Peer teaching in medical education: twelve reasons to move from theory to practice

OLLE TEN CATE1 & STEVEN DURNING2

1Center for Research and Development of Education at UMC Utrecht, the Netherlands, 2Uniformed Services University of the Health Sciences, USA

Abstract

목적 : 얼마나 Peer teaching(동료교수, PT)이 자주 이용되는지, 그리고 그 이유

Objective: To provide an estimation of how often peer teaching is applied in medical education, based on reports in the literature and to summarize reasons that support the use of this form of teaching.

방법 : 2006년의 문헌을 살펴보고 카테고리별 분류

Method: We surveyed the 2006 medical education literature and categorised reports of peer teaching according to educational distance between students teaching and students taught, group size, and level of formality of the teaching. Subsequently, we analysed the rationales for applying peer teaching.

결과 : 12개의 서로 다른 이유들을 찾아내었음

Results: Most reports were published abstracts in either Medical Education’s annual feature ‘Really Good Stuff’ or the AMEE’s annual conference proceedings. We identified twelve distinct reasons to apply peer teaching, including ‘alleviating faculty teaching burden’, ‘providing role models for junior students’, ‘enhancing intrinsic motivation’ and ‘preparing physicians for their future role as educators’.

결론 : 자주 사용되는 방법이긴 하나 논문으로까지 나오지는 않는다. near-peer teaching이 효과적이며, 견습생(apprentice)와 장인(master)의 사이 단계인 journeyman이라는 비유가 의학교육의 연속체에서 중요하고 가치있지만 아직 잘 활용되고 있지는 않은 것이라 할 수 있다.

Discussion: Peer teaching appears to be practiced often, but many peer teaching reports do not become full length journal articles. We conclude that specifically ‘near-peer teaching’ appears beneficial for student teachers and learners as well as for the organisation. The analogy of the ‘journeyman’, as intermediate between ‘apprentice’ and ‘master’, with both learning and teaching tasks, is a valuable but yet under-recognized source of education in the medical education continuum.

Ten Cate와 Durning은 peer teaching에 대한 광범위한 프레임워크(틀)를 제시했는데, 이 틀은 Peer teaching의 세 가지 독특한 특징을 바탕으로 한다 - 교사와 학생간의 거리, 격식, 학습그룹 크기

In Ten Cate and Durning (this issue) we provided a framework for approaching the broad concept of peer teaching. This framework is based on theory and addresses three distinct features of the peer teaching encounter: the educational distance between teacher and learner, the formality of the setting, and the learner group size.

의학교육에서 peer teaching에 대한 최근 묘사

Recent descriptions of peer teaching in medical education

2006년의 문헌을 살펴봄

A comprehensive review is beyond the scope of this paper and other authors have reviewed this topic well (Ten Cate et al. 1984; Whitman 1988; Topping 1996; Falchikov 2001). To acquire a more recent impression, we reviewed the 2006 medical education literature

다음의 저널에 2006년에 발간된 모든 논문을 살펴보았다. 

We explored the full contents of all 2006 issues of Medical Teacher, Medical Education, Academic Medicine, Teaching and Learning in Medicine, Education for Health, Advances in Health Sciences Education, The Clinical Teacher, BMC-Medical Education, Medical Education Online and the abstracts of the 2006 conference of the Association for Medical Education in Europe (AMEE). We found no reports in Teaching and Learning in Medicine, Education for Health, The Clinical Teacher, Medical Teacher and Academic Medicine in 2006.

peer teaching은 journal article까지는 잘 나오지는 않는다. 그 이유가 잘 알려져 있지는 않다.

It appears that peer teaching is practiced enough to produce a substantial number of abstracts, but does not often lead to peer-reviewed journal articles; the reasons for this are not known.

• Educational distance
• Formality of the educational setting
• Learner group size
• Terminology used
• Reasons cited

Peer teaching의 Rationale.

Rationales for the practice of peer teaching

교육에 대한 교수들의 부담 경감

To alleviate teaching pressure for faculty

4학년 학생이 교수들의 강의를 대체한다고 학습의 질이 떨어지진 않는다.

Tolsgaard et al. and Burke et al. (both in this issue), provide empirical support for the idea that replacing faculty teachers with senior medical students does not compromise the learning of the students taught, a conclusion that was previously drawn by Haist et al. (1998).

그 외에도 장점이 많다.

But even without these scaffolds, peer teaching may provide surprisingly beneficial effects (Tolsgaard et al. this issue).

학생의 인지수준에 맞는 교육 제공

To offer education to students on their own cognitive level

인지적 일치 가설(cognitive congruence hypothesis) : 지식 수준이 비슷한 경우 교육이 더 효과적이다.(지적 '거리(distance)'가 먼 경우보다 효과적이다.

The cognitive congruence hypothesis argues that a teacher with a knowledge base that is similar (i.e. congruent) to the learner’s is a more effective teacher than an expert in the field who has a dissimilar knowledge base, i.e. who is cognitively incongruent, or has a large ‘cognitive distance’ (Cornwall 1979; Lockspeiser et al. 2006).

학생간 지식의 거리가 멀지 않을 때, 비형식적인 교육일 때 'collaborative'혹은 'cooperative' 이라고 한다. 이 경우 학습에 있어서 장점은 조금 덜하다. 

When there is no cognitive distance and when the teaching task is not explicit but informal, we rather speak of collaborative or cooperative learning among students than peer teaching. Here, the relative benefit in terms of learning is less obvious. When the objective is to acquire independent, personal clinical skill, mere collaborative learning may not be more effective than individual study.

편안하고 안전한 교육환경

To create a comfortable and safe educational environment

교육 환경이 중요함

The educational environment or learning climate is appears to be important for optimizing learning and is one of the principal topics addressed in faculty development programs (Skeff et al. 1997).

동료가 학습자에게 덜 위협적이고 의학교육에서 받는 스트레스를 잘 이해할 수 있음.

Peers and near-peers however may be in even a better position to do this as they are potentially seen as less threatening by learners and often have a rich understanding of the stresses of the medical school curriculum, according to the so-called social congruence theory (Lockspeiser et al. 2006).

교육의 성과가 더 나을 뿐만 아니라, 스트레스는 낮다.

Topping (1996) cites authors who found not only better achievement in reciprocal one-to-one peer tutoring arrangements, compared to traditionally taught groups but also significantly reduced stress indicators.

학생들을 사회화시키고 롤모델을 보여줌

To socialize students in medical school and provide role models

의과대학 1학년을 시작하며 사회적으로 소외되거나 사회화 문제가 있을 수 있음. 'student counselling peer'원칙, 'helper therapy'원칙.

Specifically in the first year of medical school, the transition from secondary education or college may create alienation and problems of socialization. The ‘students counselling peers’ principle has been described as beneficial for both the student being counselled as well as the student counsellor, according to the ‘helper therapy principle’ (Whitman 1988).

뛰어난 학생들은 롤모델이 될 수도 있고, peer modelling이라고 함. hidden curriculum의 한 종류

More advanced students can also serve as powerful role models Topping (2001) has called this ‘peer modelling’. The so-called ‘hidden curriculum’ encompasses all those unwritten rules that students should follow to survive or excel the curriculum; peer modelling may play an important role in this phenomenon.

학습방법 뿐만 아니라 동기부여가 됨

To offer students an alternative motivation as well as another method for studying

어떤 부분을 가르치게 된 학생은 그 부분에 관심을 가지게 되고, 단순히 '두 번 배우는' 것이 아니라 더 지식의 유지가 더 강화된다.

Students who are tasked to teach or train others in a domain that interests them and that is relevant for their career, do not only ‘learn twice’; the literature suggests that they learn in a different way, which possibly adds to a longer and more solid retention of knowledge.

비록 예전에 공부한 것과 같더라도 가르치는 역할을 한 학생은 그것을 준비하면서 더 동기부여가 된다. 학습의 강력한 유도(driving)

One of the salient experiences with the student teaching rotation as described in this issue (Ten Cate 2007) is that students who taught were highly motivated to thoroughly prepare for the teaching, even though they studied the same content material themselves some years before. Apparently the teaching task evoked this motivation. Teaching can, next to assessment, clearly serve a powerful drive for learning.

4학년 학생이 2학년 학생에게 사회문화적 다양성을 가르치는 것이 그 이슈에 대한 지식을 높여주는데, 학습을 유도할 뿐만 아니라 가르치는 학생의 지식을 의미있는 방향으로 증대시킨다. 

Tang et al. (2004) showed how the teaching of sociocultural diversity issues in medicine to second year students, as an educational method, enhanced the knowledge of fourth year peer teachers on these issues. Not only is teaching a drive for learning, it appears to add to the teacher’s knowledge in a meaningful way. This could be through re-learning and further organizing knowledge or it may be that teaching evokes different knowledge acquisition and retention which may act synergistically to learning the material.

학생의 내적 동기 강화

To enhance intrinsic motivation in students

가르쳐야 되는 상황은 '외적 동기'처럼 보일 수 있으나, '내적 동기'도 강화시킨다. Self determination theory에 따르면 교사의 위치에 있는 학생이 단순히 학생의 역할만 하는 학생보다 더 내적 동기가 빨리 강해진다.

The obligation to teach can be viewed as an extrinsic motivator, but teaching may also enhance intrinsic motivation. Self determination theory predicts that students in a teacher role will more quickly develop intrinsic motivation to study material then when they just act in a regular student role (Ryan & Deci 2000). This may be due to the fact that the conditions for feelings of competence, autonomy and relatedness are more optimized when assuming the role of the teacher on a topic area as opposed to being a more passive learn

의사의 한 역할인 교육자로서의 준비과정

To prepare physicians for their future role as educators

'의사는 교육자가 되어야 한다'라는 점차 확대되고 있는 컨센서스에 대한 것. 

A very different argument for peer teaching is the growing consensus among the medical education community that doctors need to be educators. Dandavino et al. have elaborated this argument in a paper in this issue. Several recent competency frameworks for future physicians stipulate the role of the physician as educator (Frank et al. 1996; Bleker et al. 2004). 

The need to prepare physicians for this future role has led to...

• initiatives to train students and residents in teaching skills (Edwards et al. 2002; Busari et al. 2006; Haber et al. 2006), 
• provide teaching rotations for residents (Borleffs et al. 2002) and educational fellowships (Searle et al. 2006), 
• and make medical students qualify for teaching tasks (Evans et al. 2007; Ten Cate this issue).

To practice peer feedback as part of multi source feedback

MSF는 직무기반 medical competence의 평가에 있어서 점차 늘어나고 있는 접근법이다. 이 때 정보원중 하나는 동료들에 의한 평가이고, 이를 위해서 학생들은 서로를 평가할 수 있는 능력을 키워야 한다.

Multi source feedback (MSF) is an increasingly popular approach to the assessment of work-based medical competence in trainees and physicians (Epstein 2007). One of the sources of information for feedback and appraisal in MSF is the peer. To fulfil this objective, students should be trained to assess each other. 

Peer assessment is often not considered a easy task (Arnold et al.), and its validity is questioned (English et al. 2006; Lurie et al. 2006) (동료에 대한 평가가 너무 후함.)as students tend to rate their peers too highly (Tyler 2006). Essential is the difference between summative assessment and formative feedback. The latter appears to be much suitable to be executed by peers (Dannefer et al. 2005; Lockyer & Clyman in press). Peer assessment is not the topic of the papers in this theme issue, but the literature shows that it is increasingly practised (Arnold et al. 2005, 2007).

리더십 스킬과 자신감 훈련

To train leadership skills and confidence

리더십은 다음에 필요하다.

The role of the teacher is not merely one of knowledge transmission. 

Leadership is necessary to...

organise teaching, 

to guide and facilitate a group, 

to make decisions about what courses of action are needed during a classroom session and 

to prioritise the subject matter being taught. 

Students, who are experienced in acting as a peer teacher, specifically when distance, formality and group size are large, will likely also develop leadership skills that may be useful in other situations that an academic graduate will be expected to handle.

교육을 중요한 임무로 받아들이는 문화 형성

To modify the academic medical culture toward embracing education as a core task of health care

선진국에서 교육이 중시되지 않는 것은 단순히 재정적 문제뿐은 아니다. 

One problem regarding current medical training in western countries is the undervalued importance as well as the relative paucity of resources available for academic medical education (Cooke et al. 2006). This is not only a matter of finances; a culture that fosters educational leadership and acknowledges the importance of a profession to adequately transmit its knowledge, skills, habits and professional codes of conduct to future generations requires an attitude that is not just focused on the here an now of managed care.

자원이 제한적인 환경에서 의료 훈련 프로그램을 지속시키기 위해서

To sustain medical training programmes in severely resource-constrained settings

In most developed countries, the provision of resources for education is under pressure and peer teaching may help to alleviate some of this pressure, as was mentioned above. However, in some developing countries, the mere existence of medical education is threatened by the accumulation of societal problems. In an excellent overview, Burch (2007) discusses how South Africa’s recent combination of economic decline, a sharp increase in disease burden, a substantial emigration of medical graduates from a country with already one of the world’s lowest healthcare workers to population ratio, seriously threatens the capacity to train sufficient doctors. One recent regulation issued in this country is to spend one compulsory postgraduate year in public health care before registration as a doctor is possible

역량바탕프로그램의 졸업후 교육에서 감독책임(supervision responsibility) 강화

To offer supervision responsibility to trainees in competency-based postgraduate programmes

역량바탕교육과정에서 수련의 outcome이 중요함.

In competency-based curricula, specifically in postgraduate medical training, the outcome of training – i.e. the competence of the specialists – is considered more important than the input of the training – i.e. the training circumstances (Long 2000; Carracio et al. 2002; Ten Cate 2005; ACGME 2007).

이러한 상황에서 레지던트들은 동료 레지던트에 대한 supervision responsibility가 있다.

It has been suggested that in competency-based training, residents may be formally awarded supervision responsibilities for fellow residents, once they have mastered the required competency-level in predetermined areas, ahead of others (Ten Cate & Scheele 2007). This supervision includes being a clinical teacher and role model.

The natural interaction of learningand teaching in medical education

오랜 기간 의학은 '전문가-초심자' 관계로 전수되어왔다. 많은 세대가 개인지도를 해주는 길드 구조에서 전문직으로 키워졌으며, 이러한 길드 구조는 초심자-중간자-마스터의 단계를 이룬다. 점차 독립하게 되는 것이다. 이 중 가장 흥미로운 단계는 'journeyman'이다.

In history, medicine has long been practiced and learned in apprentice–expert arrangements. Many generations have acquired competence in our profession by joining the guild structure of personal guidance. A typical guild structure shows three levels of expertise: apprentice, journeyman and master; phases that reflect growth toward independence. Perhaps the most interesting phase is that of the journeyman, the midskilled craftsman who has completed the apprenticeship.

journeypersons는 가르치는 역할을 자주 하게 되지는 않지만, 마스터가 되기 위해 연마하는 단계를 더 밟아야 하고, journeyperson이 가르치는 역할을 맡음으로서 더 마스터에 가까워질 수 있다.

Journeypersons were often entitled to teach, but still had to develop their own skills further to become a master; indeed it is believed that having the journeyperson teach contributed to the development of mastery.

Collins는 apprenticeship을 교육에 대입해서 'cognitive apprenticeship'이라 불렀다.

Collins et al. (1989) reintroduced the apprenticeship concept in education, and called it ‘cognitive apprenticeship’. But the intermediate stage, the journeyman, seems to have vanished. Following Collins et al. (1989) ‘cognitive journeymanship’ could very well serve as a logical concept in long educational tracks, such as the medical education continuum.

Peer teaching in medical education: twelve reasons to move from theory to practice.

“Continuity” as an Organizing Principle for Clinical Education Reform

David A. Hirsh, M.D., Barbara Ogur, M.D., George E. Thibault, M.D., and Malcolm Cox, M.D.

의학교육의 궁극적인 목적 - 건강에 대한 사회적 요구 달성 - 을 위해서 학부의학교육은 모든 의학 분야를 망라하여 핵심역량에 대하여 폭넓게 숙련된 학생을 양성하는 것이다. 고도로 전문화되고 생산성을 높일 것이 요구되어 교육이 한정된 자원을 놓고 연구와 진료와 같은 다른 영역과 경쟁을 해야 하는 환경에서 어떻게 이 목표를 달성할 것인지는 중요한 도전과제라 할 수 있다.

If the ultimate purpose of medical education —to meet the health needs of society — is to be achieved, the primary goal of undergraduate medical education should be to produce students who are broadly skilled in the core competencies that transcend all disciplines of medicine.1,2 The challenge is how to accomplish this goal in a clinical learning environment fragmented by increasing specialization and demands for clinical productivity and constrained by a prevailing culture in which education must compete with research and clinical practice for medical school resources.3

의과학과 진료의 발전은 눈부신데, 미국 의과대학의 임상교육 모델은 William Osler가 살던 백년 전과 비교했을 때 거의 달라진게 없다. 학생들은 급성기 병원의 특정 전공과에 배치되어 랜덤한 순서로 짧은 로테이션을 돌게 된다. 그리고 그 속에서 학생이 겪게 되는 임상경험역시 Osler의 시대와 다를게 별로 없다.

As compared with the dramatic changes that have occurred in biomedical science and the practice of medicine, the fundamental model of clinical education in American medical schools has changed little since the time of Sir William Osler, a century ago. Students are still assigned to specialty-specific teams of interns, residents, and supervising faculty physicians for relatively brief, randomly sequenced rotations in acute care hospitals. 4,5 And the core clinical credentialing experience continues to be this same series of rotations, primarily in the third year of the traditional four-year undergraduate curriculum, just as it was in Osler’s day.

학생들은 졸업 후 수련과정에서 최소 3년, 길게는 8년 이상을 병원에서 보내게 될 것이며, 이 시기에 필요한 기술들을 연마하기에 병원이라는 환경이 학습 기회를 제공하는 측면에서는 부족함이 없으나, 현재의 모델은 미래사회의 요구와 변화를 전혀 따라가지 못하고 있다. 이를 인지한 많은 사람들은 현재의 급성기 임상교육 모델의 강점을 유지하면서, 현 모델이 가진 주요한 한계점인 '서로 다른 학습경험 사이의 연계성과 연속성'을 극복하기 위한 임상교육의 새로운 모델을 요구하기에 나섰다.

Although there is no doubt that the hospital environment remains rich in learning opportunities for medical students and that students need to learn the skills necessary to succeed in an environment in which most of them will spend 3 to 8 years of postgraduate training, there is a growing sense nationally that the current model is poorly aligned with society’s present and future health care needs.6,7 This realization has led many observers to call for a new model of clinical education, one that would incorporate the strengths of the present acute care educational model but eliminate the model’s major weakness — a lack of connection or continuity among different learning experiences.8,9

교육적 연속성

educational continuity

수련중인 의사에게 있어서, 근대 학습 이론에 기반을 둔 '교육의 연속성'이란, 전문직으로서 그리고 한 개인으로서 지속적인 발전에 대한 것이기도 하다. 교육과정의 한 부분이 아니라, 전체 교육과정에 대한 'ownership'을 갖는 것이 '교육적 연속성'의 필수조건이라고 할 수 있다.

Rooted in the principles of modern learning theory,10,11 the notion of educational continuity reflects the progressive professional and personal development required of physicians in training.12 A spirit of “ownership” of the entire curriculum, rather than one discipline-specific portion of the curriculum, is a prerequisite for educational continuity.13

Continuity of Care

언제나 가장 강력한 동기유발요인은 환자에게 헌신하는 마음가짐이었다. 봉사학습(service learning programs)에서는 학생들이 자신의 열망을 이룰 수 있게 하는 것이 가장 강력하게 학습을 지지하는 것이었으나, 임상실습경험 그 자체에서는 막상 이것을 거의 활용하지 않고 있었다.

Throughout the history of the profession, the most powerful motivator for learning has been the sense of deep commitment to patients. Connecting the student’s desire to serve with his or her desire to learn has strong support in learning theory and has been used effectively for many years in a wide variety of service learning programs in health-related disciplines. However, only rarely has service learning been part of the core clerkship experience itself.14

Continuity of Curriculum

학습자의 가치관/태도/지식/술기 등이 향상되도록 하기 위해서는, 교육과정의 각 요소들이 서로 논리적인 연결구조를 가지고 있어야 한다. 이러한 교육과정의 특징은 세 가지로 요약할 수 있다.

To support the progression of a learner’s values, attitudes, knowledge, and skills, each component of a curriculum should have a rational, considered relationship with all others. A developmentally progressive curriculum has three major aspects. 

First, there is a rational sequential order that facilitates learning, with certain types of knowledge and skills serving as the foundation for subsequent learning. Skills that are notably different, but equally complex, may still be most appropriately taught in a particular order. For example, knowledge of anatomy and pathophysiology facilitates the taking of a medical history. 

Second, more complex tasks should follow some degree of achievement in the performance of more simple but related tasks. Thus, one learns to construct a simple problem list before learning to develop a complicated differential diagnosis. Similarly, grappling with complex therapeutic decisions makes little sense for a student who has yet to master rudimentary diagnostic decision making. 

Third, the curriculum should be implemented in a learner-centered manner, such that a given student’s learning is tailored to his or her particular evolving (i.e., developmentally appropriate) needs.

Continuity of Supervision

교수와 학생간, 그리고 여러 교수들간 연계성을 확립하는 것이 중요하다. 학생들은 지속적으로 지도를 해주는 사람에 대해 환자진료에 대해서 공동의 책임을 갖는다는 직업적인 친밀감을 갖게 된다. 

Establishing connections between faculty, other caregivers, and students and among faculty across disciplines is critical to forming a productive learning community.16 Students and longitudinal preceptors share the professional intimacy of dual responsibility for patient care. Such relationships in which faculty members have personal responsibility for overseeing their own students, provide students with the emotional comfort to take intellectual risks in their learning. At the same time, trusting relationships and shared goals foster coaching, promote effective feedback, and enhance clinical performance.

장애물

barriers to educational continuity

'교육적 연속성'의 개념이 임상교육 개혁에 있어서 핵심 원칙이긴 하지만, 그 장애물 또한 만만치 않다. 

Although the concept of educational continuity provides a powerful organizing principle for clinical education reform, the barriers to changing the manner in which the traditional core clinical clerkship experience is organized should not be underestimated (Table 2). Promoting innovation on the basis of either educational theory or nascent outcomes data alone will require visionary leadership, innovative resource management, and careful attention to learning, cultural, and regulatory issues.

새로운 모델

new models of clinical clerkships

A부터 I까지 각각의 모델과 예시에 대한 설명

Promoting educational continuity is complicated by the traditional division of the core clinical clerkship experience into a disconnected series of independently governed, discipline-specific, randomly ordered, sequential blocks (Fig. 1A), each characterized by largely ad hoc patient assignments and poorly coordinated learning objectives. To provide opportunities for a more collective approach to curriculum design and management and to better deal with so-called orphan topics, medical schools have begun to assume more centralized control of the clerkship year. Over the past decade, this shift in governance has allowed for the development of a variety of new models of clinical clerkships, many of which have incorporated elements of educational continuity into the overall learning experience. 

Some schools have developed interdisciplinary “intersessions” or “interclerkships” (courses, generally of about a week’s duration, interposed between sequential clerkships) (Fig. 1B)19 and longitudinal “themes” or “threads” (courses that link similar content between clerkships) (Fig. 1C).20 Both models provide opportunities for interdisciplinary curriculum design and management. However, short of major curricular revisions (such as consolidating core clerkship objectives or extending the duration of the overall experience), time limitations curtail the ability of either approach to reach its full potential. Many of these new clerkship experiences have used small-group, problem-based learning, which although a natural locus for interdisciplinary teaching,21 had not previously been used in the clinical curriculum as commonly as in the preclinical curriculum.22 

예시) In England, at the University of Manchester, modules of thematically organized, problem-based material are now being taught alongside traditional discipline-specific “attachments” (clerkships).23 Semistructured interviews of Manchester graduates have indicated significant gains in dealing with clinical uncertainty, knowing their personal limits, and asking for help when these limits are exceeded.24 

예시) A variant of problem-based learning has been used at the University of Dundee in Scotland to integrate content across the entire curriculum.25 Task-based learning uses the clinical experience itself, rather than “paper” cases, to generate examples of a series of predetermined tasks, with the students themselves responsible for finding opportunities to explore these tasks as they move through a discipline-specific, sequential curriculum. Task-based learning is credited with enhancing the transfer of basic science knowledge to the clinical years as well as providing an opportunity for integration of core content across clinical disciplines without the need to create interdisciplinary teaching teams.26

Where curricular content sufficiently overlaps disciplines (neurology and psychiatry or obstetrics and neonatology, for example), the opportunity exists to integrate clerkships more fully across disciplinary lines (Fig. 1D). However, although there are examples of integration in which related clerkships have been grouped together for administrative or scheduling purposes, multidisciplinary governance and joint teaching have been attempted only infrequently and have proved difficult to sustain in a subspecialty-dominant practice environment.27-29

Ambulatory care clerkships are another potential locus for interdisciplinary design and management. In recent years, block or longitudinal ambulatory care clerkships (Fig. 1E and 1F, respectively) — individually or collectively organized by departments of family medicine, general internal medicine, and general pediatrics — have become relatively common components of the core clerkship year.30-34 Although single or isolated block experiences are an appropriate forum for the follow-up of time-limited disorders, they provide little opportunity for exposure to chronic disease management, a major required competency in the modern practice environment. 

Students appear to benefit from longitudinal ambulatory care experiences by developing more effective relationships with patients, gaining insight into the psychosocial aspects of care, and understanding the longitudinal management of chronic illness.35 However, this potential is often degraded by competing inpatient responsibilities and patient-scheduling problems. Recurring ambulatory- block rotations devoted exclusively to generalist community practice, alternating with discipline-specific inpatient blocks (Fig. 1G), might provide an effective solution. Combining both departmentally based and interdisciplinary governance models, this intriguing approach — recently suggested to promote continuity in internal medicine residency education36 — has yet to be tested. Applied to undergraduate education, however, it would probably require substantial lengthening of the traditional clerkship year. 

Many permutations of these basic models are possible. Any substantial combination of sequential and longitudinal experiences — so-called mixed models — would allow for some degree of both discipline-specific immersion and educational continuity (Fig. 1H). 

예시) In a pilot program at Case Western Reserve University in Cleveland, for example, time was equally divided between traditional, discipline-specific inpatient rotations and ambulatory settings, with ambulatory training being provided in specialty clinics and a yearlong continuity experience in one of the generalist disciplines.37 Weekly tutorials and seminars, organized as longitudinal themes and provided by a constant group of faculty mentors, served to bridge individual specialty-specific experiences. Grade distributions in core clerkships were similar, except in psychiatry, in which students in the integrated track achieved significantly higher scores than did students in the traditional curriculum. They also performed better on a generalist Objective Structured Clinical Examination but had a lower mean score on the National Board of Medical Examiners’ internal-medicine “shelf” exam. A majority of students reported that they would choose the integrated third year again and would recommend it to others. 

예시) Similar approaches are being tested at several teaching hospitals associated with Harvard Medical School and the University of California, San Francisco, as part of school-wide efforts on medical education reform. 

Longitudinal organization of most or all specialties that are commonly represented in the core clerkships (Fig. 1I) is an emerging but still uncommon model. 

예시) Motivated by the need for graduates who are interested in practicing in medically underserved areas, some schools have created clerkships that place students in longitudinal ambulatory care experiences — including primary care and multidisciplinary group practices — for a significant portion of their clinical training. When measured against regional workforce goals, these programs have been judged to be quite successful. 38-43 Students in these variously integrated longitudinal clerkships have performed as well as their more traditionally trained counterparts on local and national examinations of clinical competence.44-46

예시) Other schools are testing the feasibility of multidisciplinary, cross-site longitudinal integration without emphasizing primary care or attempting to steer students toward the generalist disciplines. In a pilot project at Harvard Medical School and the Cambridge Health Alliance in Cambridge, Massachusetts, students spend the entire third year learning from serial contact with a carefully selected cohort of patients recruited from their preceptors’ practices in internal medicine, pediatrics, psychiatry, neurology, and obstetrics and gynecology.47 Each patient is followed across all venues of care, including outpatient specialty and subspecialty clinics, the inpatient setting, and rehabilitative, nursing home, and home care. Special arrangements facilitate exposure to patients in the emergency department and a full spectrum of general surgical care. Weekly case-based tutorials on fundamental topics that seek to integrate basic and clinical science, simulation exercises, electronic records, and mentored educational portfolios further emphasize the interdisciplinary and personalized nature of the curriculum.48,49

결론

conclusions

새로운 임상실습 모델이 지속될 가치가 있는지 아니면 또 다른 모델이 등장할 것인지는 두고 볼 일이다. 그러나 모델이 무엇이든 임상교육 환경은 좀 더 전문가로서의 발달을 강조하고 환자 중심의 학습을 받아들어야 할 필요가 있다. 보건의료의 궁극적인 목적이 환자중심의 진료와 의료의 질 향상인 것처럼, 교육시스템에서는 학습자중심의 교육과 교육의 질 향상이 그 핵심이라 할 것이다.

Only time will tell whether any of these new clerkship models will have enduring value or whether yet others will need to emerge. Whatever the model, the clinical environment must be made more receptive to professional development, and learning must be embedded in caring for patients. Just as patient-centeredness and improvements in health care quality are becoming the overarching metrics of the health care delivery system, so too should learner-centeredness and improvements in educational quality become the proximate metrics of the medical education system.

"Continuity" as an organizing principle for clinical education reform.

Students’ perceptions of early patient encounters in a PBL curriculum: A first evaluation of the Maastricht experience

AGNES D. DIEMERS1, DIANA H. J. M. DOLMANS1, MARIJKE VAN SANTEN2, SCHELTUS J. VAN LUIJK3, AMEIKE M. B. JANSSEN-NOORDMAN1 & ALBERT J. J. A. SCHERPBIER1

1Maastricht University, 2University Hospital Maastricht, 3VUmc, Amsterdam, at the time of the study Maastricht University, The Netherlands

Introduction: Real patient encounters before the clinical phase of undergraduate medical education are recommended to stimulate integration of theory and practice. Such encounters are not easy to integrate into the three phases of the problem-based learning cycle, i.e. preparation, self-study and reporting. The authors studied students’ perceptions of problem-based learning with real patient encounters as the starting point for learning.

Method: Students’ perceptions of the programme with real patients were evaluated by means of a questionnaire. Mean item scores on a five-point Likert scale and 95% confidence intervals were calculated.

Results: Students showed satisfaction with the patient encounters and said they learned a lot from them. Reporting was also highly rated, particularly the integration of theory and practice. Preparation and self-study received lower scores.

Discussion: The findings support the view that real patient encounters can act as a powerful driving force for learning and enhance integration of theory and practice. Student learning might benefit from: better information to students and teachers regarding educational objectives, teacher training and careful selection of patients. In order to gain more insight into learning from patient encounters, further studies should address students’ and teachers’ views and behaviours in respect of this type of learning.

Introduction

PBL의 취지와 예상되는 이점에도 불구하고, 학생들은 이론적 지식을 실제 환자에 연결시키기 어려워하고 있으며, 실제 환자를 임상실습교육기간보다 이전에 만나는 것이 이 문제의 해결법으로 제시되었다.

Problem-based learning (PBL) is increasingly being used as an educational approach in medical education. It is supposed to ‘promote the transfer of concepts to new problems and the integration of basic science concepts into clinical problems’ (Norman & Schmidt 1992). Despite this assumed benefit, students in a PBL curriculum have reported difficulty in applying theoretical knowledge to real patient problems when making the transition from preclinical, mainly theoretical courses to clinical training during the clerkships (Prince et al. 2000; 2005). Contacts with real patients during the preclinical phase have been proposed as a solution to this problem (Prince et al. 2000; 2005).

문헌을 통해서도 조기 환자접촉의 효과가 확인되고 있다. 실제 환자의 맥락 속에서 이론을 배울때 'more relevant'해지고 'easier to learn'해진다. 또한 학습의 강력한 원동력이다.

Reports in the literature concerning the use of early patient encounters in PBL have confirmed the beneficial effects of such encounters (O’Neill et al. 2000; 2002; Dammers 2001). New knowledge is better internalized when students can relate it to a real patient (Prince et al. 2000). When students learn theory within the context of real patients, it becomes ‘more relevant’, and is ‘easier to learn’ and easier to remember (Norman & Schmidt 1992; Dornan & Bundy 2004; Littlewood et al. 2005). Furthermore, when real patients are used as the starting point for learning, they act as a powerful driving force for meaningful and profound learning (Norman & Schmidt 1992; Prince et al. 2000; Parsell & Bligh 2001; Dornan & Bundy 2004; Littlewood et al. 2005).

그러나 실제로 환자 접촉을 의학 교육과정에 넣는 것은 가볍게 될 일도 아니고, 그 성공이 담보되는 것도 아니다. 주요하게 거론되는 문제로는 환자의 문제를 교육과정의 주제와 맞추기도 어렵고, 핵심 교육과정을 포괄할만큼 충분한 사례를 확보하는 것도 어렵다.

The actual implementation and integration of patient contacts in medical curricula is an undertaking that should not be embarked upon lightly and success is not to be taken for granted. The main problems reported in the literature are matching patient problems to course themes and expected difficulties in selecting sufficient numbers of suitable cases to ensure coverage of the core curriculum (Bokhoven et al. 1998; O’Neill et al. 2000; 2002; Mainhard et al. 2004). 

또 다른 문제는 학생들이 이론과 실제의 의미있는 연결고리를 찾기를 어려워한다는 것이다. 실제 환자를 만나게 하는 것이 자동적으로 학생들로하여금 환자가 가진 문제의 기전(병태생리)를 학습하게 하지는 않았다. 이 연구에서 학생들은 환자와 학습을 적절하게 연결시키지 못했다고 말했으며, 그 연결이 어떤 것인지가 '제시될' 필요가 있다고 했다. 또한 Eva는 학생들이 자동적으로 analytic reasoning을 사용하지 않으며, 환자의 문제가 어떻게 기초과학과 연결되는지 분명한 교육을 받을 필요가 있고, 여러 문제간 비교를 해줄 필요가 있다고 주장했다.

Another potential problem is students having difficulty identifying meaningful links between theory and practice. One study reported that confrontation with real patients in the curriculum did not automatically result in medical students studying the pathophysiology underlying patients’ problems (van der Wiel et al. 1999). In that study, students said that they did not make the connection between patients and learning of their own accord and that they needed ‘to be shown those links’ (van der Wiel et al. 1999). Additionally, Eva (2004) argues that students do not spontaneously use analytic reasoning, but should be explicitly instructed to link the problems presented by the patient to basic science and make comparisons across problems.

조기 환자접촉과 PBL이 가진 교육적 잠재력을 합해내려면 환자 접촉을 PBL사이클에 적절하게 포함시킬수 있는 방법이 필요하다. PBL 사이클을 세 단계로 이뤄진다. 준비-자습-보고. 우리는 준비 단계 이후에 환자를 접촉하는 과정에 대한 연구를 했고, 연구의 목적은 이 4단계 PBL사이클에 대한 학생들의 평가는 어떠한지 보고자 하는 것이다.

In order to realize the combined educational potential of early patient encounters and PBL, a way has to be found to effectively integrate real patient encounters into the PBL cycle. The PBL cycle generally comprises three phases: preparation, self-study and reporting. We studied a course in which real patient encounters were incorporated into the PBL cycle immediately after the preparation phase (Figure 1). The aim of our study was to evaluate students’ perceptions of their learning organized around this four-phase PBL cycle, in which a real patient encounter was introduced as a driving force for student learning.

교육적 배경 Educational background

2001년 Maastricht 의과대학의 6년제 PBL교육과정에 전방위적 개혁이 이뤄졌다. '낡은'교육과정은 명확히 구분되는 두 개 시기로 나눠져있었다 (4년 전임상실습, 2년 임상실습). 새로운 교육과정의 목적은 학생들이 실제 환자와의 경험을 조기에 할 수 있도록 하는 것이다.

In 2001, extensive innovations were introduced into the six-year PBL curriculum of Maastricht Medical School, the Netherlands. The ‘old’ curriculum consisted of two distinct phases: a four-year preclinical phase in which PBL tutorials were the predominant educational method and two years of mainly hospital-based clinical clerkships. One of the aims of the new curriculum is to offer students experiences with real patients earlier in the curriculum. 

이를 위해 3학년에서 실제 환자와의 잦은 접촉 기회를 포함시켰고, 새로운 3학년 교육과정의 주제는 '만성질환' 이었다. 이 주제는 크게 네 개의 클러스터로 나눠진다. 매주 학생들은 외래 클리닉에서 환자를 본다. 환자와의 접촉은 PBL사이클의 시작점이고, 각 사이클은 일주일간 진행되며 10명의 학생과 학생들의 코치가 함께하는 4시간짜리 tutorial, 모든 학생들의 환자 접촉, 환자 접촉과 다음 tutorial 사이의 자습시간으로 구성된다. 

In Year 3 this is realized by the introduction of frequent real patient encounters. The theme of the new Year 3 is Chronic Diseases. This theme is divided into four subject clusters, i.e. abdominal region, locomotor system, circulation & lungs and psychomedical problems & mental healthcare. Every week students see a patient in the teaching outpatient clinic at University Hospital Maastricht. The patient encounters are the starting point for learning in the PBL cycle. Each cycle lasts a week and comprises one four-hour tutorial attended by 10 students and their coach, patient encounters for all students, and self-study between the patient encounter and the next tutorial. 

우리는 PBL의 첫 phase를 둘로 나누었다. 하나는 준비시기로, 학생들이 환자 대면을 준비하고 사전 지식을 모으는 단계이다. 환자 대면 시기는 학생들이 짝을 이뤄서 실제 환자를 만나는 것이다. 이 환자 대면으로부터 학생들은 자습할 학습 주제를 찾는다. 

We divided the original first phase of PBL tutorials into two phases: the ‘preparation phase’ in which students prepare for the patient encounter and activate prior knowledge and the ‘patient encounter phase’ in which students, in pairs, meet a real patient instead of a paper patient. From this encounter students derive learning issues for self-study. 

그 결과 네 개의 연속된 시기가 PBL사이클을 구성한다.

As a result, four consecutive phases can be discerned in the PBL cycle. 

The preparation phase takes up the last hour of the tutorial, 

the patient encounter phase is scheduled one or two days after the tutorial, (튜터리얼 1~2일 후)

the self-study phase covers the time between the patient encounter and the tutorial in the next week, and 

the reporting phase takes place during the first three hours of the tutorial. 

PBL사이클은 3학년의 주요한 교육요소이며, 강의자, 술기훈련, 그 외 다른 교육활동으로 보충된다. 이 네 phase의 내용은 아래에서 더 자세히 다룬다.

The PBL cycle is the main educational component of Year 3 and is complemented by lectures, skills training and other educational activities. The content of the four phases will now be discussed in some detail.

1. Preparation phase

The students are given the GP’s letter of referral or a vignette (Box 1) describing the problem (or a similar problem) of the patient they will see in the outpatient clinic. The patient problems are elaborated on by the group in order to activate the knowledge gained during the preceding two years of the curriculum. During elaboration, attention is also being paid to history-taking and physical examination. The students then generate learning issues and decide what to study in preparation for the patient encounter.

2. Patient encounter phase

One or two days after the preparation phase, student pairs go to the outpatient clinic where they take a history and perform a physical examination of a patient. After about 30 minutes, when history and physical examination are finished, the students consult the patient’s attending physician, who acts as their ‘clinical supervisor’. The students and the clinical supervisor then return to the patient to complete the consultation. The role of the clinical supervisor is to guide the students in generating learning issues on the basis of the problem presented by the patient and to give the students feedback on their performance.

3. Self-study phase

During the self-study phase the students work on the learning issues derived from the patient encounter. They make use of a variety of learning resources, such as books, skills training, lectures and so on. The student pairs prepare a clinical presentation on ‘their patient’ to present to the group during the reporting phase.

4. Reporting phase

This phase is partly devoted to the patient presentations, which consist of a report on history, physical examination, differential diagnosis and management plan. The presentation is followed by a discussion of what the students have learned during the patient encounters and self-study phase. The purpose of this phase is to promote integration of theory and practice. Students apply their newly acquired knowledge to the patient problems.

The coach and the clinical supervisor are both clinical staff members of the disciplines involved in the Year 3 programme. Both have had two hours’ training in advance in which it is explained to them how to guide the session as a coach and clinical supervisor.

Instruments

For this study we analysed the results of the anonymous questionnaire of the regular curriculum evaluation, which is administered routinely to all students at the end of each cluster (Appendix 1). This means that each student could complete four questionnaires over the course of the year. The questionnaire is identical for the four clusters and consists of 10 statements with a five-point Likert scale (1=fully disagree, 5=fully agree): two statements about the preparation phase, three about the patient encounter phase, two about the self-study phase and three about the reporting phase. An example of a statement about the preparation phase is: ‘The tutorials provided sufficient preparation for the patient encounters.’ An example of a statement about the patient encounter phase is: ‘I learned much from the patient encounters.’

Analysis

Data were analysed using the Statistical Package for Social Sciences (SPSS version 12.0.1). Mean item scores across all students were calculated for each cluster separately. In this way 10 scores were obtained for each of the four subject clusters. Mean scores below 3.0 were considered unsatisfactory and indicative of a strong need for improvement. Mean scores of 3.0–3.4 were considered borderline, i.e. necessitating some improvement and mean scores of 3.5 or higher were considered good. We determined 95% confidence intervals (95% CI) for the mean item scores to determine whether a score differed significantly (p < 0.05) from 3.5.

Conclusions and discussion

Overall, students appear to be satisfied with the patient encounter phase and indicate that they learn a great deal from it. This supports Dornan’s (Dornan & Bundy 2004) findings that early patient contacts have the potential to enhance learning. The reporting phase is also rated highly. Students strongly agree that the patient encounters are discussed adequately during this phase. This positive view is reinforced by the relatively high scores concerning connecting theory and practice. These results are indicative of positive effects of the early introduction of real patient encounters in a PBL curriculum (Dornan & Bundy 2004). This can be seen as support for the view that real patient encounters can act as a powerful driving force for meaningful and profound learning (Norman & Schmidt 1992; Prince et al. 2000; Dornan & Bundy 2004; Littlewood et al. 2005). It should be taken into account, though, that further research is needed to further investigate the value-added of real patients in PBL.

Students' perceptions of early patient encounters in a PBL curriculum: a first evaluation of the Maastrichtexperience.

The findings support the view that real patient encounters can act as a powerful driving force for learning and enhance integration of theory and practice. Student learning might benefit from: better information to students and teachers regarding educational objectives, teacher training and careful selection of patients. In order to gain more insight into learning from patient encounters, further studies should address students' and teachers' views and behaviours in respect of this type of learning.

Students’ perception of a modified form of PBL using concept mapping

JONAS INNIES ADDAE, JACQUELINE I. WILSON & CHRISTINE CARRINGTON The University of the West Indies, Trinidad and Tobago

우리가 사용한 PBL방법은 Maastricht의 7-step PBL방법을 기반으로 하고 있다. 7step을 요약하면 아래와 같다.

Our PBL method has been based on the Maastricht 7-step PBL method which has been well described (Schmidt 1983). In summary, the 7-step method we have been using comprises the following steps: 

(1) 잘 모르는 단어/구절/개념을 명확히 하기

(2) 답이 필요하거나 토론해야 하는 문제를 찾기

(3) 브레인스토밍을 하고, 가설을 세우기

(4) 토론한 주제에 대한 systematic inventory 만들기

(5) 학습목표를 나열하기

(6) 개별적으로 학습하기

(7) 다시 모여서 새롭게 얻은 정보를 공유하기

(1) clarifying unfamiliar terms, phrases and concepts in the clinical problem, 

(2) identifying issues in the problem that need to be answered or discussed, 

(3) discussing the issues in a free-flowing discussion (brainstorming) and generating hypotheses to explain the issues, 

(4) making a systematic inventory of the issues discussed, 

(5) listing learning objectives that are necessary to address gaps in knowledge, 

(6) private study of the objectives and related material, 

(7) reconvening as a group to discuss the objectives and relating the newly acquired information to the clinical problem. 

7단계 중 4단계에서는 mapping을 활용하고 있으나, PBL전체적으로는 그러한 방법을 사용하는 것은 아니다.

The fourth step of our conventional 7-step PBL method (systematic inventory) uses a form of mapping but that PBL method as a whole does not use much mapping.

concept map이 유용한 도구로서 보고된 바 있지만, 이러한 map을 토론의 '결과물'로서만 봄으로써 learning exercise 과정에서 학생그룹이 어떠한 과정을 겪는지에 대한 정보가 부족하다.

Although concept maps have been found to be a useful education tool in the health sciences (Weiss & Levinson 2000; West et al. 2000; Rendas et al. 2006; Gonzalez et al. 2008), the maps produced tend to be the end products of the group discussions, and lack information about the stages that the group go through during the learning exercise.

Students' perception of a modified form of PBL using concept mapping.

The students perceived the 5-phase method as promoting their passion for learning, and developing their cognitive, metacognitive and interpersonal skills

Impact of national context and culture on curriculum change: A case study (★★★)

MARIE¨ LLE JIPPES, MD, PHD1, ERIK W. DRIESSEN, PHD1, GERARD D. MAJOOR, PHD2, WIM H. GIJSELAERS, PHD3, ARNO M.M. MUIJTJENS, PHD1 & CEES P.M. VAN DER VLEUTEN, PHD1

1Department of Educational Development and Research, 2Institute for Education, 3Maastricht University, Maastricht, The Netherlands

Background: 

앞선 연구들은 한 국가의 문화가 의과대학의 교육과정 개혁에 있어서 큰 장벽이라는 것을 보여준 바 있다. 특히 Hofstede의 문화적 영역(cultural dimension) 중 '불확실성 기피'는 통합교육과정을 도입한 비율과 유의미한 음(-)의 상관관계가 있었다.

Earlier studies suggested national culture to be a potential barrier to curriculum reform in medical schools. In particular, Hofstede’s cultural dimension ‘uncertainty avoidance’ had a significant negative relationship with the implementation rate of integrated curricula.

Aims:

그러나 일부 의과대학은 그 나라의 높은 '불확실성 기피' 수준에도 불구하고 성공적으로 교육과정 변화를 이끌어낸 바가 있다. 이로부터 우리는 이런 질문을 할 수 있다. '어떻게 이들 나라는 '불확실성 기피'라는 장벽을 극복할 수 있었을까?'

However, some schools succeeded to adopt curriculum changes despite their country’s strong uncertainty avoidance. This raised the question: ‘How did those schools overcome the barrier of uncertainty avoidance?’ 

Method: 

오스트리아는 '불확실성 기피' 특성이 강하면서도, 모든 의과대학에서 통합교육을 도입하고 있다. 4개 의과대학을 면담함으로서 27가지의 핵심 변화 agent를 발견할 수 있었다.

Austria offered the combination of a high uncertainty avoidance score and integrated curricula in all its medical schools. Twenty-seven key change agents in four medical universities were interviewed and transcripts analysed using thematic cross-case analysis.

Results: 

우선, 국가적으로 강력한 법을 도입하고 학교의 자율성의 제한하는 것이 ''예외'를 인정하는 문화'', '잘못을 정부 측으로 돌리는 문화'를 억제하는데 기여했다. 새로운 법은 각 대학의 자율권을 '개혁을 촉진하는 것'에 주었다. 이것만으로는 부족할 수 있었겠지만, 변화에 대한 강력한 요구, 지지적이면서 지속적인 리더십, 선견지명을 갖춘 change agent가 중요한 것으로 보인다.

Initially, strict national laws and limited autonomy of schools inhibited innovation and fostered an ‘excuse culture’: ‘It’s not our fault. It is the ministry’s’. A new law increasing university autonomy stimulated reforms. However, just this law would have been insufficient as many faculty still sought to avoid change. A strong need for change, supportive and continuous leadership, and visionary change agents were also deemed essential.

Conclusions:

불확실성을 기피하고자 하는 특성이 강한 나라에서는 엄격한 입법을 통해 변화에 대한 저항을 막을 수 있다. 국가적 입법이 변화를 유도하고, 추가적으로 변화를 지지할 내부적 요인들이 더해지면 교수들의 반대도 극복될 수 있다.

In societies with strong uncertainty avoidance strict legislation may enforce resistance to curriculum change. In those countries opposition by faculty can be overcome if national legislation encourages change, provided additional internal factors support the change process.

Impact of national context and culture on curriculum change: a case study.

Globalization and the modernization of medical education

FRED C. J. STEVENS1 & JACQUELINE D. SIMMONDS GOULBOURNE2

1University of Maastricht, The Netherlands, 2University of the West Indies, Mona campus, Jamaica

Background: 

전세계적으로 교육자들과 학생들이 '효과적인 의학교육'이라고 생각하는 것에는 근본적인 차이가 있다. 그러나 의학교육에서 세계화가 용이한 '쉬운 공식'을 찾고 있었다.

Worldwide, there are essential differences underpinning what educators and students perceive to be effective medical education. Yet, the world looks on for a recipe or easy formula for the globalization of medical education.

Aims: 

여기서는 근대화의 운송자(carrier)로서 의학교육이 가지는 가정/주된 믿음/세계화의 영향 등을 보고자 한다.

This article examines the assumptions, main beliefs, and impact of globalization on medical education as a carrier of modernity.

Methods: 

문화적/사회적 구조를 찾고자 했다. 자메이카와 네덜란드의 두 의과대학에서 PBL에 대한 사례를 이용했다.

The article explores the cultural and social structures for the successful utilization of learning approaches within medical education. Empirical examples are problem-based learning (PBL) at two medical schools in Jamaica and the Netherlands, respectively.

Results: 

분석 결과, 사람들은 천성적으로 협동해서 일하는 것을 잘 하지 못했다. 효과적이고 효율적인 협력을 위해서는 그러한 문화를 만들어내기 위한 정교한 노력이 필요했다. 성공적인 PBL은 효과적인 의사소통기술에 기반하고 있고, 이는 현실을 이해하는데 필요한 공통의 지점에서 문화적으로 정의된다. 이러한 '공통성'은 존재하고 있는 것이 아니라, 명확하고 신중하게 만들어져야 한다.

Our analysis shows that people do not just naturally work well together. Deliberate efforts to build group culture for effective and efficient collaborative practice are required. Successful PBL is predicated on effective communication skills, which are culturally defined in that they require common points of understanding of reality. Commonality in cultural practices and expectations do not exist beforehand but must be clearly and deliberately created.

Conclusions: 

의학교육의 세계화는 디자인된 교수법을 도입하는 것 이상이며, 서구의 모델은 다른 환경에서 적용되기 위해서는 깊은 성찰과 숙고의 과정이 필요하다.

The globalization of medical education is more than the import of instructional designs. It includes Western models of social organization requiring deep reflection and adaptation to ensure its success in different environments and among different groups.

Results

2007년과 2008년, Maastricht 의과대학의 PBL은 학생들로부터 상당한 비판을 받았다. 학생들은 PBL이 그 근본 원칙에 따라 이루어지고 있지 않으며, 단순히 절차적인(ritualistic) 활동이 되어간다고 지적했다. 일부 학생들은 PBL의 유용성이나 적용가능성이 이미 시대에 뒤떨어졌다고 생각했다. 따라서 Bachelor학생들은 나름의 설문을 진행하여 의견을 모았고, 그 중 몇 가지를 아래에 기술하였다. 

In 2007 and 2008, PBL at the medical school of the University of Maastricht was highly criticized by students. Students felt that PBL was not carried out according to its essential principles and was at risk to become a ritualistic activity. Some believed that the usefulness and practicability of PBL was outdated. Therefore, students themselves conducted polling among all bachelor students to hear their opinions. These were some of the reported weaknesses of PBL (Stevens et al. 2010):

-그룹 상호작용은 거의 없으며 그룹 역학은 더 없다.

-학생들은 대개 개별적으로 학습하며, 그룹으로 학습하지 않는다. 이미 지정된 형식이 있는 경우 그룹학습은 ritualistic할 뿐이다.

-평가 단계에서 알아야 하는 것과 개별적으로 세우는 학습 계획이 맞지 않는다.

-학생들은 대체로 모국어로 된 권장 문헌과 인터넷을 사용한다.

-튜터는 그룹프로세스를 촉진하는 역할을 해야 하나, 학생들은 튜터의 전문가적 지식에 크게 의존한다.

– Little group interaction is used. Group dynamics hardly exist.

– Students largely work by themselves, not in groups. In areas where the prescribed formats are used, these are only ritualistic.

– A personal learning plan hardly fits to what students are expected to know at the assessments.

– Students largely use standard (recommended) literature and the internet, preferably in their native language.

– Tutors are required to only facilitate the group process. But students still heavily rely on the tutors’ expert knowledge. 

Mona 학생들과 마찬가지로 Maastricht학생들은 PBL시스템의 장점을 알고 있었다. 그러나 동시에 현장에서의 실패를 경험하고 있었다. Maastricht와 Mona의 학생들은 매우 달랐지만, 동시에 매우 비슷했다. 그룹역학이 작동하기 위해서는 적절한 문화적 구조와 적절한 사회적 구조가 필요했지만 이러한 기초요소가 없었던 것이다. 따라서 문화적 적절성의 문제, 구조적 한계의 문제는 여전히 남는다.

Just like the Mona students, Maastricht students are aware of the benefits of the PBL system but, at the same time, experience the practical failures. Obviously, the students in Maastricht and Mona are very different but, at the same time, very similar. They require the right cultural and social structural underpinnings to get the group dynamics going.

These basic ingredients are missing. So the question of cultural appropriation, structural limitations, and fit remains.

Discussion

From the comparison of PBL in Maastricht and at Mona, it is evident that in both contexts, the cultural underpinnings relating to systems and processes are/were not given due consideration for effective adaptation to the demands of PBL. 

The success of PBL is predicated on effective communication skills, which are culturally defined in that they require common signs and symbols and also common points of understanding of reality. 

Systemic problems are based on the culture of education, which includes the expectations of students as well as those of teachers and the school. This extends to the technological and structural support to make the model work as well as facilities to manage small groups.

Globalization and the modernization of medical education.

Early student-patient contacts in general practice: An approach based on educational principles

RAMON P. G. OTTENHEIJM, PAUL J. ZWIETERING, ALBERT J. J. A. SCHERPBIER, & JOB F. M. METSEMAKERS

Maastricht University, Maastricht, The Netherlands

Abstract

Background: Clinical teaching and learning is generally seen as an educationally sound approach, but the clinical environment does not always offer optimal conditions to facilitate students’ learning processes.

Aims: To show how insights on constructing a good learning environment for student-patient contacts in real practice can be translated into an undergraduate clinical general practice programme in Year 3 and to study its feasibility.

Method: Literature search, yielding starting points for the development of the new programme and questionnaire evaluation of the programme.

Results: Six starting points for a good learning environment for early student-patient contacts: continuing exposure to patients, transformation of experience into knowledge, active role of students, supervision and feedback, time and space for teaching and teacher training were translated into a the new programme. The evaluation showed that the programme was feasible and well received by students and GPs, although some improvements are possible.

Conclusion: In a curriculum with clear goals for early student-patient contacts, it is feasible to implement an early clinical programme in general practice based on educational principles.

Introduction

임상교육은 학부 의학교육의 중요한 요소이다. 조기 임상노출에 대한 언급은 1970년대로 거슬러 올라간다. 또한 최근의 많은 교육과정 개선이 학생들을 조기에 임상경험을 시키는 것을 목표로 하고 있다. 일반적으로 조기 임상 경험은 affective and cognitive 측면에서 긍정적인 효과가 있다. 또한 본격적인 임상실습에 잘 준비할 수 있도록 하며, 배우는 내용을 실제 환경에서 적용할 수 있게 되는 등 여러 장점이 있다. 그러나 이러한 중요성에도 불구하고 최선의 설계가 무엇인지에 대해서는 알려져 있지 않다.

Clinical education is a core component of undergraduate medical education, comprising early clinical experiences and clinical clerkships. Programme descriptions of early clinical experiences go back to the 1970s (Pittman & Barr 1977; Smith et al. 1977; Benor 1987). Many recent curriculum revisions have been aimed at promoting students’ early clinical experiences (Howe 2001; Whipple et al. 2006; Howe et al, 2007; Diemers et al. 2007; Hook & Pfeiffer 2007). Generally, early clinical experiences have positive effects on affective and cognitive outcomes and on knowledge and skill development. Further, they offer good preparation for clerkships. More specifically, they provide an authentic context for learning, help students develop clinical ways of thinking, support students’ learning of biomedical and behavioural/social sciences and offer knowledge that cannot be learned from books (Dornan & Bundy 2004; Dornan et al. 2005). However, despite the fact that the importance of early clinical experiences is underpinned by an evidence-based set of learning outcomes, little is known about the best way to construct such experiences

임상실습에 대한 연구문헌을 살펴보면 임상환경이 항상 최선의 학습환경은 아님이 드러난다. 지나친 다양성과 예측불가능성, 불연속성 등의 특징이 있기 때문에 일차의료진료환경에서 일대일로 가르치는 것이 효과적인 임상교육을 위해서 더 좋을 수도 있다.

Research on clerkships has shown that the clinical environment is not always the best setting to enhance students’ learning processes. Students’ learning experiences are characterized by variability, unpredictability, and lack of continuity (Remmen et al. 2000; Murray et al. 2001; Irby & Bowen 2004). Primary care settings and teaching based on one-to-one contacts may be environments most likely to fulfil criteria for effective clinical teaching (van Leeuwen 1995; Gordon et al. 2000).

2001년 Maastricht의과대학의 6년 교육과정의 revision이 있었고, 그 목적 중 하나는 초기 임상경험을 강화하는 것이었다. 

In September 2001, a revision of the six-year undergraduate medical curriculum of Maastricht University was launched. One of the aims was to intensify early clinical experiences in different practice settings. Until 2001, the Department of General Practice delivered two undergraduate courses based on student-patient contacts: the early clinical Adoption Programme and a clerkship in Year 6 (Martens & op ‘t Root 1992; Crebolder & Metsemakers 1994; van Bokhoven et al. 1998).

Method

우리는 조기임상경험을 '임상실습 전에 실제 환자와 실제 임상 상황에서 접촉함으로서 학습과정을 촉진하는 경험'이라고 정의했다.

We defined early clinical experience as pre-clerkship experiences with authentic patient contact in a clinical context that enhances the process of learning (Dornan et al. 2005)

1단계 : 배경정보 - 문헌 검색

Step 1 Background information

We searched Medline and Psycinfo for articles published after 1970, using the keywords: medical education, undergraduate, programmes, family practice or general practice, and supervision.

2단계 : 프로그램 기술

Step 2 Description of the programme

This step involved translation of the starting points resulting from step 1 into the new programme.

3단계 : 프로그램 평가

Step 3 Evaluation of the programme

We evaluated the first three years of the new programme by a questionnaire survey among the GPs and students participating in the programme.

Results

전 임상실습 교육과정 중 실제 진료환경에서 학생-환자간 효과적인 학습환경을 만드는 방법

Step 1: How to construct an effective learning environment for pre-clerkship student-patient contacts in real practice

1. 조기 환자 접촉의 중요성 : 환자에 대한 지속적 노출이 중요하다.

1. The importance of early patient contacts

지식의 구조화와 장기기억에 Practical experience의 중요성

학생이 illness script를 쓰는 것이 중요

조기에 폭넓은 문제에 대해 다양한 환자를 만나는 것이 중요

There is evidence that practical experience is a prerequisite for the development of medical expertise, based on cognitive psychological theories regarding clinical reasoning and how knowledge is structured in long-term memory (Bordage & Lemieux 1991; Schmidt & Boshuizen 1993; Custers et al. 1998; van de Wiel et al. 1999). It is important for students to develop illness scripts, which consist of pathophysiological knowledge, information about physical, mental and social consequences of disease and the situation in which illness develops. These structures of expert knowledge result from continuous exposure to patients and thus require extended practice in professionally relevant contexts. This underscores the crucial importance of students seeing, at an early stage, multiple patients with a wide range of problems in a professionally relevant context (Dolmans et al. 2005). Starting point A: Continuing exposure to patients.

2. 효과적인 임상교육과 임상학습

2. Criteria for effective clinical teaching and learning

Whilst we are able to describe the settings in which students learn, we are still struggling to answer the question of ‘how’ learning comes about. 

학습 사이클 : Kolb의 경험학습이론. 다양한 사례로부터 얻은 insight가 지식을 illness script로 변환시킨다.

Learning cycle. Kolb’s experiential learning theory asserts that learning occurs through interactions between persons and their concrete experiences (Kolb 1984; Scho¨n 1990). The essence of learning is transformation of experience into knowledge in a cycle which starts with a concrete experience, such as a patient encounter, followed by reflection on that experience, which in turn leads to conceptualizations and generalizations, which are then tested in new situations at which point the cycle starts again. Experiential learning may be enhanced when learners become aware of the consequences of their actions as a result of feedback and inquiry. Generalisation of insights from many different cases can restructure knowledge in memory into illness scripts (Smith & Irby 1997). Starting point B: Transformation of experience into knowledge

학생의 능동적 역할 : 관찰은 초기 단계에서, 매우 제한된 기간동안만 효과적이다. 더우기 정교한 계획과 촉진적 교수가 필요하다. 환자를 독립적으로 보는 것이 중요하다.

Active role of students. What type of practical experience do students need to develop their illness scripts and basic skills? Several teachers think it is sufficient for students to observe clinical situations to achieve the desired exposure. However, observation is only effective in early stages of training, providing preparation and debriefing take place, and even then only for a limited period of time. Students will inevitably get bored and their enthusiasm will fade. Moreover, it requires careful planning and facilitative teachers (Kachur 2003). Thus, students should not remain passive observers for long. Active approaches are ‘hot seating’, with a student leading (a part of) a consultation, and independent patient encounters, in which a student first sees a patient alone in a separate room before being joined by the teacher. Seeing patients independently is the most valued setting for achieving positive learning outcomes (Lawrence et al. 1999; Spencer 2003; Stark 2003). Starting point C: Active role of students.

감독과 피드백 : 감독은 환자outcome에 긍정적인 효과가 있으며, 감독이 없으면 환자outcome에 악영향을 끼치게 된다. 또한 감독관은 임상적으로 유능하면서 많은 지식을 가지고 있어야 하고, 교수능력과 대인관계 능력이 좋아야 한다. 피드백은 감독하는데 있어서 중요한 요소이나 의학교육에서 피드백은 표준적이지 못하다.

Supervision and feedback. Supervision has positive effects on patient outcomes and lack of supervision is harmful to patients. Supervision is key to the success of clerkships (Kilminster & Jolly 2000; Dolmans et al. 2002). Important features of supervision are continuity over time, supervisees’ control of the content of supervision and some reflection by student and supervisor. Effective supervisors give their supervisees responsibility for patient care and offer

opportunities to carry out procedures and review patients, involvement in patient care, guidance, and constructive feedback. They should also be clinically competent and knowledgeable and have good teaching and interpersonal skills (Kilminster & Jolly 2000; Cottrell et al. 2002). Feedback is an essential component of supervision (Rolfe & Sanson Fisher 2002). Unfortunately, the frequency and quality of feedback in medical education are not always up to the mark (Schamroth & Haines 1992; Paul et al. 1998). Feedback should be directed towards behaviour that is amenable to change and be specific rather than general. The needs of the receiver as well as the giver should be considered. Also, feedback should be given timely, i.e. as close as possible to the event, and selectively address one or two key issues rather than too many all at once (Irby 1994; King 1999). Starting point D: Supervision and feedback.

3. 현실적 문제점

3. Practical points

시간과 공간의 제약 : 여러 의사들이 교육과 관련해서 언급하는 문제

Time and space. Most doctors recognize that for clinical teaching the availability of time and space may pose significant problems. Therefore, ample opportunities and acceptable incentives, such as financial reward, are important issues for doctors (Hartley et al. 1999; Haffling et al. 2001; Stark 2003). Given scarcity of time, logistical matters must be dealt with adequately (Hartley et al. 1999). An example of a model of effective and efficient use of time and integration of teaching into day-to-day routine is the ‘one-minute preceptor’ (Spencer 2003). Starting point E: Time and space for teaching. 

교수 훈련 : 학생과 교수가 임상 교육의 내용/스타일/세팅에 대해서 항상 잘 맞는 것은 아니다.

Teacher training. Students and clinical teachers are not always in agreement with regard to content, style and setting of clinical teaching (Stark 2003). Clinical teachers are not fully aware of what to expect and what not to expect from students and may be uncertain about how to give feedback and how to assess. In early patient contacts they are not merely preceptors but they take on the mentor role with a strong focus on supervision and feedback. Therefore, teaching should also include time for preparation and teacher training (Irby 1995; Gordon et al. 2000; Haffling et al. 2001; Stark 2003). Starting point F: Teacher training.

2단계 : 3학년 프로그램의 일반

Step 2: General practice programme in Year 3

The starting points (left column Table 1) resulting from step 1 were used in designing the new GP programme in Year 3 of the new Maastricht curriculum. Within the context of these encounters theory and practice are addressed in an integrated manner. Thus starting points A-D are guaranteed (Figure 1).

After the encounter, they write a structured ‘SOAPEL’ report (subjective, objective, assessment and plan (SOAP) supplemented by elaboration and learning goals)

GP를 대상으로 일 년에 두 차례의 워크숍을 수행함.

Twice a year workshops are offered to inform the GPs about the curriculum and the content of the clinical general practice programme. In the workshop, GPs are instructed about how to fit the programme into their daily practice routine and specific topics are addressed (F) (Table 2).

Step 3: Programme evaluation

The questionnaire items are presented in Table 1. Table 3 shows the response rates and descriptive statistics.

Conclusion and discussion Our findings suggest that early student-patient contacts do indeed enhance learning and integration of theory and practice, and are sustainable (Diemers et al. 2007; Howe et al. 2007).

In designing this programme, we were mindful of Mainhard’s conclusion about the Maastricht Adoption Programme (Mainhard et al. 2004)

Early student-patient contacts in general practice: an approach based on educational principles.

In a curriculum with clear goals for early student-patient contacts, it is feasible to implement an early clinical programme in generalpractice based on educational principles.

Changing face of medical curricula

Roger Jones, Roger Higgs, Cathy de Angelis, David Prideaux

네덜란드에서는 과부하가 걸린 교육과정을 감축하고, 더 흥미를 유발할 수 있는, 적극적인 형태의 교육을 하라는 정부의 압박에 따라 전통적 교육과정과 PBL교육과정이 같이 이뤄지고 있다. 소규모의, 문제중심학습 그룹에 기반을 둔 통합교육과정은 첫 4년간은 공통적이다. 일부 학교들은 학생들의 술기 학습을 위해서 시뮬레이션 기술을 이용하고 있는데, Limburg, Maastricht등의 의과대학이 이러한 능동적 학습 전략을 적용하는데 앞장서고 있다.

In the Netherlands, both traditional and problem-based curricula are taught in response to pressure from the government to reduce overloaded curricula, and to create more attractive and active forms of teaching. Modular, integrated courses based on small, problem-based learning groups, are common in the first 4 years. Some schools also make extensive use of simulation techniques to help students master professional skills; the medical school of Limburg, Maastricht, has had a leading role in the development and application of these active learning strategies.28

Changing face of medical curricula.

Medical curriculum reform in North America, 1765 to the present: a cognitive science perspective. 

Papa FJ, Harasym PH.

1765년 이후로, 북미의 의과대학에서는 다섯 개의 주요한 교육과정 개혁 움직임이 있었다. 여기서는 각각에 대해서 그것의 기저에 있는 교육방법과 원칙, 내재적 한계, 극복을 위한 움직임 등을 보고자 한다. 이러한 개역 움직임의 원동력을 살펴보면 공통의 주제가 드러난다. 지식기반구조(knowledge-base structure)와 인지과정(cognitive process)에 대한 관심과 이해, 그리고 전문가와 초보자의 구분에 대한 관심과 이해이다. 이렇게 반복적으로 나타나는 주제들은 의학교육자들이 연구문헌, 연구방법, 인지과학의 이론적 관점들을 잘 활용해야만이 미래의 개혁을 효율적/효과적으로 이끌 수 있음을 보여준다. 저자들은 여기서 논의된 주제들과 관점들이 더 확장되고, 촉진되어 교육자들이 앞으로 21세기 의학교육 개혁 움직임을 만들어나가는데 도움이 되기를 바란다. 

Medical curriculum reform in North America, 1765 to the present: a cognitive science perspective.

The challenge of reform: 10 years of curricula change in Italian medical schools

HUON SNELGROVE, GIUSEPPE FAMILIARI, PIETRO GALLO, EUGENIO GAUDIO, ANDREA LENZI, VINCENZO ZIPARO & LUIGI FRATI

First and Second Faculty of Medicine, Sapienza University of Rome, Italy

진단검사와 피드백 Progress tests and feedback

10년 전, 이탈리아의 일부 교수들의 European comparative study를 한 이후로, 이탈리아는 학생의 functional knowledge 평가를 위하여 Maastricht의 모델을 본떠서 National Longitudinal Progress Test 를 도입했다. 이 시험은 학생과 교사들에게 피드백을 줄 수 있는 거대한 자원이다. 학생들은 현재 같은 학년내에서, 과목별, 국가 순위를 받게 된다. 이 시험이 다른 시험들과 함께 EU 면허시험의 한 부분으로 쓰일지는 두고 봐야 할 것이다.

After early experimentation in some Italian medical faculties in a European comparative study over 10 years ago (Albano et al. 1996) Italy introduced a National Longitudinal Progress Test based on the Maastricht model in 2006 to assess the functional knowledge of students. Under the auspices of the National Committee of Medical Degree Course Heads this could become a systematic nationwide instrument. The test provides a huge resource for feedback to students, teachers and for internal and external evaluation (Feletti et al. 1983, van Der Vleuten et al. 1996; Tenore 2008). Students currently receive feedback on their rankings compared to class, subject area and national rankings. Whether the progress test in combination with other test formats, will be used as part of a wider EU licensure exam, as its authors had originally speculated, remains to be seen (van Der Vleuten 1990; Albano et al. 1996).

The challenge of reform: 10 years of curricula change in Italian medical schools.

The Association of Faculties of Medicine of Canada

SUPPLEMENTAL REPORT OF THE INTERNATIONAL COMPARISONS - THE NETHERLANDS

JAY ROSENFIELD, MD

NOVEMBER 2008

2. Organization of medical education in the Netherlands:

네덜란드의 의과대학 시스템은, 대부분 고등학교를 졸업하고 바로 입학하게 되는데, secondary school 학생은 요구조건인 고등학교 교과과정을 마치고 국가시험을 치러야 한다. 네덜란드에 독특한 점은, 그렇게 시험을 보고 나서 학생은 의과대학에 입학하기 위해서 국가 가중추첨(weighted national lottery procedure)에 지원하게 된다는 점이다. 그러나 매우 고득점을 받은 사람은 바로 의과대학에 들어갈 수 있다. 두 번째 입학 방법은 미국 의과대학과 유사한데, Utrecht와 Maastricht에 존재하는 방법으로서 의과학분야에서 학사를 받은 사람이 4년제 의과대학 프로그램에 입학하는 것이다.

The Dutch medical school system, which is predominantly direct entry from high school, requires that secondary school students finish a pre-requisite high school curriculum and take a national examination. Unique to the Netherlands, students then apply to a weighted national lottery procedure for entrance selection to medical school. However, those with very high scores on the national exam may freely enter the medical school of their choice. A second entry route, similar to the North American system, exists at two schools, Utrecht and Maastricht, and allows for graduate entry into a four year medical programme for those with a prior bachelor diploma in biomedical sciences.

국가가 입학 정원을 조정하며, 현재는 매년 2850명이 입학한다. 그러나 지원자는 항상 이 정원을 넘어서서 30~50%의 지원자가 탈락한다. 탈락하는 이유는 추첨에서 떨어졌거나 기준에 맞지 않기 때문이다. 학생들은 교육의 질을 자세히 살피고 의과대학을 선택하기 보다는, 대부분 secondary school학생을 위해서 열리는 미팅에서 받은 인상에 따라서 이루어진다. 네덜란드의 대중들은 대개 대부분의 학교들이양질의 교육을 제공한다고 믿고 있으나, 사실 그렇지는 않다. 대학들이 생각하는 것에 비해서 지역적 요소가 차지하는 비중이 크다.

“The Government regulates the enrolment number, currently 2850 students per year (Table 1). As the interest among high school graduates has always exceeded this numerus fixus, 30 to 50% of applicants are turned down, either because they fall out of the lottery, or they do not meet selection criteria. The choice of a medical school is mostly based on impressions from organised meetings for secondary school students, more than from thorough investigation of the educational quality; the Dutch public usually trusts that all schools deliver adequate education which in itself is not untrue. Geographical convenience is a more important determining factor than universities would like to believe.

네덜란드의 의과대학은 6년제이며, Bologna framework를 따른다(학사+석사). 미국과 달리 네덜란드 학생들은 정부에서 상당한 생활비와 교육비 지원을 받는다. 많은 학생들이 용돈을 위해 부업을 한다. 매우 소수의 학생만이 빚 없이 졸업하게 된다. European 근무시간 지침에 따라서 근무시간은 매우 제한적이며, 의과대학에서 졸업한 학생들은 졸업후 교육에 지원하게 되는데, 대학병원이 주로 이를 담당함에도 학생의 지원은 대학의 관할 밖에 있다.

The medical program in the Netherlands is six years in length, and follows the Bologna framework. (bachelor plus master) Unlike North America, Dutch students receive significant government financial grants for their living expenses and education. Many students also work in jobs to make extra money needed. Very few students graduate with any significant debt. The work week is limited in hours as per the European work-time directive. Most students who graduate from medical school apply for postgraduate training, which is not under the jurisdiction of the Universities, though the University Medical Centres play a major role in the delivery of such training.

주요 이슈들

대학과 병원의 거버넌스 문제 : 학장은 병원에서 부원장을 맡고 있으며, 병원장은 부학장을 맡고 있다.

• Governance -integrated structures between academic health science centre and university— Dean is Vice-President of Hospital and Hospital President is Vice-Dean of Faculty— integrated, small and nimble governing board (Maastricht)

의과대학 시작과 함께 임상 실습을 하는 것(예컨대, 생리학 학습을 위해서 첫 해에 응급의학과 로테이션을 함)

• Introduction of clinical training right at beginning of medical school (eg emergency rotation in first year to demonstrate physiology) (Maastricht)

모든 학생들이 연구 프로젝트를 이수함

• All students complete research scholarly project (Maastricht)

학생이 교육과정 개발에 파트너로서 참여

• Students as partners in curriculum development (Maastricht)

(출처 : http://www.afmc.ca/future-of-medical-education-in-canada/medical-doctor-project/pdf/Netherlands%20Comparison%20report.pdf)

Measuring the effects of an international health professions faculty development fellowship: the FAIMER Institute

W. P. BURDICK1, D. DISERENS1, S. R. FRIEDMAN1, P. S. MORAHAN1, S. KALISHMAN2, M. A. EKLUND2,

S. MENNIN3 & J. J. NORCINI1

1FAIMER, Philadelphia, PA 19104, USA, 2Undergraduate Medical Education and PEAR, University of New Mexico SOM,

Albuquerque, USA, 3Mennin Consulting & Associates Inc., Sao Paulo, Brazil

교수개발 프로그램의 평가에 대해서 많은 예들이 있지만, 초국가적인(transnational) 프로그램에 대한 평가는 제한적이다. 우리는 여기서 국제보건전문직 교육 프로그램인 FAIMER Institute의 효과성 평가를 다루고자 한다. 이 프로그램은 교육과 관련된 것 뿐만 아니라 리더십과 경영에 대한 내용도 다루고 있으며, 교육자들의 지속가능한 커뮤니티를 개발하고자 했다. 

While there are many examples of evaluations of faculty development programs in resource rich countries, evaluation of transnational programs for faculty from developing countries is limited. We describe evaluation of the effects of the FAIMER Institute, an international health professions education fellowship that incorporates not only education content, but also leadership and management topics and, in addition, strives to develop a sustained community of educators. 

데이터는 후향적 사전/사후 설문조사와 인터뷰를 활용하여 수집하였다. 결과를 살펴보면 이 프로그램에 참여함으로서 교육리더십의 지식과 기술, 방법론을 향상시킬 수 있었으며, 그 지식을 본국의 기관에 적용할 수 있었다고 응답했다. 참가자들은 스스로 모든 교육과정 주제에 대한 역량이 향상되었다고 평가하였으며 인터뷰를 통해서 최소 하나 이상의 리더십 기술을 습득했음을 확인할 수 있었다. 

Data were obtained via retrospective pre/post surveys, as well as interviews. Results indicate that participating health professions faculty from developing countries are augmenting their knowledge and skills in education leadership, management, and methodology, and applying that knowledge at their home institutions. Fellows’ perceptions of importance of, and their own competence in, all curriculum theme areas increased. Interviews confirmed a nearly universal gain of at least one leadership skill. 

이러한 결과는 FAIMER 모델이 제공한 고관여(high engagement)경험이 변화를 이루는데 필요한 교육과 리더십/경영을 통합했음을 보여주며, 여러 문화권과 국가적 맥락을 넘어서는 지식과 기술을 제공하였고, 지지적/세계적/전문가의 네트워크 구축을 이루었음을 보여준다.

Findings suggest that the high engagement experience of the FAIMER model offering integration of education and leadership/management tools necessary to implement change, provides knowledge and skills which are useful across cultural and national contexts and results in the development of a supportive, global, professional network.

Background

보건전문직 교육과 관련한 교수개발에 있어서 리더십과 경영에 대한 것은 중요한 요소 중 하나로 지적되어왔다.

Leadership and management development has been recognized as a critical component of faculty development in health professions education, along with teaching skills (Gruppen et al. 2003; Steinert et al. 2003; Steinert et al. 2003; Souba 2004; Dwyer et al. 2006; Robins et al. 2006; Mouradian & Huebner 2007).

교수개발과 교육리더십 프로그램의 방법, 내용, 평가는 주로 고소득국가(resource rich)에서 이루어져왔고, 저소득국가(resource limited)에서는 연구가 제한적이었다. 우리는 국제 보건전문직 교수개발 프로그램에 대해 평가해보고자 한다.

The methods, content and evaluation of faculty development and education leadership programs have been widely addressed in resource rich countries (Rubeck & Witzke 1998; Hewson et al. 2001; Armstrong et al. 2003; Searle et al. 2006). However, they have been less well studied in resource limited regions (Svab et al. 1999; Yolsal et al. 2003; Dwyer et al. 2006; Wong & Agisheva 2007), where studies have focused on changes in management systems and processes, or improvements in work climate (Perry et al. 2005; LeMay & Ellis 2008) with little attention to the usefulness and relevance of curriculum content in diverse contexts. To address these questions we evaluated the effects of an international faculty development program in health professions education methods and leadership.

문헌에서 주로 다뤄지고 있는 교육리더십과 경영의 개념/방법은 마찬가지로 고소득국가에 집중되어 있고, 다른 국가들에는 적용가능하지 않을 수도 있다.

The methods and concepts of educational leadership and management commonly espoused in the literature are oriented to institutions in relatively resource rich regions and may not apply in other parts of the world (Sapre 2000; House et al. 2004; Mendelek et al. 2006; Morahan et al. 2006).

이러한 개념을 가르칠 때는 맥락(context)를 인지하고 민감하게 반응할 수 있어야 한다. 리더십에 중요하게 작용하는 위계/협력/상호작용/혁신 등의 요소들이 문화적 가치와 사회적 규범에 들어가 있기 때문이다.

Teaching these concepts, however, requires awareness and sensitivity to context, with particular attention to authentic local application since hierarchy, collaboration, interaction, innovation and other factors important to leadership are embedded in cultural values and social norms (Sapre 2000; House et al. 2004; Mendelek et al. 2006; Morahan et al. 2006).

교육자들의 국제적 네트워크를 개발하는 것은 리더십개발에 있어서 중요한 요소로 지적되어왔다. 그러나 이러한 개념은 저소득국가의 환경에서는 잘 작동하지 않으며, 국소적/지역적인 교수개발 프로그램이 보건전문직 교육자들을 집중시킬 수 있을지는 몰라도 교육자들간의 전문직 네트워크를 이루는 데에는 관심이 부족하다.

Development of international networks of educators has been cited as an important component of leadership development for over a quarter of a century (Culbertson 1981; Bolam et al. 2005; Cross et al. 2006). However, this concept rarely has been operationalized for educators from resource limited environments. Local and regional faculty development programs may result in concentrations of health professions educators, but there appears to be little intentional encouragement of professional networks for educators (Gruppen et al. 2006; MacLeod et al. 2007; Moses et al. in press).

2001년 FAIMER institute는 라틴아메리카, 아프리카, 아시아 등에서 개발도상국의 중견급 교수들을 대상으로하여 펠로우십 프로그램을 시작하였다. FAIMER institute의 목적은 교육리더십/경영/방법론적 기술을 강화하여 보건전문직 교육자들의 커뮤니티를 형성하는 것이었다.

In 2001, the Foundation for Advancement of International Medical Education and Research (FAIMER) initiated the FAIMER Institute, a fellowship program for mid-career faculty members from health professions schools in developing countries in Latin America, Africa, and Asia (Norcini et al. 2005; Burdick et al. 2006). The goals of the FAIMER Institute are to strengthen education leadership, management, and methodology skills, and develop a community of health professions educators

FAIMER 프로그램은 초국가적 접근법을 취했다는 점, 저소득국가의 보건전문직에 대한 강조를 했다는 점, 리더십 스킬과 전세계적 커뮤니티 형성을 목적으로 했다는 특징이 있다. 이러한 강조는 지금 이뤄지고 있는 국제적 보건자원 투자를 보완하는 역할을 한다고 할 수 있다. 또한 점차 많은 사람들이 보건시스템의 인력양성과 Capacity building에 집중할 것을 권고하고 있기도 하다.

The FAIMER program is unusual in its transnational approach and its emphasis on a mix of health professions faculty from resource limited countries, with an explicit goal of improving leadership skills and creating a global community of health professions educators. This emphasis is complementary to the approach of most current international health resource investments, which are devoted to priority disease prevention and treatment programs, and consistent with an increasing number of authors recommending funding focused specifically on capacity building of human resources in the health system (Drager et al. 2006; McCourt & Awases 2007; Awofeso et al. 2008; Global Health Workforce Alliance 2008).

FAIMER Institute model은 자신의 기관에서 교육혁신프로젝트를 집중적으로 진행하는 2년의 파트타임 fellowship으로 되어 있다.

The FAIMER Institute model consists of a two-year parttime fellowship that focuses on an education innovation project in the Fellow’s own institution, supported by the institution’s leadership.

Fellow들은 첫 해에 3주간 본 기관에 상주하다가, 1년간의 원거리 학습 세션을 가진 후, 두 번째 상주 시간을 갖고, 마지막으로 남은 두 번째 해에 원거리 학습을 하게 된다.

Fellows are in residence at the beginning of the first year for three weeks (Session 1), followed by a year-long distance learning session (Session 2), culminating in a second residential session lasting two weeks (Session 3), with a final distance learning curriculum for the remainder of the second year (Session 4).

이 모델은 다양한 고관여(high-engagement methods) 방법을 사용하여 의도적으로 fellow간 유대를 만들고 강화시킨다. 여기에는 다음과 같은 방법이 포함된다.

The Institute model intentionally creates and reinforces the bonds between Fellows by a variety of high-engagement methods. These include...

• team building and group dynamics exercises, 
• intensive interaction and dialogue during the residential sessions, evening ‘‘learning circles’’ during which personal stories are shared (Baldwin 1998; Danzig 1999; Wheatley 2002), 
• continuous emphasis on development of a ‘‘safe’’ learning environment, 
• creation of on-line discussion leader teams, 
• telephone contact every several weeks during the non-residential sessions, 
• and encouragement of ‘‘social presence’’ on the listserv (Kreijns et al. 2004).

Aims

The purpose of this paper is to present participants’ perceptions of the utility and personal impact of the FAIMER Institute fellowship

방법

Method

University of New Mexico School of Medicine Office of Program Evaluation, Education and Research 에서 평가팀이 와서 프로그램 평가, 자료 수집, 데이터 분석을 수행하였다.

An external evaluation team from the University of New Mexico School of Medicine Office of Program Evaluation, Education and Research has conducted the program evaluation, collected data, and performed initial data analysis (Mennin et al. 2003; Kalishman et al. 2004; Kalishman et al. 2005; Mennin et al. 2006; Mennin et al. 2007; Office of Program Evaluation, Education, and Research 2008).

연구 대상 Study population

척도 Measures

자기평가지 사용

We used self-ratings of knowledge and importance of curriculum topics and open-ended responses to a structured interview to study the effects of the Institute fellowship on Fellows’ knowledge, skills, networks, and leadership.

후향적 설문조사 Retrospective Pre/Post Survey

Fellows completed a retrospective-pre/post questionnaire (Lamb & Tschillard 2005), at the end of each of the two face-to-face residential sessions (Sessions 1 and 3). The first part of the survey asked respondents to ‘‘rate the importance to you’’ of a series of FAIMER curriculum topics on a scale from 1 (none) to 7 (very high), with separate rating scales for ‘‘before FAIMER’’ (retrospective pre-test) and ‘‘today’’ (posttest). The second portion of the survey asked respondents to ‘‘rate your skills, knowledge or competence to address’’ each of the same topics on a scale from 1 (none or no skill) to 7 (expert, teach others), also for ‘‘before FAIMER’’ (retrospective pre-test) and ‘‘today’’ ( post-test). The issues and topics for the retrospective pre/post survey were chosen to be reflective of the learning emphases and goals of the FAIMER Institute.

구조화된 면접 Structured interview

An individual structured 1–2 hour interview was conducted with each Fellow by two members of the external evaluation team (SK and MAE) at the end of their second residential session (Session 3).

분석 Analyses

Mean topic sub-scale scores were created for each Fellow by adding the ratings across items within each sub-scale and dividing by the number of items. Means, standard deviations and effect size were then calculated for each pre/post topic subscale for both importance and knowledge/skills. Effect size, the standard mean difference between paired postparticipation and pre-participation ratings, was calculated by using the mean paired difference between post-participation and pre-participation ratings as the numerator and the standard deviation of the paired differences as the denominator (Cohen 1988).

Internal consistency of responses for both pre and post responses within each topic sub-scale of the retrospective pre/post survey, based on five years of data, was calculated via Cronbach’s alpha for topics containing more than two items and via Pearson correlation coefficients for topics with two items. Cronbach’s alpha was calculated separately for years with different numbers of items. 

The internal consistency coefficients for Session 1 ratings of Importance varied from .61 to .95 with a mean of .83, and for Session 3 varied from .48 to .85 with a mean of .71. The internal consistency coefficients for rating of Knowledge for Session 1 varied from .64 to .96 with a mean of .86, and for Session 3 varied from .54 to .89 with a mean of .74.

Interviews were recorded and transcribed, and responses sorted into general categories of Useful Knowledge, Skills and Tools, Network, and Leadership by the external evaluation team, (SK, MAE). A qualitative content analysis approach (Hsieh & Shannon 2005) was used by two of the authors (WPB, DD) to independently code the interview response data and identify sub-themes within each major category. The two coders refined coding subcategories by consensus. The number of responses related to each category was tabulated independently, followed by review and reconciliation of discrepant counts.

결과 Results

fellow들의 코멘트는 크게 세 카테고리로 분류되었다.

Fellows’ comments about the social network among their FAIMER colleagues fell into three general categories: 

• the network’s qualities, 
• the network’s utility or value to them, 
• and the nature of the work done with FAIMER colleagues.

구조화된 후향적 설문조사에서 fellow들은 지식과 awareness가 유의미하게 향상되었다고 응답하였다. 

In a structured retrospective pre/post survey, Fellows reported significant increases in their knowledge and awareness of concepts in education methods and leadership/management. In addition, nearly all Fellows mentioned using at least one leadership skill or tool, suggesting that these tools can be successfully adapted to non-Western and resource-limited cultural, institutional and national contexts (Sapre 2000; House et al. 2004; Mendelek et al. 2006; Morahan et al. 2006). 

특히 appreciative inquiry와 리더십이 유용하다고 대답하였다. 자기가 지역에서 담당하고 있는 프로젝트에서 적용하도록 강조한 것이 transferability에 도움이 되었다고 말했다. 또한 스스로의 리더십 스타일이 변화했으며, 자신감, 자기효용감에도 영향을 주었다고 했다.

Fellows particularly identified appreciative inquiry and leadership as useful to them (Cameron et al. 2003; Stavros & Torres 2005). The emphasis on application of concepts to an authentic local project may be partly responsible for the transferability of these concepts to the Fellows’ home systems (Vicere & Fulmer 1998; Nchinda 2002). In addition, a majority of Fellows reported a change in their own leadership style. This change included increased self-confidence, a fundamental component of self-efficacy (Sloma-Williams et al. 2009, in press).

저개발국가에서 이루어지는 대부분의 교수개발은 교육스킬의 향상에만 집중하고, 리더십이나 관리기술에는 덜 집중하는 편이다. 또한 교육자들간의 국제적 네트워크를 형성하는 것에 목적을 두는 프로그램은 거의 없다.

Most of faculty development in health professions education in resource-limited areas, when it exists, focuses on improvement of teaching skills with less, if any, emphasis on development of leadership and management skills (Yolsal et al. 2003; Beier-Holgersen et al. 2004; Anonymous 2007; Bansal & Supe 2007). Few programs explicitly aim to create an international social network of educators (Mouradian & Huebner 2007).

5년간의 FAIMER fellow들에 대한 조사와 면접으로부터 대부분의 fellow가 리더십이나 경영에 대한 교육이 도움이 되었다고 응답하였으며, 국제적 네트워크가 상당한 가치가 있다고 말했다.

Survey and interview data from five years of FAIMER Fellows provide convergent evidence that the majority of Fellows find the concepts and methods of education leadership and management useful and applicable in their professional settings and that the international network of colleagues created is both valuable and supportive.

대부분의 fellow들이 교육방법이나 개념에 비해서 리더십/경영 방법과 개념에 대해서 많이 언급했다.

In the present study, data from the retrospective pre/post surveys about education, leadership and management topics illuminates data from qualitative analysis of interviews. A higher percentage of Fellows mentioned leadership/management methods and concepts compared to education methods and concepts when interviewed about what they had applied in their work that they had learned at the FAIMER Institute. 

한 가지 가능한 설명은 리더십/경영에 대한 주제가 그들에게 비교적 새로운 것이라는 점이다. 후향적 사전조사가 이것을 설명해준다. 사전 지식 수준은 변화관리나 경영 등에 대해서 거의 제일 낮았으나 이들 영역이 효과크기의 증가가 가장 컸다.

One possible explanation is that leadership/management topics were newer to most of them. Data from the retrospective pre survey supports this explanation; ‘‘pre’’ levels of importance and knowledge were lowest for change theory and management, personal professional development, program evaluation, project management, advanced leadership, and whole systems models to sustain change and these areas had the largest increase in effect size. 

우리는 교수개발 프로그램은 리더십이나 경영 기술까지 다루어야 한다고 주장해왔는데, 이는 모든 교육과정개혁은 반드시 '관리되어야 하는 조직의 변화'를 수반하기 때문이다. 

Our thesis has been that faculty development programs need to be expanded to include leadership or management skills in addition to education methods, because any curriculum innovation inevitably involves organizational change that needs to be led and managed. The evaluation data presented here, both quantitative and qualitative, suggest that FAIMER Fellows appreciated, learned and used these skills. 

교육방법, 학생평가, 국제적 의학교육 등은 작은 효과크기를 보였으며, 이는 fellow들이 이미 그 전에 지식과 개념을 많이 가지고 있음을 말한다. 그럼에도 불구하고 질적/양적 연구결과 모두 fellow들이 교육영역의 지식과 기술 역시 많이 사용하고 있음을 확인해주었다.

The topics education methods, student assessment, and international medical education showed slightly smaller effect sizes, which may be reflective of Fellows’ higher pre-intervention appreciation and knowledge of education methods compared to leadership and management concepts. Nevertheless, the significant increases reported in the quantitative assessment are also consistent with the qualitative data showing that a majority of Fellows reported using knowledge or skills gained in the education domain.

교수개발 프로그램의 평가는 언제나 쉬운 일은 아니지만, 여기에서는 데이터의 의미있는 해석에 양적/질적 데이터를 병합하는 것의 가치를 보여주고 있다.

Evaluation of faculty development programs in health professions education continues to present a challenge (Jayawickramarajah 1992; Irby & Hekelman 1997; Amin et al. 2004); the data here illustrate the value of qualitative and quantitative data in converging on a meaningful interpretation of the data (Greene & Caracelli 1997; Reinelt & Russon 2003; Grove et al. 2006; Westhues et al. 2008).

연구의 한계는 자기보고식이며, 개개 참가자들의 reflection에 기반하였다는 것이다. 여러 상황에 의해서 응답이 bias되어있을 수 있다. 우리는 외부 평가팀에게 의뢰하여 이러한 것을 최소화하려고 했다. 후향적 방법이 bias를 줄이기 위하여, 그리고 robust한 response rate를 위하여 사용되었지만 이것도 한계가 없는 것은 아니다. 향후에 institutional case study나 survey를 해야 할 필요가 있다.

A limitation of this study is that the source of all the effects data is self-report and reflection by individual participants. Responses may be biased by respondents’ appreciation of sponsorship and hesitancy to criticize a source of funding, or social desirability of an affirmative response. We sought to minimize this by having an external evaluation team conduct the interviews. (Mennin & Kalishman 2002). In addition, while, the retrospective pre/post-test methodology was chosen to ensure a robust response rate as well as to avoid the response bias of a traditional pre-test as reported by some researchers (Lamb & Tschillard 2005), this methodology is not without limitations (Hill & Betz 2005). In future research, institutional case studies and surveys of school leaders may be a means to assess further the impact of FAIMER Fellows as agents of change in their schools (Dannels et al. 2009).

저소득 국가에서의 교수개발 프로그램은 고소득 국가에서보다 더 제한적인데, 이는 이 분야가 덜 성숙되어있을 뿐만 아니라, 분야가 성장할 기회가 적기 때문일 수 있다. 시간과 돈이 부족한 것도 주요한 제한점이다.

Faculty development programs in health professions education in resource poor countries are more limited than those in resource rich countries, probably due to limited maturation of the field of health professions education and few opportunities for advancement in that domain (Nchinda 2002; Morahan & Fleetwood 2008). Lack of time and money are also major impediments to faculty development (Amin et al. 2005; Supe & Burdick 2006).

FAIMER institute의 효과에 대한 평가는 개발도상국의 교수들도 교육리더십, 경영, 방법론 등을 학습하고 이것을 적용할 수 있음을 보여준다. 지식을 축적하고 적절한 도구가 있고, 지지적 전문직 네트워크가 형성된다면 국제적 교수개발 프로그램으로서 효과적인 모델이 될 수 있음을 보여준다.

Evidence about the impact of the FAIMER Institute indicates that health professions faculty from developing countries are augmenting their knowledge and skills in education leadership, management, and methodology, and applying that knowledge at their home institutions. Integration of knowledge acquisition with the tools necessary to implement change, coupled with a supportive professional network, appears to be an effective model for an international faculty development program for participants from diverse developing regions.

Measuring the effects of an international health professions faculty development fellowship: the FAIMER Institute.

Setting Priorities for Teaching and Learning: An Innovative Needs Assessment for a New Family Medicine Program in Lao PDR

Jeanie Kanashiro, MD, MMEd, Gwen Hollaar, MD, MPH, Bruce Wright, MD, Khamphong Nammavongmixay, MD, and Sue Roff, MA

라오스는 동남아시아의 작은, 열대, 내륙 국가이다. 이 지역에서 가장 개발이 덜 된 국가 중 하나이며, 사회경제적 지표는 세계에서도 하위 25%에 속한다. WHO는 일차의료에 대한 평등을 요구하고 있으며 라오스도 이러한 요구에 부응하기 위하여 Family Medicine Specialist Program (FMSP)를 개발하였다. 이것은 라오스에서 개발된 졸업후 수련 프로그램으로서 지역사회 일차의료진을 양성하여 라오스 국민의 80%가 살고 있는 농촌 및 외딴 지역의 의료인력을 공급하기 위한 목적을 가지고 있다. 

Lao People’s Democratic Republic (Lao PDR) is a small, tropical, landlocked country in southeast Asia. It is one of the least developed countries in the region, and its socioeconomic indicators are among the lowest 25% in the world. The World Health Organization has long called for increased equity in primary health care access around the world. To meet this need in Lao PDR, the Family Medicine Specialist Program was developed, a Lao-generated postgraduate training program designed to produce community-oriented primary care practitioners to serve the rural, remote areas of Lao PDR, where 80% of the population lives. 

요구사정을 위하여 혁신적인 방법이 필요했기 때문에, modified Delphi technique, 지역의 의학교육 핵심지도자, 임상 전문가, 교사 등을 통해 병원기반교육과정의 목표를 개발하고자 했다. 교수-학습의 우선순위를 설정하고 라오스의 요구 환경을 파악함으로서 저소득국가에서 교육과정 개발시 사용할 수 있는 새로운 접근방법을 개발하였다. 이러한 단계는 부족한 자원을 잘 분배하여 획기적인 프로그램을 도입할 수 있기 위한 과정이며, 더 중요한 것은 이 요구사정의 모델은 다른 저소득국가에서도 활용될 수 있을 것이라는 점이다.

An innovative method of needs assessment was required to determine the health care priorities to be met by this new program. Through the use of a modified Delphi technique, local key leaders in medical education, clinical specialists, and teachers were consulted to develop prioritized objectives for the hospital-based curriculum of the program. By setting priorities for teaching and learning in the unique and needy circumstances of Lao PDR, a novel approach to curriculum planning in a low-income country was explored and ultimately formed the foundation of the new curriculum. This process served to direct the allocation of scarce resources during implementation of this groundbreaking program. More importantly, this model of needs assessment could potentially be used to customize medical curricula in other low-income countries facing challenges similar to those in Lao PDR.

Acad Med. 2007; 82:231–237.

라오스는 아시아의 최저개발국 중 하나이며, 인구는 약 600만명이고 80%의 인구가 농촌지역에 거주하고 있다. 라오스의 보건지표는 거의 가장 나쁜 수준이며 사회 지표들은 사하라 이남지방의 국가들과 비슷한 수준이다. 

Laos, or Lao People’s Democratic Republic (Lao PDR), is one of the least developed countries in east Asia. Its population is estimated at six million people, and approximately 80% of the population lives in rural areas. The health status of the Lao people is considered by the World Bank as being among the worst in the region, with social indicators comparable with those of countries in sub-Saharan Africa.1 

• Life expectancy at birth for the total population is 55 years (compared with 78 years in the United States). 
• The infant mortality rate is 87.1/ 1,000 live births (compared with 6.4/1,000 live births in the United States). 
• More than 75% of the Lao people live on less than two U.S. dollars per day. 
• An estimated 40% of the population lives below the national poverty line.2 
• Malaria, pneumonia, and diarrhea—preventable and treatable conditions—remain leading causes of morbidity and mortality.3 

Although socioeconomic and health indicators are improving, Lao PDR is ranked 135 out of 177 countries by the United Nations Health Development Index and remains among the world’s least developed nations.4

새로운 가정의학 교육과정 개발 Developing a New Family Medicine Curriculum

2004년 라오스 국립대학의 의과학과 교수(Faculty of Medical Sciences)와 라오스의 보건부/교육부는 캘거리대학의 의과대학 교수들과 함께 새로운 일차의료 프로그램을 개발하기로 하였다.

In 2004, the Faculty of Medical Sciences (FMS) at the National University of Laos (NUOL) and the Lao Ministries of Health and Education joined with the University of Calgary Faculty of Medicine to develop a new primary care program.

라오스 국립의대 대표들과 캘거리대학 대표들은 FMSP라는 2년짜리 프로그램을 만들고자 했다.

With this in mind, representatives from the FMSNUOL, the ministries, and the University of Calgary developed a two-year primary care training program called the Family Medicine Specialist Program (FMSP).

FMSP의 목표는 라오스 연수생들이 실질적으로 도움이 되는 경험을 쌓고 최소한의 지원만 받고서도 라오스의 농촌 지역에서 독립적으로 진료를 할 수 있는 역량을 갖추는 것이다.

The expressed goal of the FMSP was for Lao trainees to acquire practical, hands-on experience in the care of patients, so that they would gain the competence and confidence to practice in isolated rural settings independently with minimal assistance.

국제사회는 일차의료서비스를 전세계에 고르게 제공할 것을 요구하고 있다.

The international community has advocated a mandate to deliver primary health care services throughout the world.6

이러한 요구는 개발도상국에서 특히 절실하다. 라오스에서 의과대학 교육과정은 여러 도전을 극복해야 한다. 장애물은 다음과 같다.

This need is especially grave in developing nations. In Lao PDR, medical curriculum development faces many challenges that are specific to its low-income status. Obstacles include...

• a lack of health care professionals with adequate training and remuneration, 
• the poverty and the predominantly rural location of the general population, 
• a lack of basic resources in health services, 
• a lack of educational resources for professional development, 
• a lack of a professional infrastructure for medical personnel, 
• a lack of informational infrastructure in medical institutions, 
• the poor health-seeking behaviors of the general public, 
• difficult physical access to rural villages and health care centers, and many others.

The only medical school in the country is located at the NUOL. At graduation, a small number of students pursue further training in a foreign country or they enter one of a few small postgraduate specialty-training programs in Lao PDR.8 Other students resort to nonclinical employment within the urban center of Vientiane. Very few medical graduates go on to work independently in district health centers or provincial hospitals, where care is most needed. In 2002, the Lao government assessed its status of medical education in the country and reported severe needs in the area of health human resources development. Medical graduates were found to be unwilling and unable to practice in the remote and rural areas of the country because of a lack of adequate training and, hence, a lack of ability and confidence to provide frontline primary care.9 Before the launch of the FMSP in January 2005, there was no educational training program dedicated to providing primary health care in the country.

요구사정의 필요성 A Need for Needs Assessment

새로운 FMSP 교육과정을 정의하는 중요한 업무를 위해서는 지역의 상황에 맞고 라오스의 맥락에 맞는 혁신적 방법을 필요로 했다. 그 첫 단계는 프로그램이 도달해야 하는 보건의료 요구를 파악하는 것이었다.

The sizable task of defining a new FMSP curriculum that reflected the health care needs of the country’s tropical Asian environment and that was feasible to achieve Lao PDR’s social, cultural, and economic context required innovative methodology. The first step of planning a new medical curriculum is to identify the health care needs that the program intends to meet.10

A modified Delphi

We implemented a modified Delphi technique modeled after a study described by Lawrence et al11 to serve as the needs assessment for the first-year curriculum. The technique consisted of the following features:

The expert panel

The Lao Ministry of Health and FMS leadership at NUOL established an expert panel called “the Key Leaders” to tackle multiple curricular innovations in medical education in Lao PDR, including defining the curricular objectives of the FMSP.

Consultation with clinicians and teachers

We identified three groups of clinicians to form the second iteration of the Delphi process:

We constructed a questionnaire based on the list of objectives created by the Key Leaders.

Developing priority lists

As the final component of our Delphi technique, we created prioritized objective lists for teaching and learning by combining the responses of the above three clinician groups, collectively called “the expert clinician group.”

요구사정 결과에 대한 평가 Assessing Our Needs Assessment

교육 프로그램에서 이끌어낸 해결책은 '메이드 인 라오스'이다. 프로그램은 라오스사람들에 의해서 라오스사람들을 위해 만들어졌고, 캘거리대학 자문단의 역할은 과정에 대한 것이었지 내용에 대한 것이 아니었다.

The educational program that evolved was a “made in Laos” solution to a lack of available primary care; the program was created by Laotians for Laotians. The role of the University of Calgary consultants was mainly to help with process, not to formulate content.

한 가지 딜레마는 가르쳐야 하는 것과 라오스 농촌에서 수행할 수 있는 것 사이의 간극이었다.

One consistent dilemma the respondents faced was the polarity between wishing to teach what ought to be learned versus what can be practiced within the restricted resources of rural Laos.

한 가지 예시는 CPR의 우선순위가 낮다는 것이었다.

One prime example was the lower ranking of cardiopulmonary resuscitation (CPR) in both the surgery and pediatrics objectives.

라오스 사람들이 lifesaving external device에 대해서 가지고 있는 종교적 믿음이, 그 장치 사용을 가로막았다. 라오스 불교적 관점에서 신체를 'holy temple'로 바라보았고 환자와 가족들은 종종 침습적 방법을 사용하는게 그 믿음에 위배되는 것이라고 보았다.

Senior surgeons identified that the religious beliefs of the Lao people can prevent the use of lifesaving external devices; in the Lao Buddhist religion, the body is viewed as a “holy temple,” and patients and family members would often consider invasive maneuvers a violation of their beliefs.

첫 단계에서 핵심 리더 그룹이 인지한 교육과정에 대한 문제 중 하나는 attitudinal objectives가 없다는 점이었다.

A criticism of the curriculum that was acknowledged by the Key Leaders group in the first stage of our assessment was the lack of attitudinal objectives present in the curriculum.

영문에서 라오어로 번역하는 것 역시 이 평가의 한계로 작용했는데, 라오스 의사들과 선생님들이 여러 언어를 잘 하긴 했지만 영어는 아니었고, 라오어는 라오스의 유일한 공식 언어였다.

Language equivalency and translation of the study materials from English into Lao represented a weakness in this assessment. Lao physicians and teachers can be fluent in multiple languages, but not necessarily in English. The only official language of the country is Lao.

또 다른 약점은 농어촌 의료진을 포함시키지 못한 것이다.

A further weakness of this assessment was the inability to include existing rural practitioners.

연구의 강점은 이 과정이 두 가지 목적을 동시에 추구했다는 것이다. 하나는 보건의료의 우선순위를 밝히고자 했고, 다른 하나는 교수개발의 도구로서 라오스의 의학교육 리더들을 교육과정 개발과 요구사정에 참여시켰을 뿐만 아니라 새 프로그램에서 교사로 참여할 의사들도 포함시켰다.

The strength of this study is that the process served a dual purpose. First, it identified the health care priorities to be addressed by the FMSP. Second, it functioned as a faculty-development tool and introduced not only the Lao medical education leadership to novel methods of curriculum development and needs assessment, but it also involved the clinicians who would be the new teachers of the program.

교수개발을 제공하는 것과 더불어, 중요한 또 하나는 델파이방법의 특징인 익명성이다. 라오스 의학교육 시스템은 교사와 의사사이에 위계가 중요하다. 이는 요구사정 과정의 정확성을 해칠 수 있다. 모든 의사들을 델파이 과정에 참여시킴으로서 각각의 참여자들이 위협받지 않는 상황에서 동등하게 기여할 수 있었다.

In addition to providing faculty development, the process used a key characteristic of the Delphi method—anonymity. Within the Lao medical education system, hierarchy between teachers and clinicians can play a dominant role, which may hinder the accuracy of a needs-assessment process. By involving all available clinicians (junior and senior physicians) in the Delphi process, each participant was able to contribute equally in a nonthreatening environment and, thus, have a voice in the new curriculum.

우리가 수행한 요구사정 방법은 이해관계자들과의 관계를 증진시키고 정보를 모음으로서 다른 방법으로는 측정하기 어렵거나 모으기 힘든 자료를 수집했다는 점이다. 라오스의 통계자료는 심지어 국가적 수준에서도 분절되어있고 신뢰하기 어렵다. 라오스 의사들과의 소통을 통한 질적 자료 수집은 드러나지 않았던 독특한 이슈들을 드러나게 했다. 

The needs assessment we performed was rooted in developing relationships with the relevant stakeholders to gather information that would otherwise be immeasurable and unattainable by standard quantitative means. Statistical data in Laos is fragmentary and unreliable at best, even at the national level. The qualitative data obtained through interacting with the Lao clinicians and educators uncovered unique issues, such as creating public awareness for the program, so that rural Laotians will attend local medical centers, which are currently underused.

또한 우선순위 리스트를 작성함으로써 study guide나 logbook이 개발될 수 있었으며, 이들 리스트를 활용하여 교사들은 임상적으로 더 중요한 내용들에 집중할 수 있게 되었다.

There have been many advantages to producing the prioritized lists for teaching and learning at the outset of the FMSP. Study guides and logbooks based on the priority objective lists were developed to support both trainers and trainees. Using these lists, teachers have been directed to teach more on topics of greater clinical relevance and less on topics that are rare within the Lao context.

Setting priorities for teaching and learning: an innovative needs assessment for a new family medicine program inLao PDR.

AMEE GUIDE NO 36

Faculty development: Yesterday, today and tomorrow

MICHELLE MCLEAN1, FRANCOIS CILLIERS2 & JACQUELINE M. VAN WYK3

1University of the United Arab Emirates, 2University of Stellenbosch, South Africa, 3University of KwaZulu-Natal, South Africa

Abstract

의학교육은 그 자체가 하나의 학문으로서 진호하였다. Medical faculty에게 요구되는 사회적 책무와 함께 가르치는 일에 대해서도 professionalization의 압박이 커지고 있다. 프로페셔널하고 역량있는 선생, 교육자, 연구자, 리더를 키우기 위해서는 교수개발(faculty development, FD)가 필요하다. 그러나 FD는 쉬운 일이 아디나. 조직 차원에서의 지지가 필요하고, 적절한 자원의 배분과 우수한 교육자를 인정해주는 것이 필요하다.

Medical education has evolved to become a discipline in its own right. With demands on medical faculties to be socially responsible and accountable, there is now increasing pressure for the professionalisation of teaching practice. Developing a cadre of professional and competent teachers, educators, researchers and leaders for their new roles and responsibilities in medical education requires faculty development. Faculty development is, however, not an easy task. It requires supportive institutional leadership, appropriate resource allocation and recognition for teaching excellence.

이 가이드는 의학분야 뿐만 아니라 관련된 보건분야를 막라하여 교육에 대한 교수의 새로운 역할을 위한 FD를 담당하고 있는 사람들을 위해 만들어졌다. FD 개발의 역사적 관점을 보여주고 FD 프로그램을 만들기 위해서 도움이 될 만한 프레임워크를 제공하고자 했다. 이 프레임워크는 FD 담당자들이 계획을 세우고, 도입하고, 평가하는데 도움을 줄 것이다.

This guide is designed to assist those charged with preparing faculty for their many new roles in teaching and education in both medical and allied health science education. It provides a historical perspective of faculty development and draws on the medical, health science and higher education literature to provide a number of frameworks that may be useful for designing tailored faculty development programmes. These frameworks can be used by faculty developers to systematically plan, implement and evaluate their staff development programmes.

마지막으로 이 가이드는 미래 FD를 이끌어나갈 주요 트렌드와 원동력을 짚어보았다.

This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.

교수개발의 미래

Future directions for faculty development

의학과 의학교육의 미래를 예측한 많은 논문들이 있다.

An extensive literature exists which attempts to predict the future of medicine and medical education (Alkan 2000; Benor 2000; Harden 2000, 2006; Rennie 2000; Gorman et al. 2000; Karle 2006).

'혁명적' 관점이 아닌 '진화적' 관점에서 보았을 때, 의학교육에서 현재 일어나고 있는 세 개의 발전을 볼 필요가 있다.

From an ‘evolutionary’ rather than a ‘revolutionary’ perspective (Harden 2000), we are of the opinion that three current but related developments in medical education warrant discussion.

디지털 시대, 세계화, 상업화

The digital age, globalization and the commercialisation of medical education

정보기술, 시뮬레이션, 가상현실은 이미 의학과 의학교육에서 중요한 부분이 되었고 앞으로도 계속 진보할 것이다. Gorman 등은 외과 분야의 미래에 대해서 '더 이상의 피와 위장은 없고 비트와 바이트가 있을 것이다' 라고 했다.

Information technology, simulation and virtual reality, already an integral part of medicine and medical education, will continue to advance medical practice in the 21st century (Benor 2000; Harden 2000, 2006; Gorman et al. 2000). Gorman et al. (2000) see the future of their discipline (surgery) as ‘no longer blood and guts, but bits and bytes’ (Box 6).

Ronald Harden의 노력으로 IVIMEDS가 생겼다.

Through the labours of Ronald Harden, the International Virtual Medical School (IVIMEDS) was born (Harden & Hart 2002).

의학교육도 빠르게 사업의 영역이 되고 있다. 외국에서 온 학생들은 영국 의대생의 15%, 일부 호주 의대에서는 40%까지를 차지하고 있다.

Like health care, medical education is fast becoming a business. Foreign fee-paying learners may now account for up to 15% of medical students at UK universities and as many as 40% at some Australian universities (Hawthorne et al. 2004).

의학교육관련 문헌에서 'global'이나 'international'이라는 단어는 점차 'transnational'이란 단어로 바뀌어가고 있다. Harden에 따르면 Transnational education의 정의는 ‘the intersection of international students, international teachers, and an international curriculum customized to local needs’이며, 'transnational competence'는 'medical training that addresses health in the context of global migration'이다.

In the medical education literature, the terms ‘global’ and ‘international’ are now being replaced by ‘transnational’. Transnational education is defined as ‘the intersection of international students, international teachers, and an international curriculum customized to local needs’ (Harden 2006), while ‘transnational competence’ refers to the medical training that addresses health in the context of global migration (Koehn & Swick 2006).

의학교육을 하는 사람들이 점차 세분화되면서 의학교육에도 국제표준이 적용되고 있다. 표준 교육과정을 다운로드 받을 수 잇다.

Global standards should also apply to medical educators (Purcell & Lloyd-Jones 2003), as medical education staff become increasingly specialized (e.g. in assessment, curriculum development or research) (Benor 2000; Davis et al. 2005). One can download a draft version of curriculum standards for educational professionals from the website of the recently established Academic of Medical Educators (http://medicaleducators.org).

Purcell과 Lloyd-Jones는 두 개의 모델을 제시했는데 하나는 competency 모델이고 다른 하나는 scholarship 모델이다.

Purcell and Lloyd-Jones (2003) have evaluated two possible models regarding standards for medical educators – a competency model (Harden et al. 1999; Hesketh et al. 2001) and a scholarship model (Fincher et al. 2000).

2000년에 Benor는 2020년에 의과대학에 대해서 세 부류의 교수를 예상했다. Content experts, Assessors, Moral guide. 그리고 이것이 옳은 것으로 드러나고 있다.

In a 2020 medical school, Benor (2000) envisaged three types of medical teachers: content experts, assessors and moral guides. Have his predictions materialized almost a decade later? (Table 9). In many respects, Benor (2000) was correct.

의대생들에게 2020년의 의학교육에 대해서 물은 뒤, Rennie는 의학교육은 언제나 caring/sensitive practitioner를 양성하기 위해 노력할 것이라고 믿었다.

When asked to comment on medical students and medical education in 2020, Rennie (2000) believed that medical education would always strive to produce caring, sensitive practitioners.

Compassion에 대한 기풍은 언제나 health care의 한가운데 자리잡고 있었지만, 의학교육에서 항상 그래왔던 것은 아니다.

While an ethos of compassion has always been advocated as the central theme of health care, it has not always been at the core of medical education. 

이것이 교수들에게 시사하는 바는 무엇인가?

What does this mean for medical faculties?

의과대학의 질에 영향을 주는 요소는 Accountability, accreditation, technological advances, globalization and commercialization등이 있다. FD의 주된 과제는 행정가들의 요구, 학계의 요구, 사회의 요구를 관리하는 것이다.

Accountability, accreditation, technological advances, globalization and commercialization are some of the factors that will drive quality academic medicine. The challenge for faculty developers is to find better ways of managing the perceived needs of administrators, the expressed needs of academics and the real health care needs of society.

성공과 지속가능성은 다양한 이해관계자들이 교육의 가치를 어떻게 평가하느냐에 달렸다. Williams등은 최근 교육에 대해 인정해주지 않고 보상해주지 않는 오래된 문제를 어떻게 극복할 것인가에 대해서 '가장 큰 문제는 좋은 교육과 수익간에는 간접적인 관계만 있는 것이다. 따라서 좋은 교육을 유도하고 지속시키기 위한 대안적 모델이 필요하다. 두 가지 모델이 가능한데 하나는  regulatory model이고, 다른 하나는 quality model이다. Regulatory model은 마치 임상술기와 같이 교육스킬이 정기적으로 업데이트되는 것이다.Quality model은 교육의 질에 기반해서 지원자를 놓고 경쟁하는 것이다' 라고 했다. 

Success and sustainability will, however, depend on the value ascribed to teaching by various stakeholders. Williams et al. (2007) recently offered suggestions to overcome the ageold hiatus of recognizing and rewarding teaching ‘. . . the difficulty in sustaining the effects of faculty development programs relates to the fact that good teaching is only indirectly related to revenue, unlike clinical or research activities. Because it is unlikely that good teaching will be directly related to institutional revenue in the foreseeable future, alternative models for improving and maintaining good teaching should be sought. Two such models are a regulatory model, in which teaching skills are regularly updated, analogous to clinical skills improvement through continuing medical education, and a quality model, in which teaching institutions compete for applicants based on valid measures of teaching quality in their programs. These and other models should be examined and tested in future faculty development programs’.

결국 문제는 이것이다. 의학 선생님, 의학 교육자에게 최소요구조건 또는 최소기준이 있어야 하는가?

All of this begs a question: Should there be minimum requirements and standards of practice for medical teachers and educators? 

우리의 관점에서 최소한의 기준은 아래와 같다.

From our perspective, minimum requirements for professionalising teaching practice might then include the following:

.FD가 모든 의과대학의 미션에 핵심적으로 있어야 하고,

.조직 문화가 교육을 인정해주고 보상해야 하며

.학생을 가르치려는 사람은 일정한 공식적인 준비과정을 거쳐야 한다.

. faculty development for academics should be integral to the mission of every medical school, such that deans and administrators cannot ignore issues of quality assurance and social accountability;

. the institutional culture must recognize and reward teaching excellence and scholarship equally with research and clinical service;

. there should be formal preparation for anyone who teaches our students. For appointments and for promotion along the educator track, a teaching qualification should be mandatory. Provision should be made for initial and ongoing professional development for all faculty members and teachers.

Tomorrow's Doctor를 다시 인용하자면, '우리가 할 수 있는 것은 의사들이 적응하고 변화할 수 있도록, 새로운 아이디어와 기술의 발전을 포용할 수 있도록, 전문직으로서의 평생에 걸친 학습태도를 지속할 수 있도록 가르치는 것 뿐이다.'라는 문구는 미래의 의사들을 유연성을 갖춘 평생학습자로 길러야 한다는 것을 강조한다. 

Reiterating an extract from Tomorrow’s Doctor (GMC 1993): ‘. . . we can best strive to educate doctors capable of adaptation and change, with minds that can encompass new ideas and developments and with attitudes to learning that inspire the continuation of the educational process throughout professional life’, reminds us of the need to train tomorrow’s practitioners to be flexible, life-long learners. 

Carl Rogers는 30년도 전에 이렇게 말한 바 있다. 

한 사람이 '교육받았다' 라고 할 수 있으려면, '어떻게 배우는가'를 배운 사람이어야 한다. 그리고 어떻게 변화에 적응해야하고 어떻게 변화해야 하는지를 배운 사람이어야 한다. 지식은 만고불변한 것이 아니며, 변하지 않는 것은 '지식을 찾아나가는 과정'임을 깨달은 사람이어야 한다.

Carl Rogers (1969) expressed these very sentiments more than 30 years ago: ‘The only person who is educated is the person who has learned how to learn; the person who has learnt how to adapt and change; the person who has realized that no knowledge is secure, that only the process of seeking knowledge gives a basis for security’.

결론은 무엇인가?

What conclusions can we draw about faculty development?

우리가 교육 프로그램에 대해 다루고 있지만, Gibbs는 FD에 대해서 했던 코멘트를 다시 새겨볼 필요가 있다. 있는 것을 계속 새로 만들려고 노력할 수는 없으며, 가지고 있는 것을 실제 환경의 다이나믹한 변화에 적용가능하도록 바꾸어야 한다. 얼마나 안정적으로 만들 것이냐를 기준으로 프로그램을 만들지 말고, 변화에 얼마나 적응하여 지속가능한가를 기준으로 만들어야 한다.

Although referring to educational programmes, Gibbs’ (2006) comments ring true for faculty development ‘We cannot afford to keep ‘re-inventing the wheel’; we need to make the wheel adaptable to the dynamically changing and real-world environment. We need to design programmes that are not dependent on stability, but are sustainable by adapting to change’.

요약하자면 FD의 현재와 미래는 다음과 같다.

In summary, faculty development today and tomorrow should:

. be systematically planned and implemented, with realistic, achievable and measurable outcomes that are appropriate for the task. This requires developing objectives and measurable performance criteria early in the planning process.

. include practitioners in various clinical settings, such as the community and other health care professions.

. be task-oriented, with immediate application. 

. be tailored to suit the needs of the institution, disciplines and individual teachers, including educational scholars and leaders. These needs may become more specialised (e.g. international assessors) as medical education becoming more global or transnational.

. promote both professional and personal development, which requires continuous and long-term intervention.

. include multidisciplinary and group training, to promote collegiality and to create communities of practice in teaching, medical education research and administration.

. be underpinned by theories and principles of learning (e.g. self-directed; interactive; authentic; contextually relevant).

. be adaptable to meet the changing health care requirements and innovations in medical education (e.g. web-based learning and digital technology). . take cognisance of globalization and the need for international standards and core competencies (even amongst medical school academics and medical educators).

. involve collaboration with disciplines beyond the boundaries of medical education. With the growing emphasis on multidisciplinary team work, interprofessional faculty development is likely to become a future imperative.

가르침과 교육이 연구나 진료만큼 보상받지 못하는 기관에서는 FD에 대한 참여를 유도하기 위해서는 인센티브가 필요하다. 참여를 유도하기 위한 성공적인 전략은 학생들의 요구를 하나의 목표로 삼음으로서 교수들의 moral responsibility에 호소하는 방법이 있다.

In institutions where teaching and educational scholarship is not afforded the same reward as research or clinical care, participation in faculty development may require incentives. Successful strategies for participation include appealing to faculty’s moral responsibility by promoting student needs as an objective (Hill & Stephens 2004) or awarding CME credits (Williams et al. 2007).

마지막으로 우리는 Brown이 '고등교육에서의 교육은 알아서 변하도록 놔두기에는 너무나도 중요한 것이다'라는 말에 전적으로 동의한다.

Finally, we agree wholeheartedly with Brown (2000) that teaching in higher education is too important to be left to chance’. Medical education is at a point where faculty development that promotes the professionalisation of teaching must be an integral aspect of the life of every medical school.

Med Teach. 2008;30(6):555-84. doi: 10.1080/01421590802109834.

Faculty development: yesterday, today and tomorrow.

AMEE GUIDE NO 36

Faculty development: Yesterday, today and tomorrow

MICHELLE MCLEAN1, FRANCOIS CILLIERS2 & JACQUELINE M. VAN WYK3

1University of the United Arab Emirates, 2University of Stellenbosch, South Africa, 3University of KwaZulu-Natal, South Africa

Abstract

의학교육은 그 자체가 하나의 학문으로서 진호하였다. Medical faculty에게 요구되는 사회적 책무와 함께 가르치는 일에 대해서도 professionalization의 압박이 커지고 있다. 프로페셔널하고 역량있는 선생, 교육자, 연구자, 리더를 키우기 위해서는 교수개발(faculty development, FD)가 필요하다. 그러나 FD는 쉬운 일이 아디나. 조직 차원에서의 지지가 필요하고, 적절한 자원의 배분과 우수한 교육자를 인정해주는 것이 필요하다.

Medical education has evolved to become a discipline in its own right. With demands on medical faculties to be socially responsible and accountable, there is now increasing pressure for the professionalisation of teaching practice. Developing a cadre of professional and competent teachers, educators, researchers and leaders for their new roles and responsibilities in medical education requires faculty development. Faculty development is, however, not an easy task. It requires supportive institutional leadership, appropriate resource allocation and recognition for teaching excellence.

이 가이드는 의학분야 뿐만 아니라 관련된 보건분야를 막라하여 교육에 대한 교수의 새로운 역할을 위한 FD를 담당하고 있는 사람들을 위해 만들어졌다. FD 개발의 역사적 관점을 보여주고 FD 프로그램을 만들기 위해서 도움이 될 만한 프레임워크를 제공하고자 했다. 이 프레임워크는 FD 담당자들이 계획을 세우고, 도입하고, 평가하는데 도움을 줄 것이다.

This guide is designed to assist those charged with preparing faculty for their many new roles in teaching and education in both medical and allied health science education. It provides a historical perspective of faculty development and draws on the medical, health science and higher education literature to provide a number of frameworks that may be useful for designing tailored faculty development programmes. These frameworks can be used by faculty developers to systematically plan, implement and evaluate their staff development programmes.

마지막으로 이 가이드는 미래 FD를 이끌어나갈 주요 트렌드와 원동력을 짚어보았다.

This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.

FD의 계획과 도입

Planning and implementing faculty development

장기적 또는 의미있는 성과의 보고가 적다는 것이 '아기를 물가에 내놓아도 된다'라는 뜻은 아니다.

The general lack of reported long-term or meaningful outcomes of faculty development programmes does not mean, however, that we should ‘throw the baby out with the bath water’

비유를 들자면 FD를 여행가는 것에 비교할 수 있다. 사람들은 모두 다른 이유로 여행을 떠난다. 잘 알려지지 않은 목적지 또는 적절하지 않은 목적지로 여행을 떠나는 사람은 거의 없을 것이다. 중간에 목적지가 바뀐다면 일부는 떨어져나갈것이다. 모든 여행자를 이끌기 위해서는 그들이 누구고, 어디로 가고 싶고, 왜 그 여행을 떠났는지를 알아야 한다.

Perhaps a useful analogy at this stage would be a comparison between a faculty development programme and a journey. Passengers embark on a journey for many different reasons (Fullan 1993). If the destination is not advertised or is not suitable, few passengers will start the journey. If the destination changes en route, some will disembark along the way. To cater for all travellers, it is important to know who they are, where they want to go and why they are taking this particular excursion.

FD의 여섯 단계

A six-step approach to faculty development (adapted from Kern et al. 1998)

Kern의 여섯 단계를 세 단계로 구분하고자 한다.

For simplicity, we have divided Kern et al’s (1998) six steps into three phases:

A. planning (Steps 1–3);

B. implementation (Steps 4–5) and, finally;

C. evaluation and feedback (Step 6).

A. 계획 단계

A. Planning faculty development (Steps 1–3)

1. 문제를 명확히하고, 일반적 요구 조사

1. Problem identification and general needs assessment

Table 6의 질문을 해야 한다.

Critical questions at this stage might include (Table 6):

원동력이 주로 외부에 있다면, 그리고 개개인의 동기부여가 잘 되어있지 않다면 개별 교수들은 왜 참여해야하는지 의문을 가질 것이다.

If the driving forces are largely external and if there is little personal motivation to improve teaching, then individual faculty members will want to know why they should participate (Carroll 1993).

2. 대상자에 대한 요구조사

2. Needs assessment of target participants

FD프로그램의 일반적 요구조사가 되었다면, 개별 교수들, 학문영역, 조직 수준의 요구가 조사되어야 한다.

Having agreed on the general purpose of the faculty development programme, the needs of individual faculty members, disciplines and the institution should be identified

3. 적절한 목표와 성과 설정

3. Appropriate goals and specific measurable outcomes

Table 6에 있는 질문을 생각해보아야 한다.

Questions at this point may include:

task는 궁극적인 목적과 성과를 달성하도록 해야 하고, 인지적/정동적/운동적 부분을 다 포괄해야 한다.

The task at hand will dictate the overarching goal and specific outcomes, which may range from cognitive or affective to psychomotor.

현실적이고 측정가능한 성과는 다음을 포함해야 한다.

Realistic and measurable outcomes may then include

.인지/정동/운동 발달을 포함하는 역량

.학습 '프로세스'

.교육적/임상적 효과(이득)

. Individual competencies in terms of cognitive (knowledge), affective (attitudinal) and psychomotor (skills and performance) development.

. The learning ‘process’ (e.g. small group facilitation; reflective teaching).

. Educational (e.g. better student assessment) or clinical (e.g. improved communication with patients) benefits.

B. 도입

B. Implementation (Steps 4 & 5)

4. 교육 전략

4. Educational strategies

FD프로그램에 사용되는 교육 전략은 학습 성과와 일치해야 한다.

Educational strategies used in the faculty development programme should be aligned with the learning outcomes

FD가 학습향상에 대한 관점을 통한 교육의 변화를 추구한다면, 하나 혹은 그 이상의 이론적 모델에 기반해야 한다.

If faculty development is about changing practice with the view to improving student learning, then it should be underpinned by one or more theoretical models (Box 5).

고등교육에서의 많은 연구는 conceptual change model을 student learning model과 연결시켜왔기 때문에, Faculty developer는 주로 복합적인 접근법을 사용해왔다. 이러한 좋은 예는 아래와 같은 것이 있으며, 교수들이 좀 더 transformative conception을 적용할 수 있다면 학생의 deep learning을 촉진할 수 있음을 보여준다.

Much of the research in higher education has linked conceptual change models with student learning models and so faculty developers have tended to use a hybrid approach (Trigwell 1995; Kember 1997; Prosser & Trigwell 1997; Prebble et al. 2004; Richardson 2005). Good examples of this combination include the studies of Ho et al. (2001) and Gibbs & Coffey (2004). Gibbs and Coffey (2004) suggest that if teachers can adopt more transformative conceptions of learning, their more student-centred teaching practice should foster deep learning.

따라서 학습자중심의 접근법에 있어서 참여자는 아래와 같이 해야 한다.

Thus, in a learner-centred approach to faculty development, participants should be encouraged to

. negotiate their learning objectives (Knowles 1975),

. have hands-on practical experience (Kolb 1984),

. collaborate as members of a team (Bandura 1986),

. engage in self-directed learning (Knowles 1975),

. recognize the assumptions that underlie their beliefs and behaviours (Brookfield 1995),

. receive and provide feedback (Knowles 1975),

. solve problems and transfer this experience to other situations (Regehr & Norman 1996),

. reflect in- and on-action, alone (Scho¨n 1987, 1991) and with colleagues (Bandura 1986),

. engage in self-assessment (Williams et al. 1999), and

. apply what they have learnt to their practice (Knowles 1988; Regehr & Norman 1996).

Trigwell은 몇 가지 전략을 제시했다.

Trigwell (1995) has suggested some practical strategies that might be useful to engage academics with their practice during faculty development sessions. These include

.교수들의 다양한 사고방식을 인식한다.

.학습을 향상시킬 수 있는 교육 개념을 토론한다.

.이러한 개념에 맞는 전략과 수행을 묘사한다.

.향상된 교육을 보여준 교수에 대해 학생들의 긍정적인 코멘트를 활용한다.

. developing an awareness of the variation (i.e. different conceptions) in teacher thinking (e.g. through appropriate articles in journal clubs),

. discussing conceptions of teaching which are thought to lead to improved learning (e.g. in small group discussions with colleagues who have been recognized for their teaching excellence),

. illustrating strategies and practices that are consistent with these conceptions (e.g. through reviewing and reflecting on video-taped sessions),

. using positive student comments relating to teachers who have improved their teaching practice, which could be discussed in groups or through a peer mentoring programme.

5. 최종 도입

5. Final implementation

이 단계에서 해야 할 질문은 "FD가 multidisciplinary해야하는가?" "보장된 시간이 있는가?" "목적과 성과과 도달될 것인가" 이다.

Questions that need to be answered at this stage include: Should faculty development be multidisciplinary? Is there protected time? Are the goals and outcomes being met?

academic group을 교육과 관련된 복잡한 지식/태도/술기를 향상시키기에 효과적인 세팅이라고 보고한 근거들이 있다.

The evidence supports the academic group as an effective setting for developing the complex knowledge, attitudes and skills involved in teaching (Prebble et al. 2004).

이러한 팀워크는 professional inquiry의 문화를 촉진하기 위해서 필요하나, 그룹 FD는 학과별로 해야하는가 아니면 학제간으로 해야하는가? 둘 다 찬/반이 있다.

This team work should also aim to foster a culture of professional inquiry, but, should group faculty development be departmental or multidisciplinary? Both have pros and cons.

Neumann의 고등교육 관점에 따르면 학과기반의 FD는 pedagogical practice를 향상시키는 것에 장점이 있다.

From Neumann’s (2001) higher education perspective, department- based professional development is more likely to offer better opportunities for enhancing pedagogical practice than a centralised, generic teaching skills accreditation programme approach

학제간 FD는 교수들의 통합교육과정에 대비하게 하고 각각의 학문들이 어떻게 수직, 수평으로 통합되었는지에 대한 이해를 도와준다.

Interdisciplinary faculty development offers several benefits. A multidisciplinary approach, for example, to prepare faculty for reform to an integrated curriculum would certainly promote an appreciation and understanding of how individual disciplines become horizontally and vertically integrated.

Lave는 situated learning theory를 이용해서 어떻게 교수들의 새로운 교수를 socialize하는지 설명한 바 있다.

Lave’s (1988) situated learning theory explaining how interaction with professionals socialises newcomers into the institutional culture can also be drawn upon.

그룹 활동을 계획할 때에는 관계/지위/책임/평판 등을 고려해야 한다. FD는 collegiality와 collaboration이 필요하기 때문에, 어떤 그룹이 더 잘 함께할 수 있는지 알아야 한다.

When planning group activities, we should, however, take cognisance of, for example, relationships, status, responsibility and reputation (i.e. Maslow’s (1970) hierarchy of needs). Where faculty development requires collegiality and collaboration (e.g. developing skills to undertake curriculum reform), we need to recognize which faculty groups work best together.

다람쥐가 공룡이나 코알라랑 잘 하겠는가, 아니면 양이나 카멜레온과 잘 하겠는가?

Do the squirrels work best with the dinosaurs and koalas, or do they work better with the sheep and the chameleons? (Challis 2001).

C. 평가와 피드백

C. Evaluation and feedback (Step 6)

6. 프로그램 효과 평가와 피드백 제공

6. Evaluate programme effectiveness and provide feedback

비록 평가가 FD에서 중요한 부분이지만, 가장 무시되는 부분이기도 하다.

Although evaluation is an important aspect of faculty development, it is probably the most neglected (Prebble et al. 2004;

Steinert 2005; Steinert et al. 2006).  

계획 단계에서부터 중요한 질문들을 해야 한다.

Critical questions about measuring programme effectiveness need to be asked and answered during the planning stage, when the objectives are agreed upon (i.e. Stage 3 of Kern et al.’s (1998) approach) (Table 6).

장기적/의미있는 성과에 대해서 잘 기술하지 않으면, 기본적인 측정의 어려움 뿐만 아니라 부적절한 평가 도구를 사용하게 될 수도 있다.

As already alluded to, the poor documentation of long-term and meaningful outcomes may, apart from inherent difficulties of measuring higher level outcomes, relate to inappropriate evaluation tools, amongst a number of other factor.

낮은 레벨에 해당하는 참가자의 만족도는 몰라도 높은 레벨에서는 질적 척도가 필요하다.

While this may be appropriate for lower level outcomes (e.g. participant satisfaction) in Kirkpatrick’s (1994) model (Table 3), higher order outcomes require more qualitative measures (Skeff et al. 1997a; Knight et al. 2007).

다른 고등교육영역에서 사용된 validated inventories나 instruments를 활용하는 것도 한 가지 방법이다. 다음이 그 예이다.

It would be useful for faculty developers to use validated inventories and instruments from the higher education arena and Psychology for evaluating learner or faculty interventions. Prosser & Trigwell’s (1993) Approach to Teaching Inventory and instruments used by Gibbs & Coffey (2004) in their landmark study are two such examples.

의미있는/장기적 성과를 측정하기 위해 노력하고 있는 동안 Steinert는 Kirkpatrick 모델에서 만족도는 비록 낮은 단계에 있지만 중요하게 고려되어야 한다고 주장한다. 만약 참석자들이 그들이 투자한 시간과 노력이 의미있다고 생각하지 않으면, 더 이상 FD에 참여하려고 하지 않을 것이기 때문이다. 또한 우리는 교수들이 FD의 가치를 깨닫고 동료들에게 권하기를 원하기 때문이다. educational programme의 평가에 대해서 Goldie의 조언을 찾아보거나 clinical education intervention에 있어서 측정 원칙에 대해서는 Snell의 연구를 참고할 수 있다.

While we strive to measure ‘meaningful’ and ‘long-term’ outcomes of faculty development, Steinert (2005) has pointed out that despite participant satisfaction being assigned to the lowest level on Kirkpatrick’s (1994) model, it is nevertheless an important consideration in faculty development. If participants do not believe that their time and efforts were well spent, they may not sign up for further faculty development sessions, just as the travellers on the train journey. We would also certainly want faculty to recognize the value of courses and recommend them to colleagues. Readers should consult Goldie (2006) for a description of the range of tools for evaluating educational programmes and Snell et al. (2000) for a discussion of measurement principles relating to clinical educational interventions.

Med Teach. 2008;30(6):555-84. doi: 10.1080/01421590802109834.

Faculty development: yesterday, today and tomorrow.

AMEE GUIDE NO 36

Faculty development: Yesterday, today and tomorrow

MICHELLE MCLEAN1, FRANCOIS CILLIERS2 & JACQUELINE M. VAN WYK3

1University of the United Arab Emirates, 2University of Stellenbosch, South Africa, 3University of KwaZulu-Natal, South Africa

Abstract

의학교육은 그 자체가 하나의 학문으로서 진호하였다. Medical faculty에게 요구되는 사회적 책무와 함께 가르치는 일에 대해서도 professionalization의 압박이 커지고 있다. 프로페셔널하고 역량있는 선생, 교육자, 연구자, 리더를 키우기 위해서는 교수개발(faculty development, FD)가 필요하다. 그러나 FD는 쉬운 일이 아디나. 조직 차원에서의 지지가 필요하고, 적절한 자원의 배분과 우수한 교육자를 인정해주는 것이 필요하다.

Medical education has evolved to become a discipline in its own right. With demands on medical faculties to be socially responsible and accountable, there is now increasing pressure for the professionalisation of teaching practice. Developing a cadre of professional and competent teachers, educators, researchers and leaders for their new roles and responsibilities in medical education requires faculty development. Faculty development is, however, not an easy task. It requires supportive institutional leadership, appropriate resource allocation and recognition for teaching excellence.

이 가이드는 의학분야 뿐만 아니라 관련된 보건분야를 막라하여 교육에 대한 교수의 새로운 역할을 위한 FD를 담당하고 있는 사람들을 위해 만들어졌다. FD 개발의 역사적 관점을 보여주고 FD 프로그램을 만들기 위해서 도움이 될 만한 프레임워크를 제공하고자 했다. 이 프레임워크는 FD 담당자들이 계획을 세우고, 도입하고, 평가하는데 도움을 줄 것이다.

This guide is designed to assist those charged with preparing faculty for their many new roles in teaching and education in both medical and allied health science education. It provides a historical perspective of faculty development and draws on the medical, health science and higher education literature to provide a number of frameworks that may be useful for designing tailored faculty development programmes. These frameworks can be used by faculty developers to systematically plan, implement and evaluate their staff development programmes.

마지막으로 이 가이드는 미래 FD를 이끌어나갈 주요 트렌드와 원동력을 짚어보았다.

This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.

효과적이고 지속가능한 FD의 구성요소는?

What constitutes ‘effective’ and sustainable faculty development?

우리는 '효과적'이라는 단어를 신중하게 사용하고자 하는데, 그 이유는 많은 프로그램들이 participation이나 satisfaction 수준만 평가할 뿐 학생의 학습에 효과가 있었다는 등의 장기적인 성과는 보고하고 있지 않기 때문이다. CME에 있어서도 비슷하게 '의미있는 성과'에 대한 보고가 부족하다.

We, however, reserve the use of the word ‘effective’ since the reported success of many programmes relates to faculty participation and satisfaction rather than long-term outcomes such as changed practice or improved student learning (Prebble et al. 2004; Steinert et al. 2006; Knight et al. 2007; Williams et al. 2007). A similar paucity of ‘‘meaningful outcomes’’ has also plagued continuing medical education programmes for the same reasons (Tian et al. 2007). 

Steinert등과 Tian등은 Kirkpatrick의 평가모델을 gold standard로 삼았다. 참여자들의 만족과 스스로 응답한 변화/향상 등이 가장 흔히 보고되는데 이것들은 모두 Kirkpatrick scale에서 낮은 레벨에 대한 것들이다. Kirkpatrick의 모델에서 intervention의 효과는 다음의 네 단계로 평가 가능하다.

In reaching their conclusions, Steinert et al. (2006) and Tian et al. (2007) used Kirkpatrick’s (1994) levels of evaluation as the gold standard for assessing the outcomes. Participant satisfaction and self-reported changes or improvements were most commonly reported, which are both lower order levels of outcomes on the Kirkpatrick (1994) scale (Table 3). In Kirkpatrick’s (1994) model, effectiveness of an intervention is considered at four levels:

(1) 반응 reaction of participants (e.g. participant satisfaction);

(2) 학습 learning (in terms of knowledge, skills and attitudes);

(3) 행동 behavioural changes (willingness to transfer learning to educational environment); and

(4) 결과 results (impact on learners, trainees, patients, organizational culture).

비록 Freeth등은 Kirkpatrick의 레벨이 위계가 있다고 보지는 않았지만, '결과'에 해당하는 성과를 측정하는 것은 대단히 어렵다. 

Although Freeth et al. (2002) do not view Kirkpatrick’s levels as hierarchical, outcomes become increasingly difficult to measure as one moves from reaction to results.

Guskey는 조직의 리더들과 Faculty developer들이 같은 찬송가를 부르기 위해서는(즉 조화를 이루기 위해서는) '효과적인' FD가 무엇인지에 대한 의견의 일치가 있어야 한다. 우리의 관점에서 효과성은 'FD프로그램의 일차적 목적' 등을 비롯한 몇 가지 요인에 따라 달라지는 것으로 보인다. 

Guskey (2003) advises us that in order for institutional leaders and faculty developers to sing from the same hymn sheet, we should agree on what constitutes ‘effective’ faculty development. In our view, effectiveness will, however, depend on a number of factors, including the primary aim of the faculty development activity or programme.

Prebble 등이 지적한 바와 같이 학생이 향상되었다는 식의 성과를 측정하기 어려운 중요한 이유 중 하나는 FD와 학생성과간에 연결이 간접적 또는 두 단계를 거치기 때문이다.

As Prebble et al. (2004) have pointed out, the difficulty in measuring improved student outcomes may stem, in part, from the fact that the link between faculty development and student outcomes is an indirect or two-step process

앞서 지적한 바와 같이, 여러 문헌들로부터 teaching practice를 향상시켜서 student learning을 향상시키는 것이 가능하다는 것이 보고되고 있고, 이는 교수들의 '학습에 대한 개념 변화'를 촉진시킴으로서 가능할 수 있다.

As alluded to earlier, the literature informs us that it is possible to promote student learning by improving teaching practice, which may be facilitated by changing teachers’ conceptions of learning (Prosser & Trigwell 1997; Prebble et al. 2004; Richardson 2005). 

그러나 어떻게 교육의 'transformative conception'을 향상시키는 FD프로그램을 만들 수 있으며, '의학교육이 그 어느 때보다도 다양해진', '의학교육이 절대로 가만히 있지 않는' 이 때에 어떻게 teaching practice를 바꿀 수 있을 것인가?

But, how do we develop faculty development programmes that promote more transformative conceptions of teaching and learning and how do we change teaching practice when ‘Medical education is probably as diverse as it has ever been’ (Pritchard 2004) and when ‘Medical education seems to be in a perpetual state of unrest’ (Cooke et al. 2006)?

크게 세 분류로 나눠서 제언을 할 수 있을 것이다. (후반부에 다뤄짐)

We have chosen to group these recommendations into three main categories: effective change management strategies, effective educational practice and accountable practice.

상주하고 있는 FD전문가 Resident faculty development experts. 

자문위원을 초청하여 단기간의 훈련 코스를 요청하거나 faculty를 다른 기관으로 보내 (종종 큰 비용을 들여) 수행하는 것은 지속가능하지 못하다. 성공적인 FD는 faculty teaching과 student learning의 장기적 성과에 달려 있다.

The once popular practice of inviting consultants to offer short training courses or sending faculty to other institutions, often at great cost, is not sustainable. Successful faculty development depends on its long-term outcomes for faculty teaching and student learning

우리가 보기에, faculty가 무엇을 필요하는지 잘 알고, 즉각적으로 자문을 해 줄 수 있는 MEU/Dept of ME의 스테프들이 필요하다. 

In our view, this necessitates a medical education unit/department staffed with appropriately trained professionals who are sensitive to the needs of faculty and readily available for consultation (Hitchcock et al. 1993, Davis et al. 2005).

또 다른 권장사항은 '교육적으로 영향력이 있는' 사람을 파견보내는 것이다. 이 사람들이 동료로부터 존경받는 사람인지 여부가 중요하다. Simpson 등은 faculty developer를 'risk-taking role model'이라고 묘사하면서, 교육적 불완전함과 실수를 다함께 공유하고, 거기서 배운 교훈을 공유하면서 교육의 진전을 이루는 사람이라 칭했다.

Also recommended is the practice of seconding ‘educationally influential’ colleagues as role models and advocates, such as those who have been rewarded for teaching (Kaufman et al. 1999; Rogers 2005; Williams et al. 2007). It is critical, however, that these individuals are respected by their colleagues (Steinert 2005). Simpson et al. (2006) have described faculty developers who are ‘risk-taking role models’, whose behaviour advances education through public sharing of educational imperfections and mistakes, through lessons learnt and as individuals who are able to modify faculty development to engage participants.

새로운 것을 만드는 것에 집착하지 말기 Avoid reinventing the wheel. 

새로운 프로그램을 만드는 것에 시간과 에너지를 쏟기 보다는 이미 성공이 증명된 프로그램이 사용한 전략을 도입하는 것이 좋다. 이를 위해서 Wong과 Agisheva는 지역과 기관의 맥락을 잘 파악하여 한 문화권에서 다른 문화권으로 FD프로그램을 도입시키는데 성공했다.

Rather than expending time and energy on de novo programmes, it makes sense to adopt strategies from programmes with proven success. To this end, Wong and Agisheva (2007) successfully transposed of a well designed and successful faculty programme from one culture to another, taking cognisance of local contextual and institutional factors.

의학교육 외 영역과 협동하기 Collaboration with and beyond the medical education arena.

조직의 자원은 대개 한정되어 있으므로 변화와 밀접히 관련이 된 사람들의 협동이 필요하다.

As institutional resources are generally finite, it is not surprising that ‘Co-operation has emerged a key theme amongst academics closely involved in change

지역간 협동은 매우 성과가 좋다. AMEE, ASME, AAMC 등.

Collaboration between regional institutions can be very productive (Kent & Gibbs 2004). AMEE (Association for Medical Education in Europe), ASME (Association for the Study of Medical Education) in Europe and the AAMC (Association of American Medical Colleges) in the USA have served important networking roles regionally and internationally. (Western Cape Branch of the South African Association for Health Educationists.)

국제적 수준에서 보면, FAIMER는 잘 사는 국가와 저소득 국가간 협력을 촉진하고 네트워크를 구축해서 의학교육의 리더십과 역량을 키우고자 했다.

On a global scale, FAIMER is contributing to building capacity and leadership in medical education across the globe by fostering co-operation and establishing networks between more and less developed nations (Burdick et al. 2006).

FD에서의 협동은 의학을 넘어 다른 보건의료직과 이루어져야 한다.

Collaboration in faculty development should also extend beyond medicine and the health professions.

변화의 원동력으로 FD를 활용하기 Faculty development as change. 

모든 FD프로그램은 변화를 일으키고 지속시켜야 한다.

Any faculty development programme should endeavour to initiate and sustain change

Context가 변화에 중요하기 때문에, 열린 조직문화, 학습을 조장하는(Conducive) 조직문화가 장려되어야 한다.

As context is important for change, an open, conducive organizational culture of learning should be fostered (Eckhert 2002).

만약 FD가 변화를 위한 것이라면 Farmer는 CAS를 사용하기를 권고한다. CAS이론에 따르면 강력한 변화과정을 만들어내려면 macro 전략에 집중하기보다는 micro한 수준에 더 집중해야 한다.

If faculty development is about change, then Farmer (2004) suggests using the Complex Adaptive Systems (CAS) theory to inform our practice. The CAS Theory, rather than focusing on the ‘macro’ strategic level of an organization, purports that it is at the ‘micro’ level that the most powerful change processes take place.

이러한 측면에서 네 조건이 맞아야 한다. 

변화를 위한 열망, 

무엇을 어떻게 할 것인가에 대한 지식, 

지지적 환경, 

변화를 수용하는 포상.

In this regard, four conditions need to be met: a desire to change, the knowledge of what to do and how to do it, a supportive work environment and reward for embracing change

모든 FD프로그램은 변화관리원칙에 기반한 최선의 practice를 해야 한다.

Any faculty development programme should therefore conform to best practice regarding change management principles (Kirkpatrick 1994; Gale & Grant 1997; Bascia & Hargreaves 2000; Bland et al. 2000).

적절한 태도와 행동과 롤모델을 통해서, faculty developer는 change agent로서의 역할을 할 수 있다.

Through appropriate attitudes and behaviour and role modeling, faculty developers have the potential to act as change agents.

책임있는 행동으로서 FD Faculty development as accountable practice. 

FD가 좀더 현실에 기반을 둔 접근법을 따르기 위해서는, 진행되고 있는 많은 프로그램들에 대한 적절한 평가와 보고가 중요하다.

If faculty development practice is to promote a more grounded approach, the myriad of initiatives underway across the globe should be appropriately evaluated and reported

평가를 더 잘 해야한다는 오래된 요구에도 불구하고, 최근의 보고를 보면 이런 측면에서의 질적 데이터가 여전히 부족하다. 시간, 자금, 인력이 부족한 것이 그 이유로 꼽힌다.

Despite long-standing calls for better evaluation of practice, recent reviews still lament a lack of quality data in this regard (Prebble et al. 2004; Steinert et al. 2006). Lack of time, money and staff have been most frequently cited as factors preventing systematic evaluation of faculty development (Kreber & Brook 2001).

이러한 측면에서 두 개의 유용한 프레임워크가 있다.

Two useful frameworks relating to accountable practice are provided by Gray and Radloff (2006) and Otto et al. (2006).

In Gray and Radloff’s (2006) framework for quality management in academic development in higher education, change is viewed as faculty development moving from remediation to transformation of practice. Quality management spans faculty development from the perspective of the academic developer to that of institutional management. Otto et al. (2006) describe the application of the programme logic model (borrowed from the Kellogg Foundation) to measure the contribution of faculty affairs and development offices to the recruitment, retention and development of a medical school’s faculty. These documents are well worth reading.

FD의 순응성 Adaptability of faculty development.

개개인의 교수들이 조직적 차원과 사회적 요구에 맞게 발전하기 위해서는 FD활동은 그에 맞춰 바뀌어야 한다.

As the roles and responsibilities of individual faculty members continue to evolve in terms of institutional and societal needs, faculty development activities must be modified accordingly.

FD를 다듬기

Tailoring faculty development

FD의 단계

Levels of faculty development

(1) 새로운 staff member를 조직 문화로 끌어들이기

(2) 조직의 중요한 사건(새로운 평가법 도입 등)에 따른 별개의 기술을 개발하기

(3) 교육의 Professionalization 

(4) Educational scholarship의 개발

(5) Educational leadership의 개발 

(1) orienting new staff members into the academic culture of the institution;

(2) developing discrete skills, which may be precipitated by a key event in the life of an institution, such as the implementation of new assessment methods or online learning; 

(3) professionalizing teaching, by enhancing and extending the educational practice of academics in different

disciplines; 

(4) developing educational scholarship, by supporting individuals who will extend the field of medical education research; and    

(5) developing educational leadership, by supporting faculty members who wish to become policy-makers, chairs of educational committees or deans of faculty.

Benor의 2020 vision으로부터 위의 레벨을 가져왔다. 

We have adapted these levels from Benor’s (2000) 2020 vision of multiphasic faculty development and teacher accreditation, in which he proposed four phases of staff development

모든 교수들은 일반적인 교육 기술을 가지고 있어야 하고, 임상 교수들은 좀 더 구체적인 기술들을 가져야 한다.

All teachers would also require a repertoire of generic teaching skills (e.g. teaching in small groups), while clinical teachers need more specific skills (e.g. teaching ethically with patients or supervising residents).

Carroll은 Levinson 등의 묘사를 활용하여 FD프로그램은 개개인의 transition point(새로 임용된, 승진을 앞둔, 테뉴어를 앞둔, 집행부를 맡은, 정년을 앞둔) 에 있는 교수들을 타겟으로 해야 한다고 제안하였다.

Using Levinson et al.’s (1978) description of life as a series of transitions and plateaus at different stages in academic life, Carroll (1993) suggested that faculty development programmes should be aimed at individual faculty members at transition points (which may be regarded as phases) in their career, such as initial appointment, promotion, tenure, assumption of supervisory or leadership duties and, finally retirement.

FD의 현 상태를 고려하면, 대부분의 교수들은 아마도 level 1이나 level 2에 해당하는 훈련만 받고 있을 것이다. 국제적 표준을 따르라는 압박이 세지고 인증기관들이 professional teaching requirement를 도입함에 따라서 모든 교수들은 최소 level 3에 도달해야 한다.

Considering the global status quo in faculty development, most faculty members probably receive Level 1 and possibly Level 2 training only (Table 5). As the pressure to implement global standards gains momentum and as accreditation bodies implement professional teaching requirements, it may come to pass that all teachers would be expected to attain Level 3 as a minimum requirement. 

일부 대학들은 의학교육을 전공하는 대학원생들을 educational researcher가 되게 하거나 leader로 키우고자 할 것이다(level 4). 그러나 개발도상국과 같이 자원이 풍족하지 않은 조직에서는 level 2를 달성하는 것 조차 어려울 수 있다. FAIMER의 역할은 아프리카, 아시아, 남아메리카에 의학교육자들의 집단을 키워내서 이 지역에 역량을 키울 수 있도록 기여하는 것이다.

Some academics may choose or be encouraged to undertake post-graduate studies in medical education to become educational researchers and perhaps leaders and administrators (Level 4). It should, however, be borne in mind that for under-resourced institutions, as is the case in many developing countries, achieving Level 2 would be difficult. FAIMER’s role in creating a cadre of medical educators in Africa, Asia and South America will contribute greatly to developing this capacity in these regions.

단기과정 vs 지속과정 

Short courses vs. ongoing faculty development

단기 코스는 행동이나 교육행동을 바꾸는데 한계가 있어 보인다.

it would appear that short training courses (e.g. one-off seminars, workshops) have a limited impact on changing teaching behaviour or practice (Prebble et al. 2004).

단기 코스는 낮은 비용으로 다수의 그룹에 정보를 알리는데 효과가 있어서 FD에서 많이 사용되어왔지만, 조직의 요구에 바로 들어맞는 '시기에 딱 맞는' 훈련을 위해서도 가치가 있다.

Short courses have been used extensively in faculty development as they are cost-effective for disseminating information to large groups. Short courses should also valuable for ‘just-in-time’ training, which may dovetail with institutional needs,

지속적인 FD가 필요하다는 연구 결과가 축적되고 있다.

While the evidence leading to such a conclusion is currently insufficient, the gradual accumulation of research data suggests that for sustainable faculty development, such interventions may be necessary (Prebble et al. 2004; Steinert et al. 2006).

지속적인 프로그램은 certification이나 accreditation과도 연관이 되어서 개인적인 요구 뿐만 아니라 학문적, 기관 차원의 요구에도 잘 맞는다.

Continuous programmes may also lead to certification or accreditation, which may meet both the personal and professional needs of individual faculty members as well as those of the discipline and the institution.

Med Teach. 2008;30(6):555-84. doi: 10.1080/01421590802109834.

Faculty development: yesterday, today and tomorrow.

AMEE GUIDE NO 36

Faculty development: Yesterday, today and tomorrow

MICHELLE MCLEAN1, FRANCOIS CILLIERS2 & JACQUELINE M. VAN WYK3

1University of the United Arab Emirates, 2University of Stellenbosch, South Africa, 3University of KwaZulu-Natal, South Africa

Abstract

의학교육은 그 자체가 하나의 학문으로서 진호하였다. Medical faculty에게 요구되는 사회적 책무와 함께 가르치는 일에 대해서도 professionalization의 압박이 커지고 있다. 프로페셔널하고 역량있는 선생, 교육자, 연구자, 리더를 키우기 위해서는 교수개발(faculty development, FD)가 필요하다. 그러나 FD는 쉬운 일이 아디나. 조직 차원에서의 지지가 필요하고, 적절한 자원의 배분과 우수한 교육자를 인정해주는 것이 필요하다.

Medical education has evolved to become a discipline in its own right. With demands on medical faculties to be socially responsible and accountable, there is now increasing pressure for the professionalisation of teaching practice. Developing a cadre of professional and competent teachers, educators, researchers and leaders for their new roles and responsibilities in medical education requires faculty development. Faculty development is, however, not an easy task. It requires supportive institutional leadership, appropriate resource allocation and recognition for teaching excellence.

이 가이드는 의학분야 뿐만 아니라 관련된 보건분야를 막라하여 교육에 대한 교수의 새로운 역할을 위한 FD를 담당하고 있는 사람들을 위해 만들어졌다. FD 개발의 역사적 관점을 보여주고 FD 프로그램을 만들기 위해서 도움이 될 만한 프레임워크를 제공하고자 했다. 이 프레임워크는 FD 담당자들이 계획을 세우고, 도입하고, 평가하는데 도움을 줄 것이다.

This guide is designed to assist those charged with preparing faculty for their many new roles in teaching and education in both medical and allied health science education. It provides a historical perspective of faculty development and draws on the medical, health science and higher education literature to provide a number of frameworks that may be useful for designing tailored faculty development programmes. These frameworks can be used by faculty developers to systematically plan, implement and evaluate their staff development programmes.

마지막으로 이 가이드는 미래 FD를 이끌어나갈 주요 트렌드와 원동력을 짚어보았다.

This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.

FD를 이끄는 원동력은 무엇인가?

What drives faculty development?

Gruppen 등이 세 가지의 주된 원동력을 밝혔으며, 다른 몇 가지의 내적/외적 요인들이 있다.

While Gruppen et al. (2006) have identified three main driving forces (public accountability, the changing nature of health care delivery and the need to sustain academic vitality) of faculty development, several others, both internal and external, also warrant consideration.

내적 요인

A. Internal factors

조직 문화의 사회화 Socialization into the institutional culture.

교육을 위한 준비 Preparation for teaching. 

대부분의 의과대학 교수들이 교육에 대해서 훈련을 받거나 준비과정을 거친 적이 거의 없는 것이 사실이다.

It would be true to say that most medical academics have received little or no training or preparation for their teaching responsibilities.

효과적이고 모범적인 교사, 교육자가 되는 과정은 발달과정과 같다. 한 사람이 어떻게 교육에 접근하는가는 교육/학습에 어떠한 개념을 가지고 있는지를 반영한다.

We believe that becoming an effective and exemplary teacher and then an educator is a developmental process (Riley 1993; Higgs & McAllister 2007a,b). It is generally accepted that one’s approach to teaching reflects one’s conception of teaching and learning (Trigwell 1995; Kember 1997; Prosser & Trigwell 1997; Lueddeke 2003; Richardson 2005; Prebble et al. 2004).

그 개념의 범위는 'reproductive', 즉 지식을 전달하는 것으로부터 'transformative' 즉 가르친다는 것은 인지적 측면 뿐만 아니라 정서적(affective) 측면의 변화까지 일으킨다는 것 까지 넓다. 가르쳐보는 경험만으로 transformative 라는 개념을 익히게 된다는 근거는 거의 없기 때문에 교수들이 교육을 더 잘 하도록 하려면 기관적 차원에서 이러한 개념을 가르쳐주고 지원하는 것이 필요하다. 

Conceptions range from reproductive, in which teaching is perceived as knowledge transmission, to a transformative conception in which teaching is perceived as fostering not only cognitive but also affective change in learners. As there is little evidence suggesting that teaching experience alone promotes the adoption of transformative conceptions (Norton et al. 2005), it is becoming imperative that institutions invest in and support their teaching faculty in transforming their conceptions, which should then improve their teaching practice. 

'교육'과 관련한 커리어를 밟는 사람들은 다음과 같은 논리적 과정을 거치게 된다. 

"Teacher => Scholarly teacher => Educational scholar/Educational leader."

For individuals who choose a ‘teaching’ career path (i.e. personal development), this professional development can be followed through to its logical conclusion: from teacher, to scholarly teacher, to educational scholar (Cohen et al. 2005; Fincher & Work 2006) or perhaps educational leader (Eitel et al. 2000; Steinert et al. 2003; Rogers 2005; Cohen et al. 2005).

지원을 해주기 위해서는 교수들에게 조언을 해주고 피드백을 줘야 한다. 세 가지 모델이 있다.

To provide support, advice and feedback for teachers to improve their practice, Weimer and Lenze (1997) describe three models:

• The professional service model, in which a consultant provides organizational or technical support.
• The counselling model, in which a consultant assists teachers to seek solutions to their own problems and challenges.
• The collegial model, in which two peers provide mutual guidance.

이 세가지 모델을 조합해서 활용하는 것이 효과적일 것이다.

It is likely that a combination of these models will be effective, as each caters for different needs.

멘토링은 professional inquiry의 문화를 만들어서 새롭게 들어온 사람들이 두려워하지 않아도 되는 환경을 조성하고, 협력적 네트워크를 조성하고, 진로개발을 도와주며, 의미있는 academic encounter를 권장해준다.

Mentoring, through the creation of a culture of professional inquiry, may foster a nonthreatening environment for socializing newcomers, promoting collaborative networks, developing career paths and encouraging meaningful academic encounters (Pololi et al. 2002; Steinert 2005; Ramani 2006).

더 국제적인 관점에서 FAIMER의 성공은 멘토링 프로그램을 통해 국제적 네트워크와 협력 고리를 만들었기 때문에 가능한 것이었기도 한다.

In a more global context, part of the success of the Foundation for the Advancement of International Medical Education and Research (FAIMER) in terms of establishing international networks and collaborative links rests with its mentoring programme (Burdick et al. 2006).

학문적 활력 유지 Sustaining academic vitality. 

교수들 사이에 스트레스와 burnout은 흔한 일이다.

Stress and burnout amongst medical teachers is common (Harden 1999).

academic vitality를 증진시키기 위해서는 적절한 FD프로그램이 적절한 보상/인센티브와 연계되어야 한다.

To promote academic vitality, appropriate faculty development programmes linked to rewards and incentives would assist in retaining teachers, clinicians, researchers and administrators (Bland & Stritter 1988; Hitchcock et al. 1993; Wilkerson & Irby 1998; Bligh 2005; Gruppen et al. 2006).

외적 요인

B. External factors

사회적 요구에 부응 Meeting society’s needs. 

의학교육의 궁극적 목표가 의료전달을 향상시키는 것이기 때문에, 사회의 보건의료에 대한 요구는 지속적으로 변화한다.

While the overarching goal of medical education is to improve health care delivery (GMC 1993, Boelen 1999), the health care needs of society are constantly changing.

GMC에서는 다음과 같이 기술하고 있다.

GMC (1993) document: 

의과학과 의학기술의 발전속도를 감안하면, 미래의 의사들은 지금은 전혀 본적도 없는 지식과 기술을 활용하게 될 것이다. 우리는 발견되지 않은 과학을 가르칠 수도 없을 뿐더러 미래를 예측할 수도 없다. 하지만 현재 의학기술과 의과학의 일부는 분명 살아남아 미래 의료의 근간을 이룰 것이다. 나머지에 대해서 우리가 할 수 있는 것은 의사들이 적응하고 변화할 수 있도록, 새로운 아이디어와 기술의 발전을 포용할 수 있도록, 전문직으로서의 평생에 걸친 학습태도를 지속할 수 있도록 가르치는 것 뿐이다.

Given the pace at which the horizons of medical science and technology expand, we can be certain that the doctors of tomorrow will be applying knowledge and deploying skills which are at present unforeseen . . . We cannot teach science that is as yet undiscovered nor can we forecast its future implications. But some of the present day art and science of medicine is fundamental to its practice and will certainly endure . . . For the rest, we can best strive to educate doctors capable of adaptation and change, with minds that can encompass new ideas and developments and with attitudes to learning that inspire the continuation of the educational process throughout professional life [p. 4].

개개 의대교수들에게는 막중한 책무와 사회적 책임이 따른다.

A considerable onus and social responsibility therefore rests with individual medical faculties

교육의 전문직화과 교육에 대한 책 Accountability and the professionalization of teaching practice. 

삼차 교육에 있어서 책무는 피할 수 없는 현실이다. Brown이 약 십년 전에 지적한 것처럼 '교육에 대한 책임은 대학만 가지고 있는 것은 아니며, 대학이 하는 역할 중에서 학생/직원/기타 이해관계자가 관심을 두는 가장 대중적인 역할이다.

Accountability is a fact of life in tertiary education. As Brown (2000) pointed out almost a decade ago, ‘teaching is rarely the only occupation of an academic . . .. And yet it is the most public aspect of the work, in that students, employers and other stakeholders often focus on that part of the academic’s role’.

인증에 대한 여러 문헌들에서는 '측정가능한 성과'에 대해서 교수들이 가르치는 것을 'professionalize'해야 할 필요가 있으며, 이에 대해 보상받아야 할 것을 주장하고 있다. HPCSA에서는 '의과대학은 교육의 효과성에 대한 기준을 마련해야 한다. 의학교육에 대한 qualification이 승진에 반영되어야 한다'라고 하고 있다.

Measurable outcomes in many accreditation documents increasingly refer to the need for teachers to professionalise their practice, for which they should be rewarded (e.g. World Federation for Medical Education 2003, HPCSA 2004) – ‘Medical schools should establish effectiveness-related standards of performance for all teaching staff. . .. Qualifications in medical education should be recognized for promotion’ (HPCSA 2004).

Box3에서 다루고 있는 역량은 삼차교육에 종사하는 모든 교수들이 갖추어야 할 일반적인 기술과 능력을 평가하는 좋은 시작점이다.

(Box 3). Such competencies might be a good starting point for reflecting on generic skills and abilities of all teachers in tertiary education, including medical education.

인증에 대한 압박은 국경을 넘어 확장되고 있다.

the pressure for accreditation now extends beyond a country’s borders (Hamilton 2000; Lilley & Harden 2003; Stern et al. 2003; 2005; Karle 2006).

한 예로서 WFME는 staff development의 기본 기준을 다음과 같이 말하고 있다.

As an example, the WFME (2003) requires that as a basic standard of staff development

의과대학은 교육/연구/진료 능력에 대해서 균형잡힌 정책을 가져야 하며, 칭찬할 만한 업적에 대해서는 충분히 인정해줘야 한다.

‘the medical school must have a staff policy which addresses a balance of capacity for teaching, research and service functions, and ensures recognition of meritorious academic activities, with appropriate emphasis on both research attainment and teaching qualifications.’

의과대학 학생들을 의학의 지식과 기술을 가르치는 것 외에도 의과대학 졸업생은 가르칠 수 있는 능력을 지녀야 한다.

In addition to training medical students in the art and science of medicine, our medical graduates are also expected to teach.

미국 의과대학 학생연합(AMSA)는 Mount Sinai School of Medicine과 협동을 통해서 'Training Tomorrow's Teachers Today'라는 프로그램을 만들어서 학생들의 임상교육능력과 학문적 리더십 스킬을 높이고자 했다.

The American Medical Students’ Association, recognizing this omission, has proactively, in collaboration with Mount Sinai School of Medicine, designed the ‘Training Tomorrow’s Teachers Today’ programme to enhance students’ clinical teaching and academic leadership skills.

FD의 장애물은 무엇인가?

What are the barriers to faculty development?

Skeff등은 세 가지의 주된 장애물을 언급했다.

For Skeff et al. (1997b), three major barriers impact on faculty development: lack of institutional support, misconceptions and attitudes of teachers and the relative paucity of research on what constitutes effective teaching improvement.

학교 차원의 지원 부족

Lack of institutional support for faculty development

조직의 문화 Institutional culture

조직의 문화는 FD에 담겨지는 가치에 영향을 준다. 조직 내, 학문 내의 다양한 맥락적 상황적 요소가 이러한 mismatch에 영향을 준다.

The institutional culture affects the value ascribed to faculty development. A number of contextual and situational factors (e.g. leadership; appropriate rewards) within institutions and even within different disciplines may contribute to this mismatch, including the value assigned to teaching (Healey 2000; Knight & Trowler 2000; Richardson 2005; Norton et al. 2005).

연구가 승진의 'gold standard'인 기관에서 FD에 대한 참여가 떨어지고, FD가 하향식 접근법으로 여겨지는 상황에서도 비슷한 일이 생긴다. 

At institutions where research remains the ‘gold standard’ for appointment and promotion, participation in faculty development may require negotiation. A similar situation could arise if faculty development is perceived as a political ‘top-down’ approach, with little or no personal or professional reward (Hill & Stephens 2004).

Boyer’s (1990) identification of four scholarships, followed by Glassick et al. (1997) criteria for measuring these scholarships, has provided a template for recognizing and rewarding excellence and scholarly activities in all spheres of academia.

교수들의 태도와 오해 Teachers’ attitudes and misconceptions. 

교수들의 태도와 오해는 FD에 참여할 가능성을 낮춘다.

Teachers’ attitudes and misconceptions about their teaching reduce the likelihood of participation in faculty development (Skeff et al. 1997b).

FD의 장기적 효과에 대한 연구 부족 Paucity of research on long-term benefits of faculty development. 

앞서 언급된 것처럼 의미있는 혹은 장기적인 효과는 연구된 바가 부족하다. 

As mentioned earlier, meaningful or longterm outcomes of faculty development have generally not been measured or documented, despite several decades of research on and reported success of faculty development programmes (Skeff et al. 1997a, b; Guskey 2003; Prebble et al. 2004; Steinert 2005; Steinert et al. 2006).

FD가 진짜로 중요한가?

Does faculty development really matter?

만약 teaching이 student learning에 영향을 준다는 교육의 기본 전데를 받아들인다면, 교육에 대한 지식/교육 업무를 향상시킴으로서 학생에게 이득이 돌아갈 것이다. FD에 관한 문헌은 많지만 teaching practice에 변화가 있었는지, student learning이 향상되었는지에 관한 의미있는 결과를 보고한 연구는 적다.

If we accept the fundamental educational premise that teaching influences student learning (Lueddeke 2003; Prebble et al. 2004), then by improving educational knowledge and teaching practice, students should benefit. Despite a wealth of literature describing faculty development programmes in medical, health sciences and higher education, few studies document meaningful outcomes such as sustained changes in teaching practice or improved student learning (Skeff et al. 1997a; Prebble et al. 2004; Steinert et al. 2006; Knight et al. 2007; Williams et al. 2007).

이러한 측면에서 Prebble 등은 FD의 틀(frame)에 영향을 주는 네 개의 주된 요소를 주장했다.

In this regard, Prebble et al. (2004) identified four guiding influences, which can be used to frame faculty development. 

These include:

(1) attributes and elements that contribute to good teaching practice,

(2) teachers’ beliefs and conceptions of teaching and learning that may positively influence student outcomes,

(3) a range of conceptual models of good teaching, and

(4) learners’ perceptions of what constitutes quality teaching.

1. 좋은 교육행동에 영향을 주는 요소들

1. Teaching elements and attributes contributing to good teaching practice. 

학생들의 학습을 촉진하는 교육의 특질을 나열하는 것이 가능하다.

It has been possible to identify teaching attributes (from an extensive list) that promote student learning, such as those proposed by Cohen (1981) and Ramsden et al. (1995) (Box 4).

2. 교사가 교육에 대해 가지고 있는 믿음

2. Teachers’ beliefs about teaching.
     교육과 학습에 대한 개념을 제대로 이해하고 있지 않으면, 교사들은 교육을 지식을 전달하는 것으로 보기 쉽다.

Without an awareness of their teaching and learning conceptions, teachers generally view their task as imparting knowledge.

3. 교수-학습에 대한 개념 모델

3. A conceptual model of teaching and learning. 

학생 중심의 학습 접근법을 가지고 있는 교사들은...

In their view, teachers who adopt a ‘student-centred learning approach’ to teaching

(1) 학생의 학습의 관점에서 도달하고자 하는 것이 무엇인지에 대한 일관되고 분명한 관점을 가지고 있다.

(1) develop a coherent and articulated view of what they are trying to achieve in terms of student learning, and how they can achieve this (i.e. focus on student learning). Today, learning outcomes need to reflect more than just knowledge acquisition,

(2) 학생들이 planned learning context를 인지할 수 있는 다양한 방법을 활용한다.

(2) discover the many ways in which students perceive the planned learning context (i.e. take cognisance of the learning environment), and

(3) 자신의 분명한 관점을 학생들이 이해하도록 한다.

(3) ensure that students understand the articulated view (i.e. align teaching and learning).

따라서 FD의 주된 기능은 교수들이 자신의 teaching practice를 학생의 needs와 align시키는 것이다.

A major function of faculty development should therefore be about making teachers aware of aligning their teaching practice with the needs of students.

4. 가르침에 대한 학생의 인식

4. Students’ conceptions of teaching. 

학생들이 자신들의 학습경험에 대해서 평가하도록 하는 것은 흔히 사용되는 방법이다. 많은 사람들이 믿는 바와 달리 학생들의 평가는 적절하게 사용되면 일반적으로 신뢰도도 높고, 편향이 적어서 피드백을 주기에 유용하다. 학생들의 평가는 FD의 좋은 시작점이다.

Asking students to assess the quality of their learning experiences is commonly used by institutions to guide faculty development. Contrary to what many academics may believe, student evaluation, provided it is used appropriately, is useful, generally reliable and is relatively unbiased in terms of providing feedback to individual faculty and administrators (Dunkin 1997). Student evaluation has been recommended as a good starting point for faculty development (Hitchcock et al. 1993; Trigwell 1995).

의학교육실(Medical Education Units Offices)이 FD에 기여한 바는 무엇인가?

What contributions have medical education units offices made to faculty development?

최조의 의학교육실(offices of medical education)은 1950년대 후반부터 1960년대 초반 사이에 세워졌다. 그들의 주된 업무는 기본적으로 의학교육 연구였다. 이후 1970년대 이후에 의학교육실/교실(medical education units/departments)들은 학부 의학교육을 지원하게 되었으나 교수들에게 새롭게 요구되기 시작한 책무에도 반응하고 있었다.

Although the first offices of medical education were set up in the late 1950s and early 1960s, their focus, according to Davis et al. (2005), was primarily medical education research. Later, in the 1970s, medical education units/departments were established to support undergraduate medical programmes, but probably also in response to the evolving responsibilities (and hence needs) of teachers (Tables 1 and 2). 

1980년대와 1990년대에 PBL이 널리 퍼지면서 활동 영역이 더넓어졌고, 지난 20년간 FD의 초점은 개개 교수로부터 학과/조직의 요구에 이르게 되었다. 의학교육학과는 많은 의과대학에서 중요한 역할을 하게 되었다. 1993년 이전에는 의과대학에서 교육 전문가들을 거의 키우지 않았지만, 이제는 사회의 변화하는 요구에 맞춰서 새로운 기술을 익히고 학문적 협회를 발달시키는 역할을 하고 있다. 

The widespread adoption of problem-based learning (PBL) in the late 1980s and 1990s then sparked a flurry of activity, resulting in education units appearing in many medical faculties. Over the past two decades, with the shift in focus of faculty development from the individual teacher to departments and institutional needs (Bland & Schmitz 1988; Benor 2000; Hill & Stephens 2004), medical education departments have become integral in a number of medical colleges. Educational specialists, a rare breed at medical schools prior to 1993 (Leinster 2003), but now highly sought after, are responsible for reskilling and developing the academic fraternity in the light of society’s changing health care needs. For a comprehensive discussion on the development and roles of a medical education unit, readers should consult AMEE Educational Guide No. 28 (Davis et al. 2005).

Med Teach. 2008;30(6):555-84. doi: 10.1080/01421590802109834.

Faculty development: yesterday, today and tomorrow.