 감각과 흥분"을 느끼는 것,

학생의 삶에 중요한 역할을 하고자 하는 것

a desire to nurture and mentor students, to feel their “excitement and sense of idealism,” and to play an important role in their lives.

B. 'OF가 된다는 것'이란

B. Perceptions on being an Osler Fellow

학생과 함께 학습working하는 즐거움

The joy of working with students.

학생과 함께 working함으로써, 그들이 시간에 따라 성장하고 발전해나가는 것을 바라보고, 의사가 되는 "여정"에서 학생을 도와준다.

joy of working with students, watching them“grow and develop” over time, and helping them in the “journey” of becoming a physician.

차이를 만들고자 하는 열망

The desire to make a difference.

의학교육과 학생의 삶에 차이를 만들고자 하는 열망이 있었다. 이것은 핵심 가치(치유자와 전문직으로서의 의사)를 addressing하고, 의학교육을 구제saving 또는 복원restoring하는(잃어버린 어떤 것을 찾는 것), 학생들이 어떻게 의사갈 되어야 하는가를 가르치는 것 등으로 이룰 수 있는 목표였다

desire to make a difference in medical education and their students’ lives by addressing core values (e.g., the physician as healer and professional), by “saving” or “restoring” medical education (and in so doing, returning something that was lost), and by teaching students how to be physicians.

성찰과 리뉴얼의 과정

The process of reflection and renewal.

성찰하고, 자신의 가치를 확인하고 복원하는 기회였다. 그리고 "새로운 기분을 느끼게 하는feel again" 기회였다.

opportunity to reflect, to confirm or restore their values, and to “feel again.”

OF는 어떻게 학생과 함께 working하는 것이 자신들로 하여금 스스로의 행동을 돌아보고, "학생의 눈을 통해" 자신을 바라보게 "강제forces"하였는가를 언급함.

Osler Fellows commented on how working with students “forced” them to reflect on their own behaviors and look at themselves “through their students’ eyes.”

커뮤니티의 형성

The building of community.

커뮤니티 의식과 협력관계collegiality가 발달하였다.

sense of community and collegiality that had developed among them:

C. OF를 위한 교수개발 프로그램에 대한 생각

C. Perceptions of the faculty development component of the Osler Fellowship

공동의 목표에 초점을

A focus on a common purpose.

OF들은 워크숍의 목표가 자신의 요구에 잘 부합하였고, 내용이 즉각적으로 적용가능하였으며, 그들에게 주어진 활동이 학생들과 함께 working하는데 유리함head start를 주었다고 했음.

They particularly appreciated the fact that the workshop objectives were relevant to their needs, that the content was immediately applicable, and that the activities gave them a “head start” in working with their students.

"뭔가 다른" 종류의 내용

A “different” kind of content.

내러티브 의학과 성찰적 실천을 강조하는 것은 "thinking outside the box"와 같았으며, 어떤 사람들은 치유자와 전문직업성을 강조하는 내용이 긍정적이라고 했다.

they saw the emphasis on narrative medicine and reflective practice as “thinking outside the box;” some also saw the content, with the emphasis on healing and professionalism, as a positive value.

지속성

A sense of continuity.

OF들 상호간, OF와 교수개발자, OF와 교육내용과의 관계가 전 세션에 걸쳐 지속되었다. 다수의 OF는 이 지속성을 다른 전통적 FDP와의 두드러지는 차별성이라고 강조했다.

with each other, with the faculty developers, and with the content that ran through the sessions. A number of the Osler Fellows highlighted continuity as a distinct difference when comparing these workshops with more traditional faculty development activities.

피어(동료)-멘토십의 기회

An opportunity for peer mentorship.

더 나아가서, 생각과 경험과 정보를 토론할 기회가 자신들이 옳게 하고 있다on the right track는 확신을 갖게 하는reassuring데 도움이 되었고, 또 "기반grounded"을 유지remain하는데도 도움이 되었다. 많은 경우에 (비록 두 가지가 모두 필요할지라도) 이러한 경험의 공유와 집단적 문제-해결은 정보의 전달보다 더 가치가 있었다고 하였다.

Moreover, the chance to discuss ideas, experiences, and information had the noted benefits of “reassuring” the fellows that they were on the right track and helping themto remain “grounded.” In many ways this sharing of experiences and collective problem-solving was considered more valuable than the transfer of information, though most felt that one would not have happened without the other.

이들은 롤모델링을 통하여(즉, 동료들과 그룹 퍼실리테이터를 봄으로써) 멘토링에 대하여 배우게 되었다고 느꼈다.  OF는 존중으로서 대하는 것with respect이 교수개발 이니셔티브의 중요한 점이라고 느꼈다.

They felt that they were learning about mentoring through role modeling—that is, by watching their peers and the group facilitators. The Osler Fellows also identified the notion of being treated with respect as an important aspect of this faculty development initiative.

공동체에 소속된다는 것

Belonging to a community.

여기에는 공동체에 소속되어있다는 느낌, 확신confirmation, 강화reinforcement, 공통의 목표와 가치 등을 포함한다.

This sense included the notion of belonging to a community as well as a confirmation, or reinforcement, of shared goals and values.

고찰

Discussion

의학교육자들은 종종 교수들을 educational task를 위하여 모집하는 것이 어렵다고 말하며, 자유 지원제volunteerism에 이어서 번아웃의 가능성을 어려움으로 꼽는다. 놀라울 정도로 교수의 모집과 번아웃은 OF의 문제가 아니었다. OF라는 이름이 프로그램에 명확한 가치를 부여해주었다. 교수들이 느낀 명예로움과, 이 프로그램에 참여하는 것에 대한 recognition, 그리고 전체 프로그램에 걸쳐 축적된 reconnection의 느낌도 여기에 가치를 더해주었다.

Medical educators often talk about the difficulty of recruiting faculty members for educational tasks or the possibility of burnout secondary to volunteerism.20,21 Surprisingly, neither recruitment nor burnout was a challenge in the Osler Fellowship, For example, the name, Osler Fellow, endowed the program with a clear sense of value. The faculty members’ sense of honor and recognition in participating—as well as their sense of reconnection that accrued over the course of the program—also added value.

OF에 참여하는 것이 connection과 reconnection의 느낌을 가지게 해주었다는 것도 흥미로운 점이다. 학생과 함께 working하는 것이 교사들의 단절disconnect된 느낌을 줄여주었다는 것은 관심을 가질 필요가 있다. Brookfield는 비판적 성찰의 개념을 통해서 교수가 자기자신을 학생의 눈으로 바라보는 것이 리뉴얼에 필수vital적임을 강조하였다.

The observation that participation in the Osler Fellowship led to a sense of connection and reconnection is also of interest. The fact that working with students in a program that addressed teachers’ intrinsic values helped to mitigate this sense of disconnect merits attention Brookfield23 has described the concept of critical reflection, particularly the importance for faculty to see themselves through students’ eyes, as vital for renewal.

Conclusions

Sir William Osler는 교수를 “senior student anxious to help his juniors.” 라고 묘사했다. 그는 또한 “When a simple earnest spirit animates a college, there is no appreciable interval between the teacher and the taught—both are in the same class, the one a little more advanced than the others.” 라고 했다. 많은 경우, 우리의 OF들은 교수에 대해서 이와 같은 이미지가 강화되었reinforced으며, 각자의 발달에 있어서 apprenticeship의 가치도 강화되었다.

Sir William Osler38 portrayed the professor as a “senior student anxious to help his juniors.” He believed that “When a simple earnest spirit animates a college, there is no appreciable interval between the teacher and the taught—both are in the same class, the one a little more advanced than the others.” In many ways, our Osler Fellows have reinforced this image of the “professor” and the value of an apprenticeship in their own development.

The Osler Fellowship: an apprenticeship for medical educators.

Clinical teacher를 위한 효과적인 프로그램: 교수개발자의 역할(Med Teach, 2001)

Building an effective programme for clinical teachers: the role of the staff developer

MAGGIE CHALLIS

Centre for Postgraduate and Continuing Medical Education, Queens Medical Centre, Nottingham, UK

교수개발자의 역할

The role of the staff developer

과거는 외국과 같다. 그 곳에서는 모든 것들이 다르게 작동한다.

The past is a foreign country: they do things differently there. (L.P. Hartley, The Go-Between)

의학교육은 이제 하나의 학문으로 자리잡았다. 그러나 교수개발자의 역할은 종종 어렵다.

Medical education is now established as a discipline in its own right, However, the role of the staff developer, whose job it is to implement the findings of such explorations, is often difficult.

교수개발자의 역할은 여러 가지 영역을 매개한다. 

The role of the staff developer is to act as a go-between in several spheres:

• 교육의 전통적 모델과 대안적 모델
  to move from the traditional to an alternative model of education; 

• 교수들을 공통의 목표를 가지고 묶어주기
  to bring together staff with a common aim; 

• 교육시스템의 서로 다른 부분을 통합하기
  to integrate different parts of the educational system; 

• 의학교육과 다른 교육영역의 interface에서
  to act as an interface between medical education and other educational arenas; 

• 혁신의 rationale와 수단
  to offer a means and rationale for innovation.

이 다양한 중재자 역할을 수행하기 위해서는 교육이라는 영토에 서식하는 여러 동물들을 탑승on board하게 만들기 위한 전략이 필요하다. 동물의 왕국에 비유하자면...

To fulfil these different mediation roles, a range of strate- gies needs to be developed in order to bring on board the very varied inhabitants of the educational terrain. An analogy from the animal kingdom might be used to describe these:

• 공룡
  dinosaurs, who thrived when the land offered them an appropriate climate, but who were unable to maintain their existence once the environment changed; 

• 코알라
  koala bears, who survive under very limited environ- mental conditions, are somewhat slow and cumbersome, and live on a highly specific diet; 

• 다람쥐
  squirrels, who can leap around or run on the ground, and are not particular about the type of nuts and berries they eat; 

• 양
  sheep, who provide food and wool for clothing and are therefore immensely valuable, but who are essentially followers and live in flocks; 

• 표범
  leopards, who are the hunters, the aggressors, with a range of habitats and running and climbing skills—but who may have difficulty changing their spots; 

• 고슴도치
  hedgehogs, whose response to the unknown is to curl into a ball and wait for the danger to pass; 

• 원숭이
  monkeys, who are inventive and able to learn and adapt, and will usually get their own way; 

• 카멜레온
  chameleons, who instinctively blend into the landscape in order to remain safe.

위의 동물들 중 어떤 조합은 재앙을 초래할테지만, 어떤 조합이 안전한지를 이해하는 것, 그리고 어떤 식단이 적합하고 개별 종species의 특성을 어떻게 build on 할지를 하는 것이 성공적인 FDP의 핵심이다. 그러나 모든 사람을 만족시키는 하나의 접근법은 없다.

Bringing certain combinations of the above into the same place will result in disaster, but understanding which combinations are safe, what diet will be appropriate and how to build on the characteristics of individual species is one of the keys to a successful staff development programme. It is clear, however, that a single approach—will not meet the needs of everyone.  

의학교육의 전통적 모델

The traditional model of medical education

의학교육은 전통적으로 숙련된 교육자들로부터의 input이 별로 없었다. 임상교육은 '보고, 하면, 가르칠 수 있다‘see one, do one, teach one’ '이라는 영적 세례였다. 주니어 의사들은 삼투osmosis의 과정을 거쳐서 학습할 것이라고 기대되었다. 단순히 (교수의) 주변에 있고, (교수를) 보는 것 만이 배움의 핵심이었다.

Medical education has historically had little input from experienced educators. Clinical teaching has been characterized by the much quoted ‘see one, do one, teach one’ baptism of fire. Junior doctors have been expected to learn through a process of ‘osmosis’: simply being around and watching has been perceived as the key to learning.

의사들에게 교수-학습이라는 개념이 도입되기 시작한 것은 하루 혹은 이틀짜리 코스를 통해서였고, (막연히 교육의 효과가 있을 것이라 가정하면서) 교육의 효과를 어떻게 평가할지에 대한 follow-up은 거의 없었다. 교수-학습 이론에 약간 노출시키고, 마이크로티칭 연습 기회를 조금 가지면, medical teaching의 퀄리티 향상에 충분할 것이라고 생각한 것이다. 또한 어떤 코스를 이수하는 것이 학습이 일어났다appropriate learning taken place는 것의 지표라고 여겼다.

Where  efforts  have  been  made  to  introduce  doctors  to the  concepts  of  teaching  and  learning,  these have frequently been through the medium of a one- or two-day course,  with  little  or  no  follow-up  to evaluate how the learning,  which is assumed to have taken place, has been implemented or has led to changes in educational practice.The  perception  appears  to  be  that  some exposure to teaching and learning theory and  opportunities to practise micro-teaching  is  sufficient  in  itself  to bring about improvements  in  the  quality  of  medical  teaching , and it is  assumed  that  attending  the  course  is  an  indication  that appropriate learning has taken place.

의학교육의 전통적 모델은 한계점이 있었고, 그 한계점은 교수를 위한 교육의 한계와 정확히 일치parallel 했다.

The traditional model of medical education has many drawbacks, which are paralleled in the traditional model of teaching the teachers.

학습에 대해서 우리가 아는 것은?

What do we know about how people learn?

Vygotsky (1978). 사회적 환경이 발달을 유도한다the social envi- ronment drives development. 교사의 역할은 학습자와 교육내용subject를 'zone of proximal development' 안으로 데려오는 것이다. 여기에는 교사가 학습자의 학습준비단계를 측정하여서, 학습자료를 가장 받아들이기 쉬운 방식으로 제시하는 것을 포함한다. 학습을 촉진하는 내부 프로세스가 시작되게 만드는initiating 핵심은 학습자를 encourage하여 학습환경 내에서 다른 사람과 상호작용하게 만드는 것이다.

Vygotsky (1978) takes the stance that the social envi- ronment drives development. He linked intelligence to the capacity to learn through instruction, and saw the role of the teacher as being to bring the learner and the subject to be learned within the ‘zone of proximal development’. This involves the teacher in gauging the stage of readiness of the learner to learn, and therefore presenting the material in a way in which it will most easily be accepted. A key to initi- ating the internal processes that will stimulate learning is to encourage the learner to interact with other people within the learning environment. 

Lave & Wenger (1991). 학습을 강화하거나 방해하는 환경의 영향에 대하여 강조하였음. '정당한 주변부 참여legitimate peripheral participation’이라는 개념에서 learning and doing은 서로에게 통합적으로 묶여있으면서, 이 두 개를 분리하는 것은 불필요하고 바람직하지도 못하다고 했다. 따라서 교사가 해야할 일은 주어진 (실제) 과제에 건설적으로constructive to the task in hand 학습자를 참여시키면서, 동시에 학습자의 니즈에 맞게 구조화하고 니즈에 관련된 참여를 시키는 것이다.

Lave & Wenger (1991) have highlighted the influence of the environment in enhancing or hindering learning. In exploring the concept of ‘legiti- mate peripheral participation’, they have posited the belief that learning and doing are integrally bound up in each other to the point that separation is unnecessary and unde- sirable. The challenge to the teacher is therefore to enable participation of the learner in roles that are constructive to the task in hand, but also structured and relevant to the learner’s needs.

Kolb (1984). 생각이 경험으로 accommodate되고, 경험이 기존 개념으로 assimilate 되어야만이 학습이 일어난다고 했다. 따라서 학습은 경험을 통해서 생각idea이 바뀔 때 일어나며, 펙트보다는 스킬의 습득에 기반한다고 주장하였다. 지식은 정체된 것이 아니며, 지속적으로 생성create되고 재생성recreate 되는 것이며, 개별 학습자의 해석에 따라 달라진다. 교수의 역할은 학습자의 발달에 holistic approach를 장려하는 것이며, 학습자와 학습환경의 상호작용을 장려하는 것이다.

Other key writers on adult learning are Kolb and Schön. Kolb (1984) describes how learning can only take place when ideas are accommodated into experience, and experi- ence is assimilated into existing concepts. Thus learning takes place through a modification of ideas through experi- ence, and will be based more on the acquisition of skills rather than facts. Knowledge is not static, but is continu- ally being created and re-created, and is subjected to interpretation by the individual learner. The role of the teacher is to encourage a holistic approach to learner devel- opment and the interaction of the learner and his/her environment.

Schön (1987). 성찰이 professional learning의 핵심이라고 주장하며, 'master' of the profession으로서 교수의 역할은 학습자와 교수자 사이의 상호적reciprocal 성찰 프로세스를 포함한다. 또한 능숙skilled해지기 위해서는 연습이 중요하다고 하였으나, 이러한 연습practice란 안전하고, 위험이 적은 환경에서 이뤄져야 한다고 강조했다. 교사는 그러한 상황을 만들거나 찾아내야 하고, 교수-학습 프로세스에 그러한 상황을 이용해야 한다.

Schön (1987) also emphasizes the concept of reflection as a key to professional learning, and suggests that the role of the teacher as ‘master’ of the profession should involve a reciprocal process of reflection between learner and teacher. He also stresses the importance of practice as a means of becoming more skilled, but emphasizes that this should take place within a safe, low-risk environment. The teacher is able to create or identify such situations, and capitalize on them for teaching and learning processes.

이 모든 것들이 교사들의 역할을 이해하고 수행하는데 잘 맞을지 모르나, 임상교사clinical teacher에게는 꼭 그렇지도 않다.  Perry(1970)는 대학생의 인지적 발달 단계를 identify하였다. 이 연구의 참여자는 전체 인구를 대변하지 못하며, 하버드 대학의 남학생이다.

Whilst  all  this  makes  perfect  sense  in  a  world  where teachers understand  their role and are able to carry it out, clinical teachers are not necessarily in this situation. Perry(1970) identified stages of cognitive development amongst undergraduates.  Although  his  participant  group  was  not representative of the learner population, being male under- graduates at Harvard,

의사로서 수련을 받는 과정에서 의사들은 길고 구조화된 수련의 결과로 이 단계들을 밟아나갈 것으로 여겨진다assume. 그러나, (의사가 아닌) 교사로서는 이 모든 단계를 밟아나가지 못했다. 따라서 교수개발자들에게 있어서 첫 두 단계에 해당하는 태도만 목격하는 것은 놀라운 일이 아니다. 그러나 학습자가 이후 단계로 나아갈 수 있다는 것을 이해한다면 이제 막 교사가 된 사람들budding teacher에 대한 인식을 확장시킬 수 있을 것이다.

In their training as clinicians, doctors naturally might be assumed to move through these stages as a result of their long and structured training. However, as teachers, they have not been led through all Perry’s stages. It is therefore not surprising that, as staff developers, we encounter atti- tudes relating to the first two stages—dualism and multiplicity. However, understanding that the learner can be taken through the latter stages may help frame a programme which will expand the perceptions of the budding teacher.

 

의학교육의 영토에 살고 있는 부족의 특성은?

What are the characteristics of the tribes in the medical education territory?

Ashmore & Del Boca (1981)는 고정관념stereotype이란 반드시 부정적인 접근법만을 가져오는 것은 아니라고 하였고, Fiske는 유사한 성격을 가진 것들을 그룹으로 묶는 것은 그들이 누구인지 알고, 그들을 어떻게 대해야 하는가를 아는 것을 단순화하는 방식이라고 했다. Belbin은 선호하는 근무방식에 따라 개개인을 분류하는 프로세스를 만들었다.

However, as Ashmore & Del Boca (1981) have indicated, stereotyping is not necessarily a process which leads to a negative approach, and Fiske (1989) indicates that catego- rizing others into groups with similar characteristics makes it possible to simplify ways of knowing who they are and how they should be treated. Indeed Belbin (1981) intro- duced the process of characterizing individuals and the way in which they prefer to work,

(1) 개척자, Trailblazers, characterized by:

• being visionary but few in number; 

• being motivated by the desire to improve the quality of learning and to explore the frontiers of teaching and learning; 

• preferring to work alone; 

• being keen to give any innovation a high priority; 

• moving on to the next task once the excitement has worn off.

(2) 선구자 Pioneers, characterized by:

• being few in number; 

• being motivated by the desire to improve the learning experience of others; 

• lacking in skills, time or confidence;

• being good collaborators; 

• being keen to give a particular innovation high priority.

• being many in number; 

• being generally poor collaborators; 

• getting involved in innovation because of a new institu- tional policy, commitment or requirement; 

• preferring to continue with current practice rather than prioritize innovation.

(4) 유목민 Nomads, characterized by:

• being many in number; 

• habitually moving in and out of teams; 

• having few longer term aims; 

• taking on short-term, ‘quick fix’ aspects of innovation.

각 그룹은 받고싶은 서포트의 타입이 무엇인지 제안하도록 했음

Each group was given a suggested list of types of support that they might use to frame their discussions:

• how to create a climate for accepting change; how to clarify the nature, purpose and origin of a proposed innovation in teaching and learning; 

• how to develop skills and understanding; 

• what checklists, templates or guides might be used or developed; 

• how individual support might be given to support plan- ning and development of an individual’s change of practice; 

• how to establish a system of peer support; 

• how practice could be monitored and evaluated.

Workshop outcomes

개척자

Trailblazers

By their very nature, these people are hard to locate and pin down. But it may be possible to send scouts out to find them, or to track them down at watering holes—bars or social venues. If they are to become more involved with the work of others and disseminate their work, they will need to be offered incentives, such as some form of public recog- nition, and ample positive feedback. Because they are naturally reluctant to cooperate with others, especially each other, it may be necessary to track them by using people with group-working abilities, such as pioneers, in order to glean where the energy of the trailblazers has been used effectively.

Trailblazers generally enjoy being the centre of atten- tion, and this can be used to advantage by inviting them to give talks or run lunchtime seminar sessions. They will also benefit from being allowed to attend conferences to both disseminate their own ideas and to spot innovations which will be of use to their colleagues. Their ability to stimulate ideas and develop enthusiasm will be best harnessed in this public arena.

However, the downside of trailblazers is that their thirst for innovation can leave behind it a trail of destruction as others try to keep up with them, but become abandoned as the change agent moves on to new pastures. Their activity will therefore need to be carefully monitored and analysed so that their activities can be picked up and handed to others who will be able to follow through. Where possible, it might be useful to encourage them to participate in short staff development events where they can be helped to realize that not all their colleagues are at the same advanced point of thought as they are, but may be better equipped to support their proposed innovations. It will also be helpful to work with them individually, and try to target their activities so that they are focused on the needs of themselves, their colleagues, and the organization, and not simply on following their own path.

선구자

Pioneers

In many ways pioneers are the natural partners to work with the trailblazers’ ideas. Their ability to work in groups offers a means of translating innovative ideas into practice. However, it may be difficult to catch their interest in such a way that they work with an idea which is going to be useful to themselves, their colleagues and the organization.

Pioneers will benefit from the input of a staff developer through experiential group activity, and copious positive feedback. They will need to feel safe within the group, and be clear about what their task is, and what the expected outcomes are. Through the processes of sharing and reviewing their practice with others they will be able to build their confidence in implementation, and may be encouraged to reflect on what they have achieved in order to transfer their learning to new circumstances. This, in turn, will motivate them, and enable them to motivate others through their natural ability to work in groups. A commitment to change across a broader range of activities may then emerge, and enable them to move from working only on specific items of interest, to a more strategic approach.

정착자

Settlers

This group presents a different kind of challenge to the staff developer. Settlers need to be brought to a point at which they can appreciate the world outside the limits of their own corral. Some of their reticence to become involved in innovation may result from a sense of being threatened in their secure environment. They will therefore need to be convinced of the benefits of any proposed changes to their current practice, and be given a forum to express their doubts and anxieties. This, however, must be tempered by a structure that prevents them from merely stating why the status quo should be maintained, or dwelling on a nostalgic view of the past. The staff devel- oper can use learner feedback quite effectively with this group. Whilst they are likely to be popular, and good at what they have always done, an analytical approach to feedback may indicate limitations to the way in which they seek information (not asking questions which might result in challenging answers) or they way in which they interpret it (‘it was just a personality clash’).

Settlers need to be treated with respect and sincerity. They are generally not trying to be difficult, but are genu- inely unable to understand why they should change. Bringing them into structured contact with pioneers to work on specific projects should help them to ease into a situation where they can appreciate the views of others and begin to realize the benefits, and possibly even the personal satisfaction, as well as the challenges of change.

적잡한 교수개발 프로그램 개발

Designing an appropriate staff development programme

새로운 혁신을 도입하고자 하는 목적으로 프로젝트 그룹을 시작할 때, 한 그룹 내에서 여러 유형을 혼합하는 것이 좋다.

In implementing a project group around the innovations to be introduced, it will then be important to ensure a mix of types within the group.

미래로 향하는 계획을 세우기 위한 프로젝트 그룹이라면 Pioneers와 Nomads가 핵심을 맡는 것이 좋을 것이다.

When setting up a project group to plan the way forward, it will probably be useful to have a core of pioneers and nomads

실제 혁신의 implementation을 위해서라면 Settlers가 핵심이 된다.

When it comes to actual implementation of the innovation, settlers will be of key importance,

결론

Conclusion

Pioneers와 Settler는 혁신의 뼈대backbone이 될 수 있지만, Trailblazer와 Nomad가 아이디어의 확대와 확산에 영향을 준다면, 이로부터도 도움을 받을 수 있다.

Pioneers and settlers may form the backbone of innovation on the ground, but will benefit from the influences of trailblazers and nomads to ensure expan- sion of ideas and dissemination.

단기 코스는 앞으로도 교수개발활동의 핵심일 것이나, (교수개발 프로그램이) 자신과 관련이 없다고 생각하는 사람들에게는 다양한 마케팅 접근법이 필요하다. 예컨대 스스로를 '교사'라고 인식하는 사람은 '교수-학습'에 대한 프로그램에 관심을 가질 것이다. 비슷한 내용이 '피드백 주기', '교육에서의 슈퍼비전', '멘토링', '카운슬링 스킬' 등과 같은 이름으로 팔릴sold 수도 있다. (프로그램에 대해) 어떤 반응을 보일지는 (교사로서) 자기 자신의 역할과 학습에 대한 서포트 방식에 대한 생각에 따라서 달라지며, 용어terminology가 그 반응을 결정한다.

Short courses will probably continue to form the core of staff development activities, but a range of marketing approaches may help to bring in those who do not currently see their relevance. For instance, people who perceive them- selves as ‘teachers’ will be drawn to events with ‘teaching and learning’ in the title. On the other hand, similar ground may be covered in courses that are sold under the heading of ‘giving feedback’, ‘educational supervision’, ‘mentoring’ or even ‘counselling skills’. The terminology itself will dictate who responds, depending on how they identify their own roles and approaches to supporting learning.

이런 방식으로 두드러진 특성을 가지고 함께 팀으로 일할 사람들을 구성하는 것은 '같은 부족'이 모여서 거의 성과가 없거나 심지어는 혁신의 반대방향으로 가버리는 결과를 막아줄 수 있을 것이다.

However, it is hoped that this way of identi- fying salient characteristics of colleagues will serve as a means of forming groups who will work together as a team, and avoid some of the difficulties we often encounter when members of the same ‘tribe’ come together and end up achieving little or, even worse, simply back away from the proposed innovation.

CHALLIS, M. (2000) AMEE Medical Education Guide No 19: Personal learning plans, Medical Teacher, 22(3), pp. 225–236.

설문 시행, 분석, 보고 (BMJ, 2004)

Administering, analysing, and reporting your questionnaire

Petra M Boynton

파일럿 시행

Piloting

파일럿 검사를 시행할 때 일반적 형식에 대해서, 그리고 구체적 질문에 대해서 설문응답자들이 어떻게 반응하는가를 자세히 기록해야 한다.

During piloting, take detailed notes on how partici- pants react to both the general format of your instrument and the specific questions.

• 얼마나 오래 걸리나 How long do people take to complete it?

• 질문을 반복 또는 설명해줘야 하나 Do any questions need to be repeated or explained?

• 어떻게 답을 골랐는가 How do participants indicate that they have arrived at an answer?

• 특정 질문에 혼란 또는 놀랐는가 Do they show confusion or surprise at a particular response—if so, why? Short, abrupt questions may unintentionally provoke short, abrupt answers.

자료 수집 계획

Planning data collection

데이터 보호와 관련된 법률, 그리고 기관 차원의 규약code를 따라야 한다.

You should be aware of the relevant data pro- tection legislation and ensure that you follow internal codes of practice for your institution—

파일럿팅 단계에서는 설문을 어떻게 배포하고 다시 받을 것인지를 점검해야 한다.

The piloting phase should include planning and testing a strategy for getting your questionnaire out and back—for example,

• 누구에게 응답을 요청할 것인가 who you have invited to complete it (the sampling frame),

• 누가 응답해 주었는가 who has agreed to do so (the response rate),

• 응답은 활용 가능한 형태로 왔는가 who you’ve had usable returns from (the completion rate), and

• 언제 reminder를 줄 것인가 whether and when you needed to send a reminder letter.

행정적 실수도 연구 프로세스 진행을 방해hamper할 수 있다.

Administrative errors can hamper the progress of your research.

설문 시행

Administering your questionnaire

과학적, 윤리적 고려에는 다음을 포함해야 한다.

Scientific and ethical considerations should include:

• 설문응답자의 니즈와 선호,
  The needs and preferences of participants,

• (응답자는) 자신에게 요구되는게 무엇인지 알아야 함
  who x should understand what is required of them;

• (응답자는) 설문 진행과정에서 흥미를 보이고 협조적이어야 함
  remain interested and cooperative throughout completion;

• (응답자는) 적절한 질문을 받아야 하며, 응답이 잘 기록되게 해야 함
  be asked the right questions and have their responses recorded accurately; and

• (응답자는) 설문 작성 중, 작성 후에 적절한 서포트를 받아야 함
  receive appropriate support during and after completing the questionnaire

비-완료 비율을 줄이기 위한 방법은 시작부터 엄격한 exclusion criteria를 세우는 것이다. 그러나 접촉하기 힘든 연구대상 그룹을 systematically 배제하는 것은 비윤리적이며, 추가적인 전략이 필요할 것이다.

One way of reducing refusal and non-completion rates is to set strict exclusion criteria at the start of your research. However, research that systematically excludes hard to reach groups is increasingly seen as unethical, and you may need to build additional strate- gies and resources into your study protocol at the outset.15

비-참여자 대상 자료 수집은 연구 프로세스 모니터에도 도움이 된다.

Collecting data on non-participants will also allow you to monitor the research process.

초반의 거절률이 이례적으로 높으면, 전반적 접근법을 다시 생각해봐야 한다.

In addition, if early refusals are found to be unusually high, you might need to rethink your overall approach.10

자료 입력, 확인, 클리닝

Entering, checking, and cleaning data

상당히 일이 많다.

In reality, entering, checking, and cleaning the data account for much of the workload. Some principles for keeping quantitative data clean are listed on bmj.com.

연구가 진행될 때 같이 정리해야지, 다 끝나고 해야겠다고 생각해서는 안된다.

It is good practice to enter data into an electronic database as the study progresses rather than face a mountain of processing at the end.

자료 분석

Analysing your data

어떤 분석을 할 것인지를 미리 생각해야 함.

You should be able to predict the type of analysis required for your different questionnaire items at theplanning stage of your study by considering the struc-ture of each item and the likely distribution of responses (box 3).1 Table B on bmj.com shows some examples of data analysis methods for different typesof responses.18 19 w1 

Table B: Analysis options18 19 w1  w10