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.
Abstract
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. 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 byfaculty developers to systematically plan, implement and evaluate their staff development programmes. This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.
- PMID:
- 18677659
- [PubMed - indexed for MEDLINE]