"교육에 필요한 역량": 의학교육자를 위한 역량 (Acad Med, 2011)

"교육에 필요한 역량": 의학교육자를 위한 역량 (Acad Med, 2011)

“Teaching as a Competency”: Competencies for Medical Educators

Malathi Srinivasan, MD, Su-Ting T. Li, MD, MPH, Fredrick J. Meyers, MD, Daniel D. Pratt, PhD, John B. Collins, PhD, Clarence Braddock, MD, Kelley M. Skeff, MD, PhD, Daniel C. West, MD, Mark Henderson, MD, Robert E. Hales, MD, MBA, and Donald M. Hilty, MD

The Relationship Between Physician and Medical Educator Competencies

약 10년 전, 미국 의학교육자들은 독립적으로 진료를 할 수 있으려면 역량있는 의사란 어떤 스킬과 지식을 갖추어야 하는가에 대하여 고민했다.

A decade ago, U.S. medical educators grappled with what skills and knowledge a competent physician must be able to demonstrate in order to practice independently.3–6

그 논쟁을 통해 비전통적 역량, 진료-기반 학습, 시스템-기반 진료 등을 의사의 발달에 필수적인 것으로 인식하게 되었다.

The debate resulted in the recognition of nontraditional physician competencies, such as practice-based learning and systems-based practice, as integral to a physician’s development.

유사하게, 의학교육에서도 일부 그룹이 다양한 의학교육자들에게 필요한 역량을 도출하기 시작했으며, 이는 의사 교육을 담당하는 교수들이 그들의 역할을 위한 적절한 훈련을 받게끔 하기 위함이다. 

Similarly, in medical education, several groups have begun to identify competencies for various medical educators8–10 in an effort to ensure that faculty in charge of physician education receive adequate training for their roles.

비록 이러한 (지금까지의) 교육적 패러다임이 극도로 유용하긴 하나, 더 넓은 차원에서의 의사-역량 movement와 연결되어오지 않았으며, 의학교육에 관여하는 여러 사람들(비임상 교수부터 교육정책개발자까지)에게 적용될 수 있을 만큼 충분히 포괄적이지 못했다는 한계가 있다.

Although these educational paradigms have been extremely useful, they have not been linked to the larger physician competency movement, and they have not been broad enough to be applied to all those involved in medical education (from nonclinical faculty to educational policy makers).

 

프레임워크 개발

Framework Development

우리는 이 프레임워크를 다음의 과정을 통해서 개발함

We built this framework on an extensive review of the literature on teaching and learning as well as on expert opinion, which we solicited in three ways (described below):

• first, through a medical educator conference focused on teaching competencies;
• second, through discussion during several regional and national presentations; and
• third, through individual discussions with educational experts.

프레임워크에 대한 핵심 질문

Key Questions Informing the Framework

1. 교육에 참여하는 모든 사람이 educational training을 받아야하는가?

1. Does every person who teaches need educational training?

현재 의료행위를 하는 의사들은 다양한, 그리고 보다 공식적인 교육 기준에 따라서 역량을 보여주어야 한다. 마찬가지로, 의학교육자들에게도 기준이 필요하다. 의학교육자들은 appropriately and systematically 교육하는 능력이 있어야 하고, 롤모델 능력, 평가 능력, 피드백 제공 능력 등을 갖춰야 한다.

Now, medical practitioners must demonstrate their competency using a different, more formal (possibly higher) educational standard. Likewise, medical educators should also be held to a different standard; they must be able to demonstrate their ability to appropriately and systematically teach,15,16 role model,17,18 evaluate,19 and provide feedback20 to learners.

다수의 의학교육자들은 의사가 아니지만 의사의 역량 발달에 중요한 윤리/의사소통/practice management/advocacy 등의 전문가이다. 이처럼 의학교육자들이 다양해지면서 학습자-교수자의 접촉시간은 줄어들었으며, 이는 교육자들이 가르치고 피드백을 제공하고 평가하는 것을 보다 집중적으로, 정확하게 수행해야 함을 의미한다.

many medical educators are nonphysicians with expertise in skills that are critical for physician competency development— ethics, communication, practice management, and advocacy. This increase in medical educator heterogeneity, concurrent to a decrease in educator–learner contact time, means that educators must be able to teach, provide feedback, and evaluate in a more concentrated and accurate manner.

학습자와 일상적casual 상호작용을 하는 교육자들은 교육/평가/지도/refer/재교육 등을 소그룹/대그룹으로 하는데 필요한 핵심 지식/술기/태도를 갖추어야 한다. 더 중요한 책무를 맡은 교육자들은 추가적 훈련을 받아야 한다.

Given these changes in educational standards, our discussants felt that educators who have more than casual interaction with learners should develop the core knowledge, skills, and attitudes to teach, evaluate, guide, and refer/remediate individuals or small/large groups; educators with more significant responsibilities should obtain additional training.

2. 의학교육에 기초(토대)라고 할 수 있는 원칙이 있는가?

2. Are there foundational principles in medical education?

비록 개개 교육자들이 학습자와 갖는 상호작용이 다르고, 서로 다른 분야에 전문가이지만, 우리는 네 가지 원칙을 정리하였다. 학습자 참여, 학습자 중심, 적응능력, 자기성찰(learner engagement,23 learner- centeredness,24,25 adaptability, and self- reflection)

Although individual educators might differ in their interactions with learners and their content expertise, discussants identified four principles that all educators should value, endorse, and practice: learner engagement,23 learner- centeredness,24,25 adaptability, and self- reflection.15 For the Teaching as a Competency framework,

 

• 학습자 참여란 개별 학습자 혹은 학습자 집단과 연결connect with하는 능력, 지적으로 관계 맺는intellectually engage 능력을 말한다.
  learner engagement is the ability to connect with and intellectually engage an individual learner or groups of learners.
• 학습자 중심이란, 학습자를 최우선에 두고, 학생의 요구를 사정assess하고, 학습과 학습행동에 장애가 되는 요인을 이해하고, 교육 프로그램을 '학습자가 어디에 있는가'에 맞춰서 tailoring하는 것이다.
  Learner- centeredness (which is akin to patient- centeredness) is the philosophy of putting the learner first, assessing his or her needs, understanding her or his barriers to learning or practice, and tailoring the education program to meet the learner “where the learner is.”
• 적응능력이란 교육프로그램, 교육법, 우선순위, 내용 등을 학습자의 반응/학습 및 교육환경/심지어는 개별 교육상황에 맞추어서 바꾸는 것이다.
  Adaptability refers to the need to change programs, teaching modalities, priorities, and content over time to respond to learners, the practice/teaching environment, or even the teaching encounter.
• 자기성찰이란 교육자가 자신의 교육상황과 그 효율성을 비판적으로 생각해보고, 관련된 피드백을 수집하고, 자신의 스킬을 발전시키는 것이다.
  Self-reflection signifies the ability of educators to think critically about their educational encounters and their efficacy, to gather relevant feedback, and to devise ways to improve their skills.

3. 다양한 교육적 책임에 대해서 어떤 것이 '필수스킬'이고 '특화specialized스킬' 인가?

3. Which skills are “core” versus “specialized” for different types of educator responsibilities?

예를 들어, 모든 교육자가 갖추어야 할 필수 지식은 다음이 있다.

For instance, core knowledge for all educators might involve

• 내용 지식 (교육 주제에 대한 전문성) content knowledge (expertise in the educator’s topic area),
• 절차 지식 (해당 주제에서 효과적인 의사소통가, 교사가 되는 법) process knowledge (how to be an effective communicator/teacher within that content area), and
• 평가 지식 (학습자가 잘 배웠는가를 확인하는 법) assessment knowledge (how to ensure that the learners have learned the material).

 

프로그램 개발자를 위한 특화 스킬에는 다음과 같은 것이 포함될 수 있다.

Specialized skills for a program developer might include

• 교육 이론의 이해 understanding educational theory;
• 프로그램/교수자/학습자 평가를 위한 테크닉 knowledge of techniques for assessing the program, educator, and/or learner; and
• 연구수행 능력, 더 발전된 테크놀로지에 대한 숙달 proficiency in conducting research and using advanced technology.

 

4. 교육자 스킬 개발의 연속체를 가장 잘 표현해주는 단어는 무엇인가?

4. Which terms best express the continuum of educator skills development?

프레임워크를 개발하며 프레임워크를 구성하는 가장 좋은 용어에 대해 논의함 “competency,” “expertise,” “best practice,” and “role.” 등을 고려했음. 각각 잘 사용되는 상황이 있음.

During development, discussants debated the best term around which to build the framework; they considered “competency,” “expertise,” “best practice,” and “role.” Each of these terms has been used successfully in different settings. For instance,

• U.S. educators have used the Dreyfus skills continuum(from novice to expert) to develop a “competency” framework for practicing physicians, signifying important milestones necessary for independent clinical practice.
• “Expertise” denotes a level of skill higher than that which a starting medical educator may need for independent practice.
• “Best practices” can be used to benchmark performance and set appropriate developmental milestones.
• The term “role,” used extensively in Canada as part of CanMEDS, denotes areas of physician practice skills.

여기서는 competency와 role의 두 가지를 사용

5. 교육 혹은 학습을 평가해야 하는가?

5. Should we assess teaching or learning?

의학교육의 목표는 학습자를 참여engaging learner 시켜서 학습을 촉진promote learning하는 것이다. 참여적 학습의 성과는 더 나은 환자돌봄, scholarship, 지역사회/공공 서비스, 건강시스템 등이 있다. 그러나 '가르치는 것'과 '배우는 것' 사이에는 선형적 관계가 있는 것이 아니다.

the goal of medical education was to promote learning by engaging learners. The output of this engaged learning could be better patient care, scholarship, community/public service, or health systems. however, the process of a teacher’s teaching and a learner’s learning may not have a linear relationship.

 

'환자성과'와 마찬가지로 '학습자성과'는 다양한 학습자-, 교육자-, 환경- 요인에 따라 영향을 받는다. 예를 들어서 교육자들은 효과적인 학습 환경을 만드는데 책임이 있고, 적절한 학습 도구과 방법을 적용해야 한다. 학습자의 책임에는 절절한 준비, 집중, 학습 습관이 있으며, 이를 통해 새로운 스킬을 실천할 수 있어야 한다. 일부 부가적으로, 학습자-의존적 요인으로는 웹-참여, peer-to-peer 학습, 자기주도적 학습 등이 있다. 환경적 요인에는 시간/시설/자원/기회 등이 있으며, 더 나아가 리더(지도나)는 교육자의 능력이 효과적으로 영향을 미칠 수 있는 잠재적 문화를 형성하는데 초점을 두어야 한다.

As with patient outcomes, learner outcomes are influenced by multiple learner, educator, and environmental factors. For instance, educators are responsible for creating an effective learning environment and for applying appropriate learning tools and methods. The learner’s responsibility includes appropriate preparation, attention, and work habits which will in turn allow him or her to incorporate these new skills into practice. Some additional, learner- dependent factors that influence learning include Web participation, peer-to-peer learning, or self-directed learning. Environmental factors include those related to time, facilities, resources, and opportunities for learning. Further, leaders’ focus on an institution’s educational mission shapes its hidden culture, deeply influencing the ability of educators to be effective.

"교육에 필요한 역량" 프레임워크

“Teaching as a Competency” Framework

여섯 개 공통 역량

We identified six core competencies, appropriate for all medical educators:

(1) medical (or content) knowledge,

(2) learner-centeredness,

(3) interpersonal and communication skills,

(4) professionalismand role modeling,

(5) practice-based reflection, and

(6) systems-based practice.

 

• 내용 지식: 내용을 가르치고, 그 전문분야 내에서 학습자의 능력을 평가 
  Medical (or content) knowledge: Teach content and assess each learner’s abilities within their field of expertise.
• 학습자 중심: 학습자의 성공과 웰빙에 헌신하고, 학습자가 전문직 역할을 할 수 있게 성장하는 것을 도움
  Learner centeredness: Demonstrate a commitment both to learners’ success and well-being and to helping learners grow into their professional roles.
• 대인관계와 의사소통 기술: 학습을 촉진할 수 있게 하는 유연한 가르침과 의사소통 스타일
  Interpersonal and communication skills: Flexibly tailor teaching and communication styles to facilitate learning
• 프로페셔널리즘과 롤모델: 교육적으로, 내용과 관련된 행위에 있어서 최고의 모습을 보이며, 학습자의 행동에 롤모델이 됨.
  Professionalism and role modeling: Demonstrate best educational and content-related practices, and role model those behaviors for learners.
• 실천-기반 성찰과 향상: 지속적인 가지평가와 평생학습을 통해서 교육자로서 효과성과 능력을 향상
  Practice-based reflection and improvement: Demonstrate continuous selfassessment and lifelong learning to improve their effectiveness and capacity as educators.
• 시스템-기반 학습: 학습자를 위하여 더 넓은 차원의 자원을 활용하며, 최적의 교수-학습을 제공함
  Systems-based learning: Utilize resources within the larger system of medical education to advocate for learners and to provide optimal teaching and learning.

네 개 특화 역량

four specialized competencies for faculty with additional programmatic roles:

(7) program design and implementation,

(8)evaluation and scholarship,

(9) leadership,27 and

(10) mentorship.

 

• 프로그램 설계와 도입: 타당sound하고 지속가능한 프로그램을 설계하고 도입함
  Program design and implementation: Design and implement sound, sustainable educational programs.
• 평가와 연구: 프로그램/프로세스/연구분야 대한 새로운 지식을 창출하는 방향으로 학문적, 실용적 접근법을 활용한다.
  Evaluation and scholarship: Utilize scholarly and practical approaches to prioritize program evaluation in a way that creates new knowledge about the program, the process, and the field being studied.
• 리더십: 미래의 요구를 고려한 의학교육의 공통의 비전을 창출한다. 팀 구성원이 발전하고 성공할 수 있는 시스템을 만든다.
  Leadership: Create a shared vision for medical education, while anticipating future needs. Create systems in which team members can grow and succeed
• 멘토십: 개개 학습자의 커리어 발전에 긍정적 초점을 유지한다.
  Mentorship: Sustain a positive focus on the career growth of individuals (learners, faculty, staff).

 

The six core competencies

 

The four specialized competencies

 

Relationship between teaching competencies and educator roles

 

직접적으로 가르치는 역할을 하는 교육자들은 특화 스킬을 반드시 갖출 필요는 없으나, 일부 역량에 친숙할 필요는 있다. 

They also believed that educators with direct teaching roles would not necessarily need competency in specialized skills but may need some familiarity with those competencies (such as curriculum development and evaluation). 

장점/적용/한계/향후 연구

Framework Strengths, Applications, Limitations, and Future Research 

강점

Strengths

 

적용

Applications

이해관계자들이 자원의 우선순위를 설정하는데 도움을 줌

A sound conceptual framework can help stakeholders— more carefully prioritize their resources.

조직의 강점과 약점을 평가하는 접근법을 제공함으로써, 어디에 자원을 투입했을 때 가장 교수의 스킬 세트가 발전할지 짚어낼 수 있게 도와줌

Using the Teaching as a Competency framework to discuss educator development can help pinpoint areas where resources may be best deployed for developing faculty skill sets by providing an approach for assessing organizational strengths and weaknesses.

의학교육자들의 지속적 발전을 위한 스킬의 연속체임. 의학교육자들이 모든 이해관계자의 요구를 맞출 수 있게 도와줄 수 있음. 역할-특이적 교육자 역량은 교육적 재정과 교수 채용/보상/유지의 우선순위를 정하는데 도움이 될 수 있다. 가장 중요하게는 교육자들이 자신의 역할에서 성공하기 위한 스킬 세트와 자원을 유심히 생각해볼 수 있다.

Our framework acknowledges the continuum of skills necessary for a medical educator’s continued growth. In addition, it might help medical educators meet the needs of all stakeholders— by recognizing the real needs of each stakeholder through better engagement. Recognizing role-specific educator competencies may help institutions prioritize their educational dollars and recruit/reward/retain faculty differently. And, perhaps most important, the Teaching as a Competency framework can help educators think carefully about the skill sets and resources they will need to succeed in their positions.

 

한계와 향후 연구

Limitations and future research

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Acad Med. 2011 Oct;86(10):1211-20. doi: 10.1097/ACM.0b013e31822c5b9a.

"Teaching as a Competency": competencies for medical educators.

Srinivasan M1, Li ST, Meyers FJ, Pratt DD, Collins JB, Braddock C, Skeff KM, West DC, Henderson M, Hales RE, Hilty DM.

Author information

• 1Department of Medicine, University of California, Davis, School of Medicine, Sacramento, California 95833, USA. malathi@ucdavis.edu

Abstract

Most medical faculty receive little or no training about how to be effective teachers, even when they assume major educational leadership roles. To identify the competencies required of an effective teacher in medical education, the authors developed a comprehensive conceptual model. After conducting a literature search, the authors met at a two-day conference (2006) with 16 medical and nonmedical educators from 10 different U.S. and Canadian organizations and developed an initial draft of the "Teaching as a Competency" conceptual model. Conference participants used the physician competencies (from the Accreditation Council for Graduate Medical Education [ACGME]) and the roles (from the Royal College's CanadianMedical Education Directives for Specialists [CanMEDS]) to define critical skills for medical educators. The authors then refined this initial framework through national/regional conference presentations (2007, 2008), an additional literature review, and expert input. Four core values grounded this framework: learner engagement, learner-centeredness, adaptability, and self-reflection. The authors identified six core competencies, based on the ACGME competencies framework: medical (or content) knowledge; learner- centeredness; interpersonal and communication skills; professionalism and role modeling; practice-based reflection; and systems-based practice. They also included four specialized competencies foreducators with additional programmatic roles: program design/implementation, evaluation/scholarship, leadership, and mentorship. The authors then cross-referenced the competencies with educator roles, drawing from CanMEDS, to recognize role-specific skills. The authors have explored their framework's strengths, limitations, and applications, which include targeted faculty development, evaluation, and resource allocation. The Teaching as a Competency framework promotes a culture of effective teaching and learning.

Comment in

• Teaching as a competency: practical suggestions. [Acad Med. 2012]

PMID:

 

21869655

 

[PubMed - indexed for MEDLINE]