Faculty development through international exchange: The IMEX initiative
OLLE TEN CATE1, KAREN MANN2, PETER MCCRORIE3, SARI PONZER4, LINDA SNELL5 & YVONNE STEINERT5
1University Medical Center Utrecht, the Netherlands, 2Dalhousie University, Canada, 3University of London, UK, 4Karolinska Institutet, Sweden, and 5McGill University, Canada
배경
Introduction
교수개발이란 academic personnel에게 교육, 연구, 행정 업무에 필요한 기술을 지원하는 다양한 활동을 말한다. 대부분의 교수개발은 교수법에 집중되어 있다. 의과대학의 교수들이 다만 그 분야의 전문지식을 가지고 있고, '가르침을 받은'적이 있기 때문에 가르칠 수 있는 능력이 있을 것이라고 '추측'하는 것 뿐이지, 제대로 교수법에 대한 교육을 받은 적은 없기 때문에 이는 그다지 놀라운 일은 아니다. 지난 30년간 의학교육은 수많은 계기를 통해 진화해왔고, 그 중에는 보건의료 양상의 변화, 새로운 기술의 영향, 교육이론의 발달 등이 잇다. 그 결과, 교수들은 자신들이 배웠던 방식으로 행동하지 않게 되었다. 많은 의과대학에서는 교수법 훈련 프로그램을 제공할 뿐만 아니라 '요건화'하고 있는 경우도 있다. 지난 20년간 의학교육분야에서 최소 하나 이상의 새로운 책이 출판되고 있으며, 컨퍼런스, 논문, 학회지 등 역시 다른 여러 영역을 능가하는 속도로 빠르게 성장하고 있다.
Faculty development refers to the range of activities designed to support academic personnel in developing the skills necessary for conducting their teaching, research or administrative tasks (Steinert et al. 2006). Most initiatives focus on faculty development in teaching (Leslie et al. 2013). This is not surprising, as teachers in medical schools traditionally were not trained to teach but were assumed to have that ability because of their content knowledge and their own experience of being taught. Medical education has evolved in the past 30 years for a number of reasons, including changes in the pattern of healthcare, the impact of new technologies and advances in educational theory. As a result, teachers cannot just act like the teachers by whom they were taught. Many medical schools now offer or even require teachers to take training in teaching skills. In the past two decades, at least one new book has appeared each year on teaching in medical education, and conferences, journals and publications on medical education have shown a growth rate that exceeds many other domains (Lee et al. 2013).
교수개발 프로그램은 다양한 종류가 있을 수 있다. 또한 많은 의학교육학술지, 심포지엄, 컨퍼런스, 저널클럽 등 역시 새로운 insight와 methodology를 경험할 수 있는 기회를 제공하고 있다. 초창기에는 교수법에 대한 교수개발이 '가르치는 것'그 자체에 집중되었으나, 점차 그 목표가 넓어져서 이제는 교육과정 개발, 변화관리, 교육분야의 연구에까지 확장되었다.
The range of available faculty development initiatives includes one-on-one training consultations, local, national and international workshops and courses, certificate programs and programs leading to an academic degree (Steinert 2010; Wilkerson & Doyle 2011). In parallel, the many medical education journals, symposia, conferences and journal clubs offer a plethora of opportunities to become acquainted with new insights and methodologies in teaching and learning. While initially faculty development in teaching focused on the practice of teaching, the objectives have expanded to include wider educational functions such as curriculum development, change management and educational research (Bligh 2005; Molenaar et al. 2009; Jaarsma et al. 2013).
다양한 세팅, 문화, 대학과 접촉하면서 교수개발의 관점을 확장되었고, 한 곳에서 다른 곳으로 자리를 옮긴 교수는 스스로의 관점을 더 넓힐 수 있는 기회를 갖게 된다. 그러나 이러한 경험은 한 국가에서는 두 곳, 또는 세 곳을 넘지 않는다. 생의학 연구에 있어서 국제적 협력은 매우 권장되고 있는데, 교육 프로그램과 교수개발의 질을 높이기 위해서 국제적 협력을 못할 것도 없지 않을까? 의학교육연구의 국제적 협력은 여러 문헌에서 점차 늘어나고 있으나, 혁신과 개발에 대한 교류는 아직 그렇게 많지 않다.
The type of experiences that widen perspectives in the field should ideally involve acquaintance with different settings, cultures and schools. Faculty members who have moved from one location to a different one have the benefit of broadening their perspective, but these experiences are usually limited to two or sometimes three places within one country. International collaboration is recommended for biomedical research (Radda 2013), so why should international collaboration not similarly enhance the quality of education programs and faculty development? While international collaboration in medical education research is seen in the growing literature (Rotgans 2012), international collaboration and exchange on innovation and development is less visible.
2006년, 의학교육 연구와 개발에 적극적으로 기여하고 있는 다섯 개의 의과대학이 그들의 교수들에게 국제적 경험을 통해 더 많은 발전의 기회를 주기 위해서 공식적 협력을 시작하였다. 개개인의 교수들은 서로 다른 국가로 옮겨 다니며, 여러 국가에서 취직을 하여 international medical educator가 될 수도 있고, Harvard Macy Program이나 FAIMER program과 같이 international course들도 있지만, 우리가 아는 한 서로 다른 기관에서 교육활동이나 교수 경험 기회를 쌓으면서 international experience를 하는 프로그램은 없다.
In 2006, five medical schools, well known for their active contributions to medical education research and development, decided to initiate a formalized collaboration to broaden the opportunities for development of their own faculty members with a significant international experience. While individual faculty members may cross borders and take up employment in a different country, thereby becoming international medical educators (McLean 2013), and international courses such as the Harvard Macy program and the FAIMER program recruit participants from across the globe (Armstrong et al. 2003; Burdick et al 2006), we know of no programs that specifically focus on the acquisition of international experiences at a variety of locations with opportunities to participate in educational activities or teach at different institutions.
방법
Method
2006년, Dalhousie University, Karolinska Institutet, McGill University, St George’s University of London and University Medical Center Utrecht는 IMEX initiative를 설립하였다.(International Medical Educators Exchange)
In 2006, Dalhousie University, Karolinska Institutet, McGill University, St George’s University of London and University Medical Center Utrecht, decided to establish the International Medical Educators Exchange (IMEX) initiative.
프로그램의 목적 : 캐나다와 유럽의 여러 의과대학에서 직접 교육에 참여함으로서 높은 수준의 교수개발을 달성하는 것.
The aim of the program is to stimulate high-level faculty development by providing an international orientation beyond the attendance at conferences and creating a network of global colleagues to broaden the understanding of medical education on a more global level. In particular, we aim to...
provide participants with a concrete experience in medical education at a number of medical schools in Canada and Europe and to
generate exchange of ideas, discussions and
seeds for collaboration.
We hope the program will have an impact on personal careers and institutional development.
프로그램 규모 및 대상자
Every six months, a site visit of one week at one of the participating schools is offered to a group of six to 13 faculty, made up of one to three mostly mid-career scholars from each of the five schools, who have signed up for multiple visits over a period of two to four years. The IMEX website (www.imexchange.eu) shows a roster of site visits. We specifically target senior clinical and non-clinical teachers and curriculum developers at each of the five institutions, with an annual enrollment of one to three faculty(ies) per institution per year into the IMEX program.
참가자 선발
All interested faculty members apply formally with a CV, a personal application letter, a letter of recommendation from their Head of the Department and a description of topics of interest they would like to explore during the week. The IMEX Board, with representatives of all five schools, approves each application. The successful applicant is then called an IMEX Scholar. Scholars must enroll for at least three site visits.
비용
The fee for a site visit includes hotel accommodation, a social program, catering during the day, incidental expenditures and all scholarly program activities. One of the five institutions manages the central organization (financial handling, processing of applications, maintaining a website and preparing for the annual Board meetings).
프로그램 구성
A week’s IMEX program can vary somewhat, depending on the location, the special interests or activities of the institution, and the desired pursuits of the participants. However, at a minimum, it includes the following:
- an explanation of the local medical curriculum (undergraduate and/or postgraduate) and the local medical education system
- presentations on selected topics of interest by local experts
- observation of local educational activities in practice
- active observation of, or participation in, teaching
- one-on-one meetings of IMEX scholars with local colleagues who share similar disciplines or interests
- group discussions with reflections on the program of the day, exchange of experiences and presentations of personal projects to the IMEX group.
- a social event with dinner, which, among other things, serves as a team building activity
In addition, inter-scholar collaboration between IMEX site visits is encouraged but is not mandatory. In many cases IMEX scholars stay in touch and may collaborate between visits.
평가
Every site visit concludes with a short oral and written evaluation of the week, and after three site visits, each IMEX scholar is sent a more global evaluation and reflective electronic survey, including questions on the impact of the IMEX experience on personal competence as a teacher and educator, daily work, career, international collaborations, the scholar’s own institution and participant satisfaction with the general program format, with space to expand their answers. This report summarizes the results of the general IMEX survey, conducted in 2012 and 2013, including all scholars who had participated in the program to date (August 2013).
결과
Results
From the autumn of 2006 to the summer of 2013, IMEX organized 14 site visits (three in Utrecht, three in Montreal, three in London, three in Halifax and two in Stockholm). One Stockholm visit did not take place due to a late cancellation of some scholars for personal reasons and consequently the agreed minimum number of participants (6) was not reached. In that same period, 31 scholars had participated in at least one site visit, for a total of 121 IMEX individual visits; five scholars visited fewer than three sites and have not yet finished the program, nine went to three sites, 12 went to four sites and eight went to five sites. The group size varied from 6 (the very first week in Utrecht) to 13 (Utrecht, spring 2012).
All 29 who had completed at least three site visits were sent the anonymous overall IMEX survey. We received 22 responses (76%), six of whom had not checked the box to allow their data to be used in a publication. This report is therefore based on 16 responses (55%).
Impact of IMEX
Table 1 shows the respondents’ answers regarding the impact of IMEX on their perceptions of their career and competence. IMEX was viewed as having an impact on personal competence, career and international orientation and collaboration; less impact was reported on daily work or the respondent’s institution.
A typical comment regarding the impact on personal competence was:
“IMEX has definitely influenced my personal competence, but it is not so easy to pinpoint it on specific knowledge or skills. It broadens your scope, makes you realize differences and similarities between (educational) cultures, realize that your own (local, national) problems and frustrations are sometimes more general and it [teaches] you a lot about other solutions and approaches. It also gives you an opportunity to learn about aspects of medical education in which you are less involved in daily practice.”
Impact on daily work was explained with comments such as the following:
“I can now speak to colleagues and other faculty with some authority about values and solutions in other countries. This is not limited to medical education but extends to health care delivery.” and “I now incorporate ideas and issues I have learned internationally into my daily work as a teacher and academic. IMEX was a very important trigger for the research I have newly embarked on which was a direct result of my first IMEX visit to Utrecht.”
The impact of the IMEX program on career is less apparent. We have noticed in our institutions that IMEX alumni often take major steps in an education career, such as accepting responsibilities as program director of undergraduate or postgraduate education, but a direct causal link with IMEX, if present, cannot easily be established. Participant comments included:
“Somewhat useful, but limited in a formal way. However, a distinguished part of my pedagogic CV” and “I have written about my IMEX experience as part of my application for promotion to […] and it has been an important element of this application.” One respondent mentioned, “Since my involvement in the IMEX program, I have been selected as the Associate Dean for CME at [my] University. I bring a broader perspective than many of my peers to the table in discussions of issues in medical education and to my work in CME”.
International collaborations have happened to variable degrees; it does, however, seem to occur for some and it appears that there are external factors that influence the degree to which these collaborations can develop.
“We all seem to have very busy careers at home and trans-border academic work has not happened to a substantial extent yet” and “It has been given me a new network”; however, one scholar mentioned, “I now have a regular working relationship with colleagues at X medical school and was invited to present work at a professional day they were running for staff”.
IMEX’s impact on the home institution of the scholars was explored in terms of how a hosted IMEX visit affected a much larger part of the local institutional community.
“When you are the host for a IMEX site visit you influence and engage a lot of people around you” and “As a participant institution of IMEX we have benefited from two IMEX visits”.
In a more general sense,
“At X, all 5 participants have so far had a substantial impact on the faculty, as all of us still are in more or less leading positions on the medical programme”.
IMEX scholars’ views of the program features of IMEX
Table 2 shows how almost all defining features of IMEX were valued as very important and successful.
Taking an active part in local educational activities scored lowest of all features. It was not always possible to engage scholars in local teaching, which may have caused this view among the participants, but it may not be an essential outcome of the course.
“While exposure to education is important, I feel the real value is in working with interested colleagues. Learning is after all a contextual and social activity.”
Observing education may be sufficient. “Just the possibility to see and hear teaching outside our own “bubble” was eye-opening to all the possibilities and knowledge/experience that is out there” even if the observed education is not perfect.
“It does not have to be the successful educational sessions to observe to make them valuable, it is equally important to observe things that [give] you ideas about how to improve” and “Being in a different country changed the way I thought about my own subject and ‘made it strange' - something that is very difficult to achieve in day-to-day life. It also highlighted to me the strengths of my own curriculum which are sometimes difficult to see when you are so close to them.”
Leaving one’s own institution to have a week of protected time to reflect on education with similarly interested colleagues was highly valued.
“The one week modules are a guarantee for putting everyday work aside” … “The most important aspect of IMEX was to allow time for reflection. It allowed [me] as well to interact with like-minded colleagues and to make friends” … “Observing education and talking to experts one-on-one are the two most important things with IMEX”.
Suggested improvements and overall view
Suggestions for improvement of the program included an addition of a US medical school to the consortium, better coordination of follow-up activities, and better organization of responsibilities for the visit at the local IMEX site, avoiding too much of an organizational burden on local IMEX participants, as at many sites, domestic IMEX scholars take responsibilities in the organization of the week.
Most participants would recommend IMEX to colleagues:
“The IMEX experience is amazing. I would recommend it to any academic looking to expand their horizons, particularly in mid-career. The space it gave me to reflect and think about wider issues was invaluable and the unexpected spin-off was that it sparked new research ideas. A thousand thanks for this IMEX”.
논의
Discussion
Based on the past seven years of IMEX implementation and the evaluation by scholars who have completed three site visits, we believe that IMEX has lived up to its expectations. The objectives intended by the founders of the program appear to have been attained. It has been possible to sustain the organization over time and IMEX scholars are almost invariably satisfied with most site visits and most features of IMEX. We believe that we have contributed to the quality of the educational culture in the five institutions, even though we have not rigorously measured this, nor could we easily establish a causal relationship with IMEX; a more rigorous approach is needed (Armstrong & Barsion 2006). We have no doubt, however, that IMEX fits very well into a medical educator’s scholarly career development (Fincher et al. 2000; Simpson et al. 2007).
참가자 반응
Participants spoke consistently...
of personal development,
of broader views of medical education in other contexts, and
of more balanced views of their own institutions.
They also described the value of meeting and developing relationships with new international colleagues, thus enlarging their personal networks. Increasingly, the faculty development literature reports personal and professional development as an outcome of longitudinal faculty development experiences (Armstrong & Barsion 2006; Branch et al. 2009). This seems to be perceived by the IMEX scholar after some time has elapsed since their participation, suggesting that the personal development benefits reported may continue into the future.
Our initiative may also serve as an example for other schools. We have discussed the possibility of expanding IMEX to include more schools, but the inevitable consequence would be that groups would be larger or would have to split, and the current formula of having groups of scholars meet again at a next site would not be sustainable. Given logistical limitations, we cannot guarantee that the groups stay together, but almost all scholars meet their colleagues and friends again on at least one other IMEX site visit.
One regular and continuing challenge is the financing of applicants. On top of the IMEX site visit fee, scholars must travel to the site and possibly give up clinical and other income. Interested faculty members have sometimes not been able to organize the funding. One of the five institutions has generously covered travel costs for foreign scholars visiting their school and home scholars visiting other institutions. Other schools have supported IMEX scholars in various other ways. On one occasion, a scholar from a non-consortium institution requested to attend and filled a vacant slot. We have declined requests to participate by medical educators from other countries so as not to dilute the institutional collaboration. However, we recognize that broader involvement may support the sustainability of the program.
Our data collection has limitations. Not all alumni responded and not all questions were answered. As our survey was anonymous, we could not follow the initial request with a targeted reminder. Moreover, as mentioned previously, we did not attempt to validate the perceived impact on personal career development, but believe that the personal feelings of IMEX alumni about this have worth in themselves.
IMEX has clearly shown its added value as a new component to the portfolio of faculty development activities. An international dimension in the development of medical educators broadens their perspective on medical education in way that adds to most regular faculty development programs.
Faculty development through international exchange: The IMEX initiative.
Abstract
Abstract Background: Faculty development is often local and international experiences are usually limited to conferences and courses. In 2006, five schools across the globe decided to enhance international faculty experiences through an exciting new collaboration: the International Medical Educators Exchange (IMEX) initiative. Method: Twice a year, one of the five schools in the Netherlands, Canada, Sweden and the UK organizes a week of faculty development activities for experienced medical educators from each school, including group discussions, short presentations, observations and active engagement in local education, one-on-one meetings with local faculty members, and many opportunities for in-depth discussion. We administered a survey to evaluate the impact of this international exchange. Results: By August 2013, 31 IMEX scholars had attended at least one of the 14 site visits held; most of them (29) had attended 3-5 site visits. Responding IMEX alumni (55%, N = 16) felt that their experiences impacted their personal competence and international orientation, and to some extent their career, their daily work and their institution. Most features of the IMEX program were valued as highly important and highly successful. Discussion: IMEX has established itself as an important additional faculty development opportunity for those medical educators who wish to develop and pursue a career in education.
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