보건의료인력 교육과 보건의료를 연결시키는 모델 : FAIMER 국제 교수개발

A model for linkage between health professions education and health: FAIMER international faculty development initiatives

WILLIAM BURDICK1, ELIANA AMARAL2, HENRY CAMPOS3 & JOHN NORCINI1

1FAIMER, USA, 2State University of Campinas/UNICAMP, Brazil, 3Universidade Federal do Ceara´ , Brazil

도입

Introduction

교수개발과 지역사회 보건증진을 연결시키는 것이 보건의료인력교육자와 연구자 모두에게 중요하다. 개개인 차원, 조직 차원에서 보건의료인력 교육을 통한 보건증진이 가능할 수 있겠지만, 이런 것을 서로 연결시켜주는 문헌은 제한적이다. 한편으로는 건강결정인자로 교육 외에도 영양, 물 안전, 위생과 같은 더 강력한 요인들이 있기 때문일 것이다. 

Linking faculty development to improvement of community health is of particular interest to health professions educators and researchers (Burdick et al. 2007; Haan et al. 2008). While individuals and institutions engaged in health professions education have the potential to improve health (Boelen 1999; Frenk et al. 2010), limited literature connects capacity building in education with improvements in health (Burdick et al. 2007). In part, this is because there are many stronger determinants of health, such as nutrition, water safety, and sanitation (Wilkinson & Marmot 2003), than the education of doctors and nurses. Understanding the mechanism by which faculty development may promote development of socially accountable institutions and improve health can be useful for improving this connection and evaluating program effectiveness. In this article, we present a testable model for the link between faculty development and improvement in health, and offer an example of that model.

개개인 차원의 역량 강화를 위해서는 의미있는 학습 경험을 통해 새로운 지식을 얻고, 새로운 분야에 접근할 수 있는 기회가 있어야 한다. 시스템 차원의 역량 강화는 개개인의 역량 강화를 넘어서는 것이며, 이들간의 네트워크를 강화하는 것이 중요하다. 이를 위해서는 다음과 같은 것이 필요하다.

Individual capacity building requires participation in a meaningful learning experience, opportunity to apply new knowledge, and opportunities for advancement in the new field (Nchinda 2002). System capacity building goes beyond development of the individual to strengthening collaborating organizations and the web that connects them. It requires...

• strengthening domain knowledge and communication skills of members of the system, 
• plus interactive, or relational, skills such as creating a shared vision, 
• organizational capacity such as leadership, and management, and 
• programmatic capacity such as the ability to develop projects aligned with community needs (Foster-Fishman et al. 2001). 

개개인의 역량을 강화하는 데 있어서 '프로젝트'를 하는 것은 중요한데, 이는 새롭게 배운 리더십/관리 기술 등을 실제로 적용시킬 수 있는 기회이기 때문이다.

Projects are an important part of the individual capacity model since they provide the opportunity for authentic application of new skills, particularly leadership and management skills. (Gusic et al. 2010; Burdick et al. (in press)).

사회적 네트워크를 개발하고 활용하는 것은 시스템 차원의 역량 강화에 중요한 것이다. 또한 교육 기관의 사회적 책무를 강화하는 쪽으로 이끄는 역할을 하는데 중요하다. community of health professions educator를 만든다는 중간단계 목표는 장기적 목표인 'field leadership'을 강화하는데 필요하다. 협동, 지식확산과 같은 Field leadership은 보건의료인력교육 영역을 더욱 강화할 것이다. 교육 분야의 다양한 영역이 이에 기여할 수 있다.

Development and use of social networks is a key element of system capacity building (Culbertson 1981; Bolam et al. 2005; Cross et al. 2006; Moses et al. 2009) and represents an important link in the mechanism leading to enhanced social accountability of education institutions. This intermediate goal of developing a community of health professions educators is a precursor to achieving the longer term goal of building “field leadership” (Mouradian & Huebner 2007). Field leadership skills like collaboration and knowledge diffusion strengthen the health professions education field. A dynamic field of education then can contribute to improvement of the health of communities through...

• robust peer review, 
• high quality research to ascertain health needs, 
• implementation of effective learning and assessment methods, 
• advocacy for academic promotion criteria attuned to scholarship in education and community health, and 
• promotion of rigorous accreditation systems that consider social accountability (Boelen 2004).

FAIMER Institute는 미국에 자리를 잡고 있으며, 전 세계에서 연수생을 받는다. 5개의 FAIMER Regional Institute가 있어서, 세 개는 인도에 있고, 한 개는 남아프리카게, 다른 하나는 브라질에 있다. US기반 프로그램은 2001년에 시작하였고, 나머지는 2005년에서 2008년 사이에 시작하였다.

The FAIMER Institute is based in the United States, with an international distribution of Fellows. There are five FAIMER Regional Institutes: three based in India, serving mainly Indian faculty with a small number from surrounding countries; one in South Africa, serving southern Africa; and one in Brazil, conducted in Portuguese and serving Brazilian faculty. The US-based program was started in 2001; the others in 2005–2008 (Burdick et al. 2006, 2010).

FAIMER 교육 프로그램은 여러 국가를 아우르는 접근법을 활용한다는 점이 독특하며, 개발도상국의 다양한 보건의료인력 교육을 강조하고 있다. 또한 리더십을 키우고, 보건의료인력교육자의 커뮤니티를 만들기 위해 노력하고 있다. 이러한 노력은, 대부분의 국제적 보건의료에 대한 자원투자가 질병 예방과 치료 프로그램에 집중되어 있는 것에 상보적인 것이라 할 수 있으며, 보건시스템의 의료인력 양성에 힘을 쏟아야 한다는 여러 저자들의 의견과도 부합하는 것이다.

The FAIMER education 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).

의과대학과 다른 보건의료인력을 양성하는 대학이 갖는 사회적 책무성은 점차 더 커지고 있으며, 사회적 요구에 따라서 교육 시스템을 개선시킬 필요가 있다. 

There is greater recognition of the social responsibility of medical schools and other health professions schools to re-orient and improve their education systems to more directly address societal needs (Boelen & Woollard 2010). We describe a model for faculty development in health professions education with individual and system capacity building that has the potential to lead to improvements in health, and provide a case study of the Brazil FAIMER Regional Institute (FRI) in its application.

모델

The model

우리의 교수개발 모델의 핵심 목표는 다음과 같다.

In our model of faculty development, key goals are ....

(1) enhanced knowledge of education methods, 

(2) strengthened leadership and management skills, and 

(3) creation of a network of educators, leading to a strengthened field of health professions education. 

An additional element, demonstrated by the example of the Brazil FRI, is the engagement of the public sector (Figure 1).

여러 주제별 워크숍을 통한 교육방법에 대한 지식과 리더십 스킬은 각 연수생 본국의 조직에서 역량 강화를 위한 혁신 프로젝트에 적용하도록 했다. 개인과 조직의 역량을 강화하기 위해서는 개개인의 네트워크가 필요하고, 조직간 정보를 공유하고 협력하는 것이 필요하다. 이 네트워크의 중요한 특징은...

Knowledge of education methods, developed through topical workshops, and leadership skills applied to the development of an education innovation project, lead to individual and institutional capacity building. Leveraging individual and institutional capacity building requires a network of individuals and institutions sharing information and collaborating. An important and codified manifestation of this network is...

a strong field of health professions education, with robust peer review of new knowledge, collaborative research, shared advocacy, and mentorship and support for individuals. 

In addition to the people who form the network,...

a field has its own language, values, and norms, projected in the form of a membership organization, 

periodic plenary meetings, and 

often a standardized tool for communication, such as a journal and website (Fraser & Greenhalgh 2001; Mouradian & Huebner 2007).

공공부문의 협조 

Public sector engagement

Engagement of the public sector is a critical element in the success of health improvement initiatives (Levine 2007). The capacity to scale up these interventions has many enabling features, but strengthening the health system is one in which government can play a key role (Mangham & Hanson 2010). Aligning faculty development efforts with public initiatives is therefore an important concept in leveraging improvements in education.

An important element of our approach has been to try to involve relevant government agencies. In India, the Medical Council of India has coordinated faculty development plans by building upon existing FRI and using a database of FAIMER Fellows in the country. In Brazil, (Appendix) the Secretariat of Labor Management and Health Education (SGTES – Secretaria de Gestão do Ensino e Trabalho e Educação em Saúde) participated in the initial planning meetings for the Brazil FRI, and provides the majority of the funding.

사회적 네트워크 구축

Social network development

The design of FAIMER education programs is highly interactive to enhance learning (Michael 2006), and 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 dialog 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 online 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).

Our model proposes that an active community of educators can lead to several outcomes that can then lead to a field of health professions education with greater social accountability. The potential outcomes of a network of educators include a robust system for peer review and dissemination of new discoveries, personal and professional mentoring, collaboration, and policy advocacy for improved accreditation systems. The resulting field could be characterized by educators responsive to local needs through aligned curricula, health worker training, and community education. Other indicators could be a path for promotion for work in education, schools with high-quality research, and application of new knowledge and skills to education and healthcare practice.

FAIMER Fellows from other programs reported that the impact of their project on their institution was significant. 

• More than half of the 49 responding Fellows from the Philadelphia FAIMER Institute identified changes related to increased quality of teaching and collaboration in education when asked to identify changes in their schools or communities resulting from their projects. 
• In addition, 41% responded that there is more faculty interest in research in education. Other frequent changes cited by one-third or more of respondents included improvements in assessment and student performance. 
• One-third noted that the curriculum is better aligned with community health needs. 
• By contrast, only one-tenth to one-fifth reported increases in knowledge in rural healthcare, working in community settings, training of community health workers or community service among students. 
• Only 4% responded that their project resulted in better health (Burdick et al. (in press)).

리더십과 관리기술 향상

Enhanced leadership and management skills

Leadership skills are developed through conceptual discussions that are then applied to Fellows’ projects. Myers–Briggs Temperament Index (MBTI) is used as a way for Fellows to better understand their natural tendencies in professional interactions and leadership situations. A group exercise of “crossing the river” tangibly demonstrates leadership and group decision-making dynamics. Conflict management and change management concepts are presented using authentic role plays gleaned from previous Fellows’ experiences. A strong emphasis is placed on “appreciative leadership” values, and involvement of stakeholders.

Evidence from the first 5 years of the Philadelphia FAIMER Institute indicates that ..

• our education intervention is achieving its short-term goal of enhanced leadership and management skills. 
• When asked in an interview to describe if and how they had applied concepts and skills learned at the FAIMER Institute to their work, 98% of the Fellows mentioned at least one leadership skill or method, making this the most frequently mentioned category of skill used. 
• Within the leadership/management domain, the specific skills or tools mentioned included appreciative inquiry and/or appreciative leadership by 49%, conflict management and team building/group process each by 40%, use of the Myers–Briggs Type Indicator for understanding one's own leadership style and Gantt charting each by 38%, and project management tools in general by 29% (Burdick et al. 2010).

교육과 평가 능력 향상

Improved teaching and assessment

Workshops on large group, small group, and individual teaching discuss basic concepts of adult learning, and then ask Fellows to apply them to examples from their own teaching experiences. Additional sessions on student assessment, performance assessment, and standard setting reinforce the connection between teaching and assessment.

In a study from the Philadelphia FAIMER Institute, there were significant increases between Fellows’ reported “before and after” data about perceptions of the importance of, and their own competence in, all eight curriculum theme areas in Session 1 and all five curriculum theme areas in Session 3. In all cases, the effect sizes ranged between 1.3 and 2.7 (p < 0.0001) (Burdick et al. 2010).

사회적 네트워크 구축

Social network development

The program begins with a series of structured exercises intended to create bonds between participants. Fellows interview several others, asking for one answer each time to inquire about their profession role, a personal aim for the program, and one personal fact. They then introduce each other to the group. After MBTI assessment, and “crossing the river,” they debrief with observers on the interpersonal and group dynamics that led to successes and frustrations in completing the task. In addition to extensive interaction during the daytime portion of the residential component, Fellows meet in the evening several times during the program in “learning circles,” in which the social bonds are strengthened through shared personal stories (Baldwin 1998; Danzig 1999; Wheatley 2002). During the online intersession period, Fellows interact with each other and the faculty advisors through e-learning modules, periodic conference calls with a mentoring group, and social exchanges on a Listserv. When Fellows return for the second residential session, a structured process is used to introduce them to the first-year Fellows.

Discussion

The FAIMER faculty development model of building a social network, strengthening leadership and management skills through an authentic project, enhancing knowledge of education methods, and engagement of the public sector has potential to change education in ways that lead to improved health. The Brazil FRI represents an example of how that model is implemented.

The model is a manifestation of a theory of change, or program theory, and as such can provide a framework for evaluation (Sridharan & Nakaima 2011). Demonstrating gains in health as a result in education improvement is difficult due to the long lead time and myriad of other social variables. Short-term and intermediate outcomes in the model, however, may be just as important to identify. Evidence for this model suggests that an effective learning environment has been created, with significant gains in self-reported knowledge and skill. Improved teaching and assessment methods, as well as the skills to diffuse this knowledge to others through the network of educators, should lead to stronger health professions units in institutions. This may, in turn, lead to more robust quality improvement systems such as feedback collection, and curriculum evaluation, and has the potential to improve education throughout the institution.

Evidence from the Brazil FRI and other FAIMER Institutes also suggests that locally authentic education innovation projects are being completed, and that a portion of them have potential to show direct effects on health. Some projects may directly lead to improvements in health when they include student or faculty led patient education initiatives, health surveillance projects, or community-based education interventions that increase access to care. Achievement of short-term outcomes may provide necessary (but not sufficient) support for validity of the model.

Intermediate outcomes provide further evidence. Reports from Fellows suggest that a strong, meaningful network of educators is being created locally and globally. It is used by Fellows for diffusion of knowledge and resources, and as a source of professional and personal support. In addition to the volume of intra-network communication, the growth and development of regional organizations dedicated to health professions education is an indicator for the successful growth of health professions networks, one of the central intermediate outcomes of the model (Sood 2008).

FAIMER education programs address a demand for pro-active engagement of academic institutions in building sustainable health systems that arises from several factors. 

• First, academic institutions play a vital role in production and maintenance of the skilled workforce expected to meet the needs of the population (Boelen 2000; WHO 2006). 
• Second, global focus on strengthening health systems, efforts to reinforce policies supporting primary healthcare, and increasing demand for universal coverage of health systems highlight the need to develop effective leadership to promote successful and sustainable innovation in academic institutions (WHO 2008, 2010; Reich & Takemi 2009). 
• Finally, “third generation” education reforms that use transformative learning and leadership development to produce enlightened change agents require formidable innovations in the education pipeline (Frenk et al. 2010). Individual faculty and the education systems in which they work must be equipped through high-quality faculty development to be able to initiate and sustain these innovations.

As more faculty are oriented to the social mission, the culture of the school is changed (Langdon & Wiik 2010), with values, norms, language, and practices that create a learning environment that emphasizes the community as well as the individual patient. Explicit development of a theory of change for how their innovation project may result in a long-term outcome of improved community health is one way to help align faculty and their school with the social mission of health professions education. The resulting socially oriented learning environment may help create a new professional, highly qualified, aware, and knowledgeable of the social determinants of health, accepting their role as health advocate, and helping to reduce the gap between health needs and the care provided.

Our model of faculty development, with emphasis on active learning, leadership, use of projects, social network development, and engagement with the public sector, may provide a testable framework for connecting improvement in health professions education with improvement in health.

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Med Teach. 2011;33(8):632-7. doi: 10.3109/0142159X.2011.590250.

A model for linkage between health professions education and health: FAIMER international faculty developmentinitiatives.

Burdick W1, Amaral E, Campos H, Norcini J.

Author information

Abstract

Linking faculty development to improvement of community health is of particular interest to health professions educators and researchers. While individuals and institutions engaged in health professions education have the potential to improve health, limited literature connects capacity building in education with improvements in health. Understanding the mechanism by which faculty development may promote development of socially accountable institutions and improve health can be useful for improving this connection and evaluating program effectiveness.

PMID:

 

21774649

 

[PubMed - indexed for MEDLINE]