Clinical teacher를 위한 효과적인 프로그램: 교수개발자의 역할(Med Teach, 2001)

Clinical teacher를 위한 효과적인 프로그램: 교수개발자의 역할(Med Teach, 2001)

Building an effective programme for clinical teachers: the role of the staff developer

MAGGIE CHALLIS

Centre for Postgraduate and Continuing Medical Education, Queens Medical Centre, Nottingham, UK

교수개발자의 역할

The role of the staff developer

과거는 외국과 같다. 그 곳에서는 모든 것들이 다르게 작동한다.

The past is a foreign country: they do things differently there. (L.P. Hartley, The Go-Between)

 

의학교육은 이제 하나의 학문으로 자리잡았다. 그러나 교수개발자의 역할은 종종 어렵다.

Medical education is now established as a discipline in its own right, However, the role of the staff developer, whose job it is to implement the findings of such explorations, is often difficult.

교수개발자의 역할은 여러 가지 영역을 매개한다. 

The role of the staff developer is to act as a go-between in several spheres:

• 교육의 전통적 모델과 대안적 모델
  to move from the traditional to an alternative model of education; 

• 교수들을 공통의 목표를 가지고 묶어주기
  to bring together staff with a common aim; 

• 교육시스템의 서로 다른 부분을 통합하기
  to integrate different parts of the educational system; 

• 의학교육과 다른 교육영역의 interface에서
  to act as an interface between medical education and other educational arenas; 

• 혁신의 rationale와 수단
  to offer a means and rationale for innovation.

이 다양한 중재자 역할을 수행하기 위해서는 교육이라는 영토에 서식하는 여러 동물들을 탑승on board하게 만들기 위한 전략이 필요하다. 동물의 왕국에 비유하자면...

To fulfil these different mediation roles, a range of strate- gies needs to be developed in order to bring on board the very varied inhabitants of the educational terrain. An analogy from the animal kingdom might be used to describe these:

• 공룡
  dinosaurs, who thrived when the land offered them an appropriate climate, but who were unable to maintain their existence once the environment changed; 

• 코알라
  koala bears, who survive under very limited environ- mental conditions, are somewhat slow and cumbersome, and live on a highly specific diet; 

• 다람쥐
  squirrels, who can leap around or run on the ground, and are not particular about the type of nuts and berries they eat; 

• 양
  sheep, who provide food and wool for clothing and are therefore immensely valuable, but who are essentially followers and live in flocks; 

• 표범
  leopards, who are the hunters, the aggressors, with a range of habitats and running and climbing skills—but who may have difficulty changing their spots; 

• 고슴도치
  hedgehogs, whose response to the unknown is to curl into a ball and wait for the danger to pass; 

• 원숭이
  monkeys, who are inventive and able to learn and adapt, and will usually get their own way; 

• 카멜레온
  chameleons, who instinctively blend into the landscape in order to remain safe.

위의 동물들 중 어떤 조합은 재앙을 초래할테지만, 어떤 조합이 안전한지를 이해하는 것, 그리고 어떤 식단이 적합하고 개별 종species의 특성을 어떻게 build on 할지를 하는 것이 성공적인 FDP의 핵심이다. 그러나 모든 사람을 만족시키는 하나의 접근법은 없다.

Bringing certain combinations of the above into the same place will result in disaster, but understanding which combinations are safe, what diet will be appropriate and how to build on the characteristics of individual species is one of the keys to a successful staff development programme. It is clear, however, that a single approach—will not meet the needs of everyone.  

의학교육의 전통적 모델

The traditional model of medical education

의학교육은 전통적으로 숙련된 교육자들로부터의 input이 별로 없었다. 임상교육은 '보고, 하면, 가르칠 수 있다‘see one, do one, teach one’ '이라는 영적 세례였다. 주니어 의사들은 삼투osmosis의 과정을 거쳐서 학습할 것이라고 기대되었다. 단순히 (교수의) 주변에 있고, (교수를) 보는 것 만이 배움의 핵심이었다.

Medical education has historically had little input from experienced educators. Clinical teaching has been characterized by the much quoted ‘see one, do one, teach one’ baptism of fire. Junior doctors have been expected to learn through a process of ‘osmosis’: simply being around and watching has been perceived as the key to learning.

의사들에게 교수-학습이라는 개념이 도입되기 시작한 것은 하루 혹은 이틀짜리 코스를 통해서였고, (막연히 교육의 효과가 있을 것이라 가정하면서) 교육의 효과를 어떻게 평가할지에 대한 follow-up은 거의 없었다. 교수-학습 이론에 약간 노출시키고, 마이크로티칭 연습 기회를 조금 가지면, medical teaching의 퀄리티 향상에 충분할 것이라고 생각한 것이다. 또한 어떤 코스를 이수하는 것이 학습이 일어났다appropriate learning taken place는 것의 지표라고 여겼다.

Where  efforts  have  been  made  to  introduce  doctors  to the  concepts  of  teaching  and  learning,  these have frequently been through the medium of a one- or two-day course,  with  little  or  no  follow-up  to evaluate how the learning,  which is assumed to have taken place, has been implemented or has led to changes in educational practice.The  perception  appears  to  be  that  some exposure to teaching and learning theory and  opportunities to practise micro-teaching  is  sufficient  in  itself  to bring about improvements  in  the  quality  of  medical  teaching , and it is  assumed  that  attending  the  course  is  an  indication  that appropriate learning has taken place.

의학교육의 전통적 모델은 한계점이 있었고, 그 한계점은 교수를 위한 교육의 한계와 정확히 일치parallel 했다.

The traditional model of medical education has many drawbacks, which are paralleled in the traditional model of teaching the teachers.

영국에서는 현재 진료행위를 하는 의사들에 대한 revalidation 쪽으로 움직이고 있는데, 이 (revalidation) 프로세스에서 다룰 것 중 하나가 teaching이다.

In the UK there are currently moves to assure and enhance the quality of performance of practising clinicians through revalidation (GMC, 2000), and teaching is one aspect of the individual’s work that will be addressed within this process.

학습에 대해서 우리가 아는 것은?

What do we know about how people learn?

Vygotsky (1978). 사회적 환경이 발달을 유도한다the social envi- ronment drives development. 교사의 역할은 학습자와 교육내용subject를 'zone of proximal development' 안으로 데려오는 것이다. 여기에는 교사가 학습자의 학습준비단계를 측정하여서, 학습자료를 가장 받아들이기 쉬운 방식으로 제시하는 것을 포함한다. 학습을 촉진하는 내부 프로세스가 시작되게 만드는initiating 핵심은 학습자를 encourage하여 학습환경 내에서 다른 사람과 상호작용하게 만드는 것이다.

Vygotsky (1978) takes the stance that the social envi- ronment drives development. He linked intelligence to the capacity to learn through instruction, and saw the role of the teacher as being to bring the learner and the subject to be learned within the ‘zone of proximal development’. This involves the teacher in gauging the stage of readiness of the learner to learn, and therefore presenting the material in a way in which it will most easily be accepted. A key to initi- ating the internal processes that will stimulate learning is to encourage the learner to interact with other people within the learning environment. 

Lave & Wenger (1991). 학습을 강화하거나 방해하는 환경의 영향에 대하여 강조하였음. '정당한 주변부 참여legitimate peripheral participation’이라는 개념에서 learning and doing은 서로에게 통합적으로 묶여있으면서, 이 두 개를 분리하는 것은 불필요하고 바람직하지도 못하다고 했다. 따라서 교사가 해야할 일은 주어진 (실제) 과제에 건설적으로constructive to the task in hand 학습자를 참여시키면서, 동시에 학습자의 니즈에 맞게 구조화하고 니즈에 관련된 참여를 시키는 것이다.

Lave & Wenger (1991) have highlighted the influence of the environment in enhancing or hindering learning. In exploring the concept of ‘legiti- mate peripheral participation’, they have posited the belief that learning and doing are integrally bound up in each other to the point that separation is unnecessary and unde- sirable. The challenge to the teacher is therefore to enable participation of the learner in roles that are constructive to the task in hand, but also structured and relevant to the learner’s needs.

Kolb (1984). 생각이 경험으로 accommodate되고, 경험이 기존 개념으로 assimilate 되어야만이 학습이 일어난다고 했다. 따라서 학습은 경험을 통해서 생각idea이 바뀔 때 일어나며, 펙트보다는 스킬의 습득에 기반한다고 주장하였다. 지식은 정체된 것이 아니며, 지속적으로 생성create되고 재생성recreate 되는 것이며, 개별 학습자의 해석에 따라 달라진다. 교수의 역할은 학습자의 발달에 holistic approach를 장려하는 것이며, 학습자와 학습환경의 상호작용을 장려하는 것이다.

Other key writers on adult learning are Kolb and Schön. Kolb (1984) describes how learning can only take place when ideas are accommodated into experience, and experi- ence is assimilated into existing concepts. Thus learning takes place through a modification of ideas through experi- ence, and will be based more on the acquisition of skills rather than facts. Knowledge is not static, but is continu- ally being created and re-created, and is subjected to interpretation by the individual learner. The role of the teacher is to encourage a holistic approach to learner devel- opment and the interaction of the learner and his/her environment.

Schön (1987). 성찰이 professional learning의 핵심이라고 주장하며, 'master' of the profession으로서 교수의 역할은 학습자와 교수자 사이의 상호적reciprocal 성찰 프로세스를 포함한다. 또한 능숙skilled해지기 위해서는 연습이 중요하다고 하였으나, 이러한 연습practice란 안전하고, 위험이 적은 환경에서 이뤄져야 한다고 강조했다. 교사는 그러한 상황을 만들거나 찾아내야 하고, 교수-학습 프로세스에 그러한 상황을 이용해야 한다.

Schön (1987) also emphasizes the concept of reflection as a key to professional learning, and suggests that the role of the teacher as ‘master’ of the profession should involve a reciprocal process of reflection between learner and teacher. He also stresses the importance of practice as a means of becoming more skilled, but emphasizes that this should take place within a safe, low-risk environment. The teacher is able to create or identify such situations, and capitalize on them for teaching and learning processes.

이 모든 것들이 교사들의 역할을 이해하고 수행하는데 잘 맞을지 모르나, 임상교사clinical teacher에게는 꼭 그렇지도 않다.  Perry(1970)는 대학생의 인지적 발달 단계를 identify하였다. 이 연구의 참여자는 전체 인구를 대변하지 못하며, 하버드 대학의 남학생이다.

Whilst  all  this  makes  perfect  sense  in  a  world  where teachers understand  their role and are able to carry it out, clinical teachers are not necessarily in this situation. Perry(1970) identified stages of cognitive development amongst undergraduates.  Although  his  participant  group  was  not representative of the learner population, being male under- graduates at Harvard,

 

의사로서 수련을 받는 과정에서 의사들은 길고 구조화된 수련의 결과로 이 단계들을 밟아나갈 것으로 여겨진다assume. 그러나, (의사가 아닌) 교사로서는 이 모든 단계를 밟아나가지 못했다. 따라서 교수개발자들에게 있어서 첫 두 단계에 해당하는 태도만 목격하는 것은 놀라운 일이 아니다. 그러나 학습자가 이후 단계로 나아갈 수 있다는 것을 이해한다면 이제 막 교사가 된 사람들budding teacher에 대한 인식을 확장시킬 수 있을 것이다.

In their training as clinicians, doctors naturally might be assumed to move through these stages as a result of their long and structured training. However, as teachers, they have not been led through all Perry’s stages. It is therefore not surprising that, as staff developers, we encounter atti- tudes relating to the first two stages—dualism and multiplicity. However, understanding that the learner can be taken through the latter stages may help frame a programme which will expand the perceptions of the budding teacher.

새로운 개념을 도입할 때(학습자-중심 접근법 등)  Rogers 가 제시한 프레임워크를 유의해야 한다. 다음의 특성을 가진 혁신이 가장 잘 받아들여진다.

In introducing new concepts—such as a learner-centred approach to medical teaching—any innovator would do well to take heed of the framework offered by Rogers (1983), who proposes that innovation will be most easily accepted if it can demonstrate the following features:

• 상대적 변화: 기존의 것보다 나은가?
  Relative advantage—is the innovation better than what it is designed to replace? 

• 호환성: 기존 문화에서 중시하던 가치와 일관되는가?
  Compatibility—is the innovation consistent with the existing values in the culture into which it is to be introduced? 

• 시험가능성: 제한된 환경에서 실험해볼 수 있는가?
  Trialability—can it be, or has it been experimented on on a limited basis? 

• 관찰가능성: 혁신의 결과가 관찰가능한가?
  Observability—will the results of the innovation be readily visible? 

• 복잡성: 혁신을 도입하고 활용하는 난이도는 수용할 만 한가?
  Complexity—is the degree of perceived difficulty in implementing and using the innovation acceptable?

 

상대주의 Relativism 

• 너와 동의하지는 않지만 네가 옳을 수도 있어. ‘I don’t agree with you but you may be right’ 

• 다수의 타당한 대안이 있을 때는 결정을 내리는 것이 불가능해 ‘You can’t make a decision when there are several reasonable alternatives’

상대주의에 대한 헌신 Commitment in relativism 

• 비록 나중에 새로운 주장에 대한 근거가 드러나서 결정을 바꾸더라도, 선택은 가능할 뿐더러 만드시 내려져야 한다.‘A choice can and must be made even if it has to be changed later in the light of new evidence or arguments’

 

 

의학교육의 영토에 살고 있는 부족의 특성은?

What are the characteristics of the tribes in the medical education territory?

Ashmore & Del Boca (1981)는 고정관념stereotype이란 반드시 부정적인 접근법만을 가져오는 것은 아니라고 하였고, Fiske는 유사한 성격을 가진 것들을 그룹으로 묶는 것은 그들이 누구인지 알고, 그들을 어떻게 대해야 하는가를 아는 것을 단순화하는 방식이라고 했다. Belbin은 선호하는 근무방식에 따라 개개인을 분류하는 프로세스를 만들었다.

However, as Ashmore & Del Boca (1981) have indicated, stereotyping is not necessarily a process which leads to a negative approach, and Fiske (1989) indicates that catego- rizing others into groups with similar characteristics makes it possible to simplify ways of knowing who they are and how they should be treated. Indeed Belbin (1981) intro- duced the process of characterizing individuals and the way in which they prefer to work,

(1) 개척자, Trailblazers, characterized by:

• being visionary but few in number; 

• being motivated by the desire to improve the quality of learning and to explore the frontiers of teaching and learning; 

• preferring to work alone; 

• being keen to give any innovation a high priority; 

• moving on to the next task once the excitement has worn off.

(2) 선구자 Pioneers, characterized by:

• being few in number; 

• being motivated by the desire to improve the learning experience of others; 

• lacking in skills, time or confidence;

• being good collaborators; 

• being keen to give a particular innovation high priority.

(3) 정착자 Settlers, characterized by:

• being many in number; 

• being generally poor collaborators; 

• getting involved in innovation because of a new institu- tional policy, commitment or requirement; 

• preferring to continue with current practice rather than prioritize innovation.

(4) 유목민 Nomads, characterized by:

• being many in number; 

• habitually moving in and out of teams; 

• having few longer term aims; 

• taking on short-term, ‘quick fix’ aspects of innovation.

각 그룹은 받고싶은 서포트의 타입이 무엇인지 제안하도록 했음

Each group was given a suggested list of types of support that they might use to frame their discussions:

• how to create a climate for accepting change; how to clarify the nature, purpose and origin of a proposed innovation in teaching and learning; 

• how to develop skills and understanding; 

• what checklists, templates or guides might be used or developed; 

• how individual support might be given to support plan- ning and development of an individual’s change of practice; 

• how to establish a system of peer support; 

• how practice could be monitored and evaluated.

Workshop outcomes

개척자

Trailblazers

By their very nature, these people are hard to locate and pin down. But it may be possible to send scouts out to find them, or to track them down at watering holes—bars or social venues. If they are to become more involved with the work of others and disseminate their work, they will need to be offered incentives, such as some form of public recog- nition, and ample positive feedback. Because they are naturally reluctant to cooperate with others, especially each other, it may be necessary to track them by using people with group-working abilities, such as pioneers, in order to glean where the energy of the trailblazers has been used effectively.

Trailblazers generally enjoy being the centre of atten- tion, and this can be used to advantage by inviting them to give talks or run lunchtime seminar sessions. They will also benefit from being allowed to attend conferences to both disseminate their own ideas and to spot innovations which will be of use to their colleagues. Their ability to stimulate ideas and develop enthusiasm will be best harnessed in this public arena.

However, the downside of trailblazers is that their thirst for innovation can leave behind it a trail of destruction as others try to keep up with them, but become abandoned as the change agent moves on to new pastures. Their activity will therefore need to be carefully monitored and analysed so that their activities can be picked up and handed to others who will be able to follow through. Where possible, it might be useful to encourage them to participate in short staff development events where they can be helped to realize that not all their colleagues are at the same advanced point of thought as they are, but may be better equipped to support their proposed innovations. It will also be helpful to work with them individually, and try to target their activities so that they are focused on the needs of themselves, their colleagues, and the organization, and not simply on following their own path.

선구자

Pioneers

In many ways pioneers are the natural partners to work with the trailblazers’ ideas. Their ability to work in groups offers a means of translating innovative ideas into practice. However, it may be difficult to catch their interest in such a way that they work with an idea which is going to be useful to themselves, their colleagues and the organization.

Pioneers will benefit from the input of a staff developer through experiential group activity, and copious positive feedback. They will need to feel safe within the group, and be clear about what their task is, and what the expected outcomes are. Through the processes of sharing and reviewing their practice with others they will be able to build their confidence in implementation, and may be encouraged to reflect on what they have achieved in order to transfer their learning to new circumstances. This, in turn, will motivate them, and enable them to motivate others through their natural ability to work in groups. A commitment to change across a broader range of activities may then emerge, and enable them to move from working only on specific items of interest, to a more strategic approach.

정착자

Settlers

This group presents a different kind of challenge to the staff developer. Settlers need to be brought to a point at which they can appreciate the world outside the limits of their own corral. Some of their reticence to become involved in innovation may result from a sense of being threatened in their secure environment. They will therefore need to be convinced of the benefits of any proposed changes to their current practice, and be given a forum to express their doubts and anxieties. This, however, must be tempered by a structure that prevents them from merely stating why the status quo should be maintained, or dwelling on a nostalgic view of the past. The staff devel- oper can use learner feedback quite effectively with this group. Whilst they are likely to be popular, and good at what they have always done, an analytical approach to feedback may indicate limitations to the way in which they seek information (not asking questions which might result in challenging answers) or they way in which they interpret it (‘it was just a personality clash’).

Settlers need to be treated with respect and sincerity. They are generally not trying to be difficult, but are genu- inely unable to understand why they should change. Bringing them into structured contact with pioneers to work on specific projects should help them to ease into a situation where they can appreciate the views of others and begin to realize the benefits, and possibly even the personal satisfaction, as well as the challenges of change.

유목민

Nomads

Nomads, like trailblazers, are hard to pin down, but their energy, once captured, can be put to good use. Their apparently irritating habit of drifting from one area to another can be a strength as long as the staff developer knows where they are and what their current interests might be. At this level, they may be a useful vehicle for communication about the particular project they are involved in, and, with sufficient and appropriate encour- agement, may be able to help make connections between all the different environments in which they have participated.

If the aim is to change their behaviour in order to dwell long enough to become really involved in a longer term venture, they will need to be brought quite explicitly to realize the benefits of the plan/enact/evaluate/reflect cycle of learning. They may tend to stick on the first two stages. They need to be shown how they can best complement the attributes of the other inhabitants of the territory, and use their own strengths of clear-sightedness and problem solving to move a group forward. They are likely to respond well to honesty and constructive feedback about their performance, and will listen to arguments relating to their own learners’ needs. A well-developed appraisal system will help nomads to realize how their talents can best be harnessed.

적잡한 교수개발 프로그램 개발

Designing an appropriate staff development programme

첫 번째 과제는 위와 같은 분류(학)를 밝히는 것이다.

The first task is to identify the typologies, as described above.

새로운 혁신을 도입하고자 하는 목적으로 프로젝트 그룹을 시작할 때, 한 그룹 내에서 여러 유형을 혼합하는 것이 좋다.

In implementing a project group around the innovations to be introduced, it will then be important to ensure a mix of types within the group.

미래로 향하는 계획을 세우기 위한 프로젝트 그룹이라면 Pioneers와 Nomads가 핵심을 맡는 것이 좋을 것이다.

When setting up a project group to plan the way forward, it will probably be useful to have a core of pioneers and nomads

실제 혁신의 implementation을 위해서라면 Settlers가 핵심이 된다.

When it comes to actual implementation of the innovation, settlers will be of key importance,

결론

Conclusion

Pioneers와 Settler는 혁신의 뼈대backbone이 될 수 있지만, Trailblazer와 Nomad가 아이디어의 확대와 확산에 영향을 준다면, 이로부터도 도움을 받을 수 있다.

Pioneers and settlers may form the backbone of innovation on the ground, but will benefit from the influences of trailblazers and nomads to ensure expan- sion of ideas and dissemination.

단기 코스는 앞으로도 교수개발활동의 핵심일 것이나, (교수개발 프로그램이) 자신과 관련이 없다고 생각하는 사람들에게는 다양한 마케팅 접근법이 필요하다. 예컨대 스스로를 '교사'라고 인식하는 사람은 '교수-학습'에 대한 프로그램에 관심을 가질 것이다. 비슷한 내용이 '피드백 주기', '교육에서의 슈퍼비전', '멘토링', '카운슬링 스킬' 등과 같은 이름으로 팔릴sold 수도 있다. (프로그램에 대해) 어떤 반응을 보일지는 (교사로서) 자기 자신의 역할과 학습에 대한 서포트 방식에 대한 생각에 따라서 달라지며, 용어terminology가 그 반응을 결정한다.

Short courses will probably continue to form the core of staff development activities, but a range of marketing approaches may help to bring in those who do not currently see their relevance. For instance, people who perceive them- selves as ‘teachers’ will be drawn to events with ‘teaching and learning’ in the title. On the other hand, similar ground may be covered in courses that are sold under the heading of ‘giving feedback’, ‘educational supervision’, ‘mentoring’ or even ‘counselling skills’. The terminology itself will dictate who responds, depending on how they identify their own roles and approaches to supporting learning.

이런 방식으로 두드러진 특성을 가지고 함께 팀으로 일할 사람들을 구성하는 것은 '같은 부족'이 모여서 거의 성과가 없거나 심지어는 혁신의 반대방향으로 가버리는 결과를 막아줄 수 있을 것이다.

However, it is hoped that this way of identi- fying salient characteristics of colleagues will serve as a means of forming groups who will work together as a team, and avoid some of the difficulties we often encounter when members of the same ‘tribe’ come together and end up achieving little or, even worse, simply back away from the proposed innovation.

CHALLIS, M. (2000) AMEE Medical Education Guide No 19: Personal learning plans, Medical Teacher, 22(3), pp. 225–236.

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Research Article

Building an effective programme for clinical teachers: the role of the staff developer

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DOI:

10.1080/01421590120043044

Maggie Challis^a

pages 270-275

Publishing models and article dates explained

• Published online: 03 Jul 2009