Transformation으로서의 교수개발: 과정-지향적 프로그램의 교훈(Teach Learn Med, 2012)

전환으로서의 교수개발: 과정-지향적 프로그램의 교훈(Teach Learn Med, 2012)

Faculty Development as Transformation: Lessons Learned From a Process-Oriented Program

Dorene F. Balmer and Boyd F. Richards

Center for Education Research and Evaluation, Columbia University Medical Center, New York,

New York, USA

배경

BACKGROUND

임상가 교육자를 위한 종단적 교수개발 프로그램은 내용을 중심으로하는 경향이 있습니다. 즉 효과적인 교육, 교육 리더십, 커리큘럼 디자인, 장학금 또는 평가를위한 교육 이론, 원칙 및 / 또는 관행에 중점을 둡니다. 이러한 프로그램의 강의 계획은 didactic 발표, 그룹 토론, 역할극, 학술 프로젝트 및 성찰 연습과 같은 전략을 통해 원하는 내용을 전달하고 적용하도록 신중하게 계획된 학습 이벤트 순서를 반영합니다.

Longitudinal faculty development programs for clinician educators tend to be oriented around content, that is, they focus on education theory, principles, and/or practices for effective teaching, educational leadership, curriculum design, scholarship, or evaluation.1,2 The syllabi of such programs reflect a carefully planned sequence of learning events designed to transmit and apply desired content via such strategies as didactic presentations, group discussions, role plays, scholarly projects, and reflective exercises.

어떤 종단 교수 개발 프로그램은 이러한 콘텐츠 지향을 공유하지만, 참여자가 개인 성찰을 강화하고 대인 관계를 형성하도록 돕는 등 프로세스 지향적인 2 차 목표를 강조한다. 예를 들어, 한 프로그램에서는 특정 교육 스킬 습득을 목적으로 했지만 동시에 성찰 및 관계 형성을 촉진하고자 했다. 사실 교수개발 프로그램에 대한 리뷰를 보면 (지식, 기술 및 태도의 습득과 같은) 일차적 목표 달성보다 이차적 목표를 달성하는 것이 중요 할 수도 있음을 시사한다. 이는 2차적 목표의 달성이 더 "future proof"하고 지속가능하기 때문이다.

Although other longitudinal faculty development programs share this content-orientation, they also call attention to process-oriented, secondary aims such as helping participants enhance personal reflection and form supportive interpersonal relationships.13–15 For example, one program was designed to promote acquisition of specific teaching skills that also promoted reflection and relationship formation.14 Indeed, a review of longitudinal faculty development programs suggests that achieving secondary aims may be as important, and more “future proof” or sustainable, than achieving primary aims, that is, the acquisition of knowledge, skills, and attitudes.1

의학 교육에서 사회 및 행동 과학을 홍보하는 주된 목적을 달성하기 위해, 이 프로그램의 리더는 사회 및 행동 과학에 관한 소그룹 토론을 퍼실리테이션하는 교수들과 함께 매주 세미나를 개최했습니다. 프로그램은 narrative medicine에 의해 지지받는 프로세스에 의존했다. 일반적으로 교수 개발 프로그램에서 다루는 내용을 버린 것은 아니다. 대신, 효과적인 교육, 교육 이론 등에 관한 대화가 narrative medicine에 의해서 emerge하였다.

To accomplish the primary aim of promoting the social andbehavioral sciences in medical education the leader of the program held weekly seminars with faculty who facilitated small-group discussions around the social and behavioral sciences, in which she relied on the processes espoused by narrative medicine. Content typically covered in faculty development programs was not dismissed; alternatively, it emerged as conversations about effective teaching, education theory, and so forth were evoked by narrative medicine.

묘사

DESCRIPTION

참가자

Participants

Relevant participant demographics are displayed in Table 1. For clarity, we refer to FCM preceptors, all of whom attended weekly seminars while leading a small group of medical students, as participants in the process-oriented faculty development program.

세팅

Setting

In keeping with our ethnographic approach to evaluation, we recognized that the program did not occur in isolation but interacted with other systems within and beyond the institution. Locally, curriculum redesign at Columbia P&S, brought to fruition in 2009 with a new curriculum, created a period of flux and innovation. For example, the new curriculum was guided by inductively created school-wide learning objectives that elevated many of the same values embraced by the faculty development program (e.g., peer learning, teamwork, and selfawareness).17 At the same time, narrative medicine, a program birthed at Columbia P&S, was gaining a national and international reputation and, as a result, gaining credibility within the research-oriented institution that Columbia is known to be.

프로그램 설명

Program Description

The program leader engaged faculty with the social and behavioral sciences using the processes of shared reading and guided reflection espoused by narrative medicine. The structure of the weekly faculty seminar evolved over the years. 

• Initially, outside experts in the social and behavioral sciences were recruited to attend and to lead individual seminars. 

• By the 2nd year, participants assumed this responsibility in an attempt to enhance their content-specific teaching skills. 

내러티브 의학이 핵심

Time devoted to the narrative processes of reading and writing fluctuated from seminar to seminar, as did the nature of the readings and writings. However, narrative medicine remained a “keystone” to which the group consistently returned while the focus on behavioral and social science content remained secondary.

수동적 참가자도, 지식의 흡수자도 아님. 의미있는 대화에 기반한 능동적 참여.

Participation in the weekly seminars was neither passive attendance nor absorption of content. Rather, participants actively engaged with text as a basis for meaningful conversations around issues related to teaching generally and to the social and behavioral sciences more specifically. 

• They read stories written and published by others, wrote their own stories, and told stories about themselves and their students. 

• For example, close reading of “another’s” story (e.g., John Berger’s short story “A Fortunate Man: The Story of a Country Doctor”)18 provided a safe venue for personal reflection about one’s personal experiences related to the narrative. 

Writing이 thinking를 보여준다는 가정.

Working from the premise that writing is making thinking manifest, participants also engaged in writing their own narratives. 

• For instance, they wrote to prompts about patients that baffled them and about their fears as a teacher. 

이야기를 공유

They shared oral stories in the weekly “check in,” stories not only about their personal lives but also about students’ experiences with, and understanding of, the social and behavioral sciences.

공통의 목표는 있었지만, 이것에 제약을 받지는 않음.

Although all participants had a common purpose for participating in the seminars (i.e., all were, at the time of their entry into the program, serving as preceptors in FCM), this primary purpose for coming together did not limit the focus of discussions. Rather, participants were encouraged to draw upon and generalize lessons learned to all the educational venues and roles in which they were involved.

평가

EVALUATION

평가방법

Evaluation Methods

We took an ethnographic approach to evaluation, believing it to be most appropriate for evaluating this complex and emerging faculty development program. To facilitate observation, we joined the program as participant-observers; thus, we claim to know the program in ways that “outsiders” cannot. 

• Research assistants captured near-verbatim notes on a laptop computer of weekly seminar discussions from June 2006 to March 2010 (n = 91/110; 83%). These notes supported our direct observation. 

• In the spring of 2010, we conducted in-depth, open-ended interviews with a sample (n = 8/25; 32%) of participants who represented the larger group. An interview guide was constructed to solicit responses about faculty member’s experience with the program. All interviews were audio-recorded and transcribed verbatim. 

• We obtained various documents (e.g., course websites, accreditation reports), created with input from program participants. 

We managed data from notes from the seminars with Microsoft Access 2007 and data from the interviews with Atlas.ti software (v. 6; Scientific Software Development).

In an iterative process, we tagged data from meeting notes and interviews with inductively derived codes (e.g., “student leadership,” “bonding”).19 

• We applied codes to segments of data, revising the code list as patterns in the data became more apparent. 

• In the final stages of analysis, we had “conversations” with the data, that is, we moved back and forth between the data sources, the codes, and two concepts from education: transformational learning and teaching as a social practice. These concepts address change at individual, interpersonal, and institutional or social levels and were helpful in understanding and in organizing our findings. 

• With these concepts serving as interpretative lens, we iteratively formed assertions to capture the insights we gained from the data about the impact of the program on individuals, interpersonal relationships, and the institution. 

To build trustworthiness, we triangulated data sources and repeatedly checked our assertions with the program leader and the participants.20

참가자들에게 미친 영향: 교육 기술과 개인적 성장

Impact on Participants: Teaching Skills and Personal Growth

참여자는 교수진 개발 프로그램에 참여한 결과 자신의 성장을 인정했습니다. 사회 및 행동 과학 교사로서의 성장을 포함하여 다른 차원에서 성장이 발생했습니다.

Participants recognized growth in themselves as a result of engaging in the faculty development program. Growth occurred along different dimensions, including growth as teachers of social and behavioral sciences:

참가자들은 소그룹 촉진 목표 설정, 온라인 자료 사용과 같은 학습 전략을 통해 학생들이 개인적인 편견을 탐구하고 조사하는 것을 도왔습니다. 자신들이 주간 세미나에 대한 ownership을 얻은 것처럼, 그들은 학생에게 FCM 소그룹 토론을 이끌어 낼 수있는 기회를 제공하는 것이 중요함을 알게 되었다.

Participants reported learning teaching strategies such as setting goals for small-group facilitation and using online resources to help students explore and scrutinize personal biases. Just as they had taken ownership of the weekly seminars, they came to value giving students the opportunity to lead FCM small group discussion.

참가자들은 지속적으로 학생들의 리더십을 가장 강력하고 예기치 못한 교수 전략으로 인식했습니다. 한 참가자는이 전략을 다른 교수진과의 작업 에까지 확장하여 교사의 사회적 관행에 작지만 중요한 진출을했다고 설명했습니다.

Participants consistently identified student leadership as among the most powerful, and unanticipated, teaching strategy they learned and applied to other venues. One participant described extending this strategy to her work with other faculty members, thus making small but important inroads in the social practice of teaching:

프로세스 중심의 교수 개발 프로그램 또한 개인 성장을 촉진했습니다. 내러티브 역량을 개발함에있어, 참가자들은 자신과 다른 사람의 관점에서 자신을보고 여러 관점에 참여할 수있는 방법을 습득했습니다. 한 참가자는 자신의 변형 또는 "재충전"에 대해 설명했습니다.

Process-oriented faculty development program also fostered personal growth. In developing narrative competence, participants acquired the wherewithal to see themselves from their own and other’s perspectives, and to attend to multiple perspectives. One participant described his own transformation, or “recharging”

대인관계에 미친 영향

Impact on Interpersonal Relationships

개인적 성장은 관계의 변화에 ​​기여했습니다. 참가자들과 동료들과의 관계에서 그들이 더 비판적으로 성찰적인 교사가 될 수 있도록 self-scrutiny의 과정을 밟았다. 서술적 역량을 개발함으로써 참가자들은 다른 사람의 관점을보다 잘 수행 할 수 있었고 따라서 진정으로 "다른"것을 알 수있었습니다.

Personal growth of individuals contributed to transformation in relationships. It was in participants’ relationships with peers that they underwent a process of self-scrutiny that enabled them to become more critically reflective teachers. By developing narrative competence, participants were better able to take on another’s perspective, and thus truly know “another.”

이 관계 구축과 관점 잡기에 관해 주목할만한 세 가지가 있습니다. 

첫째, 참가자들은 관계로부터 지지받을 필요가 있다는 새로운 인식에 도달했습니다. 그들에게 가르침은 집단적이고 공동체적인 활동이었다.

Three things were remarkable about this relationship building and perspective taking. First, participants came to a new recognition of their need to be supported in relationships. For them, teaching was a collective and communal activity.

이 교수진 개발 프로그램에 대해 저에게 놀라는 점은 이런 종류의 장소가 보편적으로 필요하다는 것을 인식하는 것이 었습니다. 그러한 느낌을 받은 사람은 나 혼자가 아닙니다.

What surprised me about this faculty development program was to recognize that there’s a universal need for this kind of venue. I’mnot alone in that feeling.

둘째, 프로그램에서 구축된 관계는 '우연적'이라기보다는 참여자가 그들에게 중요한 가치와 관행에 대해 공개적으로 말할 수있는 "affiliation"였습니다.

Second, the relationships built in the program were not so much “opportunistic” but were “affiliations” wherein participants could speak openly about values and practices that mattered to them.

나는 내가 가깝게 느끼는 우리 부서 밖에서도 동료이 있다는 것이 좋습니다. 그건 내 다른 일에서 내 관점을 유지하는 데 도움이됩니다. 나는 여태껏 그러한 긍정적인 의도와 함께 프로젝트에 참여하는 가까운 동료 그룹을 갖지 못했습니다.

I like having colleagues outside of my own department that I feel very close to, affiliated with in terms of our goals and the teaching. That helps maintain my perspective in my other work. I haven’t had such a close group of colleagues working on a project together with such positive intentions.

셋째, 관계는 풍부한 connectedness을 반영합니다. 이 프로그램은 개별 굣수들이 일주일에 한 번씩 모인다거나 또는 몇 명의 특수한 교사의 집단에 관한 것이 아닙니다. 이 프로그램은 교수진이 결성한 inclusive community에 관한 것이며, 왜 그리고 어떻게 배웠는지에 깊은 관심을 갖는 커뮤니티에 관한 것이 었습니다.

Third, the relationships reflected a rich connectedness. The program was not about individual faculty members coming together once a week, or about a collection of a few special teachers. It was about the inclusive community these faculty members formed, a community that gave thoughtful attention to why, and how, they taught.

나는이 응집력있고, 똑똑하고, 훌륭하고, 돌보는 그룹에 참여하고 있으며, 의학 교육과 관련하여 많은 공통된 의제를 공유할 수 있었다. 이와 같은 삶의 측면을 갖는 것이 좋았으며, 정말 지지받는다는 느낌을 받았고 공동체 경험의 일부가 된다고 느꼈다.

I’m participating in this cohesive, smart, wonderful, caring, group, shared a lot of common agendas vis-`a-vis medical education and so it’s nice to have that aspect of life, feel really supported and be part of a community experience.

기관에 미친 영향

Impact on the Institution

대부분의 교수진은 교육 기관 내의 여러 교육적 역할을 담당하는 프로그램에 참여했습니다. 많은 사람들이 프로그램 시작 후 종종, 프로그램에 참여의 결과로 이후 추가적 역할을 맡았습니다. 2010 년 봄, 프로그램 평가의 일환으로, 참가자들은 교육 지도자 (교육 과정위원회의 구성원이나 코스의 디렉터), 진행중인 교육 프로젝트의 참가자 (새로운 코스 설계, 반사필 작성 도구), 또는 과목이나 임상실습의 교사(강사, 주치의)로 현재 역할을 나열하도록 요청 받았다. 교수진은 평균 6 개의 역할을 보였습니다 (SD = 0.95, 범위 = 3-11). 7 명의 교수는 8 개 이상의 역할을보고했지만 4 개는 5 개 미만의 역할을 수행했습니다.

Most faculty entered the program with multiple educational roles in the institution. Many assumed additional roles after the program begun, often as a result of their involvement in the program. In the spring of 2010, as part of program evaluation, participants were asked to list their current roles as 

• educational leaders (members of curriculum committees or directors of courses), 

• participants in ongoing educational projects (designing new courses, creating reflective writing tools), or 

• teachers in the courses or clerkships (lecturer, attending). 

On average, faculty reported six roles (SD=0.95; range=3–11). Seven faculty reported eight or more roles, whereas four had fewer than five roles.

이 수치에서 분명히 알 수 있듯이, 프로세스 중심 프로그램의 아이디어를 "주입"하는 것은 소수의 좋은 자리에 있거나 동기가 높은 교수진의 노력과 관련이 없습니다.

As evident in these numbers, the “infusion” of ideas from the process-oriented program was not tied to the efforts of a few well-positioned or highly motivated faculty members in a few venues.

• 25 명의 참가자 중 13 명이 P & S Questions를 작성하기 위해 협력했습니다.이 질문은 성찰적인 임상 진료의 개발을 안내하는 일련의 질문입니다.

• 13 of 25 participants collaborated to create the P&S Questions, a series of questions that serve as a guide to the development of reflective clinical practice.

• 25 명의 참가자 중 11 명이 Columbia P & S에 대한 학교 차원의 학습 목표를 세우는 데 중추적 인 역할을 담당했습니다.이 목표는이 특정 기관에서 의과 대학 학생이 된다는 것의 의미에 대한 생각의 틀입니다.

• 11 of 25 participants played a pivotal role in constructing newschool-wide learning objectives for Columbia P&S, a framework for thinking about what it means to be a medical students at this particular insitution.17

• 의료 학생 커리큘럼위원회에 25 명 중 7 명이 참석합니다.

• 7 of 25 participants serve on the medical student curriculumcommittees.

• 25 명의 참가자 중 5 명이 물리 진단 및 의료 인터뷰의 기술과 과학 사이의 사일로를 무너 뜨리기 위해 행정부와 협력했습니다.

• 5 of 25 participants worked together with administration to break down the silo between the skills and science of physical diagnosis and art of medical interviewing.

• 25 명의 참가자 중 5 명은 공식 커리큘럼에서 성찰적 글쓰기를 포함시키고 합법화하기위한 노력에 필수적입니다.

• 5 of 25 participants have been are integral to efforts to including and legitimizing reflective writing in the formal curriculum.

• 25 명의 참가자 중 13 명이 학생의 건강 및 복지, 지역 사회 소아과 및 전문 직업 교육과 같은 전통적인 의학 교육의 벽을 넘어서는 의학 분야에 적극적으로 참여하고 있습니다.

• 13 of 25 participants are actively engaged in aspects of medicine beyond the traditional walls of medical education, for example, student health and wellness, community pediatrics, and interprofessional education.

• 임상 커리큘럼에서 공식 역할이 다양하지만, 각 참가자는 임상의로서 의학자 및 기타 연수생과의 interface에서의 기회를 갖는다.

• Although their formal role in the clinical curriculum varies, each participant, by virtue of being a practicing clinician, has the opportunity to interface with medical students and other trainees.

결론

CONCLUSION

변형 학습(Transformational learning)은 광범위하게 정의되며, 마음의 습관과 관점에 변화를 가져 오는 과정입니다. 변형 학습은 개인 차원에서 시작되지만 집단 학습으로 나아가는 연속체를 따라 진행됩니다. 변형 학습의 단계 또는 경기장에는 초대, 참여, 관여, 헌신, 협력 및 학습 공동체가 포함됩니다. '사회적 실천으로서의 가르침'의 개념은 변형 학습에 기반하며, 교육자 그룹이 지역 및 기관 차원에서 교육 관행을 규제하는 규범을 어떻게 변화시키는 지에 초점을 둔다.

Transformational learning is, broadly defined, a process of effecting change in one’s habits of mind and points of view.22 Although transformational learning is initiated at an individual level, it progresses along a continuum toward collective learning. Stages, or arenas, of transformative learning include invitation, participation, engagement, commitment, collaboration, and learning community.23 The concept of teaching as social practice builds on transformational learning and sheds light on how groups of educators change the norms that regulate the practice of teaching at a local and institutional level.24

이 사례 연구에서 네러티브 의학이 지지하는 guided reflection 과정은 개개인의 수준에서 변화와 긍정적 인 변화를 조장하고 차례로 관계로 스며 들어 교육 기관 전반에 퍼지기 시작했습니다. 과정 지향적 교수개발 프로그램의 참가자들 간의 관계 웹은 기관의 규범 만들고 재형성 할 수 있는 강력한 기회를 창출했다(예를 들어 학교 전체의 학습 목표). 교수법은 "하향식"처방 때문이 아니라, 교수법을 규율하는 규범을 바꾸기 위해 무엇이 중요한지에 대한 집단적 "상향식"이해 때문에 변화하기 시작했습니다.

In this case study, the process of guided reflection as espoused by narrative medicine fostered transformation and positive change at an individual level, which in turn seeped into relationships, and then started to spread throughout the institution. The web of relationships among participants in the process oriented faculty development program created the opportunity, and the means, to address and reshape powerful norms of institutions, as for example, expressed in the school-wide learning objectives. Teaching practices started to change, not because of a “top-down” prescription, but because the collective, “bottom up” understanding of what matters started to change the norms that regulate teaching practices.

우리의 연구 결과는 의학 교육의 실행에 함의가 있다. 커리큘럼 개편 기간 동안, 특히 변화를 계획하거나 실행하는 데 직접적으로 책임이없는 교수들이 갖는 경향은 "생존"하는 것일 수 있습니다. 그러나 기관에 영향을 미칠수 있는 가능성은 (규범이 유동적이며 새로운 아이디어가보다 쉽게 ​​받아 들여지는) 교과 과정 변화의 시기에 더 클 수 있습니다. 따라서 관계와 변화를 촉진하는 프로세스에 중점을 둔 프로그램은 개혁에 영향을 미치고 성공을 보장하기위한 방향과 추진력을 형성하는 강력한 촉매가 될 수 있습니다. 유사한 교수 역할을 수행하는 교수들을 대상으로 맥락과 직접적으로 연결되는 교수개발 프로그램은 변형 학습을 촉진하는데 이점이 있을 수 있으며, 이는 공통의 관심사를 갖는 공동체 형성과 가르침을 regulate하는 규범에 영향을 줄 수 있는 가능성 크기 때문이다. 

Our findings have implications for the practice of medical education. The tendency for faculty members may be to “just survive” during periods of curriculum reform, especially those not directly responsible for planning or implementing the changes. However, the potential to impact an institution may be greater in times of curricular change, when norms are in flux and new ideas accepted more readily. Consequently, a program focused on processes that promote relationships and transformation has the potential to become powerful catalysts for influencing the reforms and shaping the direction and momentum to ensure their success. Faculty development programs that target groups of faculty members with a similar teaching role and a direct link to context, may have an advantage in promoting transformational learning, because they may be more likely to form a community with shared interests and the capacity to influence norms that regulate teaching.24,25

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Teach Learn Med. 2012;24(3):242-7. doi: 10.1080/10401334.2012.692275.

Faculty development as transformation: lessons learned from a process-oriented program.

Balmer DF1, Richards BF.

Author information

1

Center for Education Research and Evaluation, Columbia University Medical Center, New York, New York, USA. db2595@columbia.edu

Abstract

BACKGROUND:

Faculty development programs tend to be oriented around content, yet many have produced positive outcomes unrelated to the content. We describe a faculty development program that utilized the processes of shared reading and guided reflection espoused by narrative medicine.

DESCRIPTION:

To date, 25 preceptors in the Foundations of Clinical Medicine course have participated. The program consists of weekly seminars in which participants actively engage with text as a basis for conversation around content as well as teaching strategies.

EVALUATION:

Using qualitative methods, we examined notes from seminars, in-depth interviews, and review of curricular documents; we used conceptual frameworks from education as interpretive lenses. Participants recognized both personal growth and transformation in relationships with each other, which created the opportunity, and the means, to address and reshape norms and teaching practices at the institution.

CONCLUSIONS:

Process-oriented faculty development programs may foster growth of individuals, contribute to transformation in relationships, and ultimately influence teaching practices.

PMID:

 

22775789

 

PMCID:

 

PMC3895942

 

DOI:

 

10.1080/10401334.2012.692275