오슬러 펠로우십: 의학교육자를 위한 견습(Acad Med, 2010)

오슬러 펠로우십: 의학교육자를 위한 견습(Acad Med, 2010)

The Osler Fellowship: An Apprenticeship for Medical Educators

Yvonne Steinert, PhD, J. Donald Boudreau, MD, Miriam Boillat, MD, Barry Slapcoff, MD, David Dawson, MD, Anne Briggs, and Mary Ellen Macdonald, PhD

우린느 멘토가 되고자 한다. 그리고 의과대학생들이 의학을 배우는 여정동안voyage 그들의 인간성를 유지하고 의료의 예술art적 측면에 대한 감각을 유지할 수 있게 이끌고자 한다.

We are trying to mentor, accompany, and guide medical students on a voyage that will preserve their humanity and their sense of appreciation of the art of medicine. (Osler Fellow, Class of 2009)

Physician Apprenticeship이라는 플래그쉽 과정은 학부교육 4년간 지속되며, 모든 학부생은 6그룹으로 나눠져서 정기적으로 시니어 학생과 Osler Fellow(이하 OF)라 불리는 의사를 만나야 한다. Sir William Osler는 McGill의과대학의 가장 저명한 졸업생이자 교수이다.

a flagship course, Physician Apprenticeship, which spans the four years of the undergraduate curriculum. all students (n  172) in each undergraduate class are divided into groups of six who meet regularly with two senior students and a practicing physician called an Osler Fellow, in honor of Sir William Osler, one of McGill University’s most prominent medical school graduates and faculty members.

 

오슬러 펠로우십 개요

Description of the Osler Fellowship

두 가지 핵심 요소

The Osler Fellowship consists of two key components:

(1) 4년간 정기적 미팅 regular meetings with students across the four years of their undergraduate education and

(2) OF를 서포트하기 위한 지속적 FDP a longitudinal faculty development program specifically designed to prepare and support the Osler Fellows in their role.

OFship의 핵심은 학생이 일반인layman에서 의사physician이 되기까지의 이행과정을 촉진facilitate하는 것이다.

The meetings with students, a vital aspect of the Osler Fellowship, help to facilitate each student’s transition from layman to physician.

표2에 11개 워크숍의 주제

Table 2 outlines the topics of the 11 half-day faculty development workshops,

 

 

 

방법

Method

디자인

Design

참가자 모집

Participant recruitment

인터뷰 스케줄

Interview schedule

A research assistant with experience in qualitative research who was not associated with the Osler Fellowship conducted all of the interviews. The interview questions were pilot tested with members of the Centre for Medical Education and tapped three major areas of inquiry:

•   What motivated clinical teachers to accept the invitation to be Osler Fellows?

•   What was it like to be an Osler Fellow, and what was the impact of this experience?

•   What were the Osler Fellows’ perceptions of the faculty development component of the Osler Fellowship, and how did this program differ from other faculty development initiatives in which they had participated?

Most questions were open-ended to enable participants to talk freely about the issues. Probes accompanied each question to stimulate thinking, to encourage detailed, expansive responses, and to solicit examples of more general observations. During the face-to-face interviews, which lasted 30 to 45 minutes, the interviewer took minimal field notes; he wrote more extensive field notes within 24 hours of the session to capture main themes and preliminary impressions. The interview questions evolved slightly as the process unfolded; when salient issues emerged in one interview, the interviewer reiterated them in subsequent conversations to test for relevancy.

데이터 분석

Data analysis

Following a recognized qualitative descriptive methodology,18 we transcribed all interviews using standard rules of transcription. We removed identifiers and names from the final transcripts and checked each transcript for accuracy. Thematic content analysis guided the data analysis.19 Two of us (Y.S. and D.B.) independently read all transcripts, identified recurrent themes through multiple, close readings, and agreed on the final themes by consensus. We noted similar themes across transcripts, assembling and analyzing these together. A third investigator (M.B.) read a third of the transcripts to contribute to the confirmation and refinement of the emerging themes; no new themes were added. The final step in the analysis included developing major themes and their component sub themes as well as identifying exemplar quotations to illustrate each theme.

결과

Results

A. 왜 clinical teachers들은 OF가 되어달라는 요청을 받아들였는가?

A. Why clinical teachers accepted the invitation to be Osler Fellows

선택되었다는 명예로움

The honor of being chosen.

Osler라는 이름의 명성cachet이 이러한 기분을 갖는데 중요한 역할을 했음

The cachet of Osler’s name also played a role in this sentiment of honor and recognition,

프로그램의 목표가 자신의 개인적/전문직업적 가치의 부합

The match between program goals and personal/professional values.

여기에 참여하는 것은...다음을 할 수 있는기회라 생각하였음

they saw their involvement as an opportunity

• 의과대학에 reconnect되고 to reconnect to the faculty of medicine,

• 학생을 알게되고 to get to know the students, and

• 의학교육에 변화를 가져오는 to make a difference in medical education

그리고 이 기회는 (기존 교육과정에서는 놓치고 있던 부분인) '치유자이자 전문직으로서의 의사'에 초점을 맞춤으로써 가능한 것이라고 보았다. 또한 어떤 사람은 새로운 교육과정이 그것을 무시하기에는 너무나 중대하였기에, 참여하는것은 자신의 의무obligation이라고 보았다.

by focusing on the physician as healer and professional, a value they considered missing from the previous curriculum. Others commented that it was their “obligation” to participate, especially as the direction of the renewed curriculumwas too important to ignore.

학생과의 connection

The connection with students.

학생을 성장시키고 멘토링을 해주고자 하는 열망

학생들의 "이상주의에 대한 감각과 흥분"을 느끼는 것,

학생의 삶에 중요한 역할을 하고자 하는 것

a desire to nurture and mentor students, to feel their “excitement and sense of idealism,” and to play an important role in their lives.

B. 'OF가 된다는 것'이란

B. Perceptions on being an Osler Fellow

학생과 함께 학습working하는 즐거움

The joy of working with students.

학생과 함께 working함으로써, 그들이 시간에 따라 성장하고 발전해나가는 것을 바라보고, 의사가 되는 "여정"에서 학생을 도와준다.

joy of working with students, watching them“grow and develop” over time, and helping them in the “journey” of becoming a physician.

차이를 만들고자 하는 열망

The desire to make a difference.

의학교육과 학생의 삶에 차이를 만들고자 하는 열망이 있었다. 이것은 핵심 가치(치유자와 전문직으로서의 의사)를 addressing하고, 의학교육을 구제saving 또는 복원restoring하는(잃어버린 어떤 것을 찾는 것), 학생들이 어떻게 의사갈 되어야 하는가를 가르치는 것 등으로 이룰 수 있는 목표였다

desire to make a difference in medical education and their students’ lives by addressing core values (e.g., the physician as healer and professional), by “saving” or “restoring” medical education (and in so doing, returning something that was lost), and by teaching students how to be physicians.

성찰과 리뉴얼의 과정

The process of reflection and renewal.

성찰하고, 자신의 가치를 확인하고 복원하는 기회였다. 그리고 "새로운 기분을 느끼게 하는feel again" 기회였다.

opportunity to reflect, to confirm or restore their values, and to “feel again.”

OF는 어떻게 학생과 함께 working하는 것이 자신들로 하여금 스스로의 행동을 돌아보고, "학생의 눈을 통해" 자신을 바라보게 "강제forces"하였는가를 언급함.

Osler Fellows commented on how working with students “forced” them to reflect on their own behaviors and look at themselves “through their students’ eyes.”

커뮤니티의 형성

The building of community.

커뮤니티 의식과 협력관계collegiality가 발달하였다.

sense of community and collegiality that had developed among them:

C. OF를 위한 교수개발 프로그램에 대한 생각

C. Perceptions of the faculty development component of the Osler Fellowship

공동의 목표에 초점을

A focus on a common purpose.

OF들은 워크숍의 목표가 자신의 요구에 잘 부합하였고, 내용이 즉각적으로 적용가능하였으며, 그들에게 주어진 활동이 학생들과 함께 working하는데 유리함head start를 주었다고 했음.

They particularly appreciated the fact that the workshop objectives were relevant to their needs, that the content was immediately applicable, and that the activities gave them a “head start” in working with their students.

"뭔가 다른" 종류의 내용

A “different” kind of content.

내러티브 의학과 성찰적 실천을 강조하는 것은 "thinking outside the box"와 같았으며, 어떤 사람들은 치유자와 전문직업성을 강조하는 내용이 긍정적이라고 했다.

they saw the emphasis on narrative medicine and reflective practice as “thinking outside the box;” some also saw the content, with the emphasis on healing and professionalism, as a positive value.

지속성

A sense of continuity.

OF들 상호간, OF와 교수개발자, OF와 교육내용과의 관계가 전 세션에 걸쳐 지속되었다. 다수의 OF는 이 지속성을 다른 전통적 FDP와의 두드러지는 차별성이라고 강조했다.

with each other, with the faculty developers, and with the content that ran through the sessions. A number of the Osler Fellows highlighted continuity as a distinct difference when comparing these workshops with more traditional faculty development activities.

피어(동료)-멘토십의 기회

An opportunity for peer mentorship.

더 나아가서, 생각과 경험과 정보를 토론할 기회가 자신들이 옳게 하고 있다on the right track는 확신을 갖게 하는reassuring데 도움이 되었고, 또 "기반grounded"을 유지remain하는데도 도움이 되었다. 많은 경우에 (비록 두 가지가 모두 필요할지라도) 이러한 경험의 공유와 집단적 문제-해결은 정보의 전달보다 더 가치가 있었다고 하였다.

Moreover, the chance to discuss ideas, experiences, and information had the noted benefits of “reassuring” the fellows that they were on the right track and helping themto remain “grounded.” In many ways this sharing of experiences and collective problem-solving was considered more valuable than the transfer of information, though most felt that one would not have happened without the other.

이들은 롤모델링을 통하여(즉, 동료들과 그룹 퍼실리테이터를 봄으로써) 멘토링에 대하여 배우게 되었다고 느꼈다.  OF는 존중으로서 대하는 것with respect이 교수개발 이니셔티브의 중요한 점이라고 느꼈다.

They felt that they were learning about mentoring through role modeling—that is, by watching their peers and the group facilitators. The Osler Fellows also identified the notion of being treated with respect as an important aspect of this faculty development initiative.

공동체에 소속된다는 것

Belonging to a community.

여기에는 공동체에 소속되어있다는 느낌, 확신confirmation, 강화reinforcement, 공통의 목표와 가치 등을 포함한다.

This sense included the notion of belonging to a community as well as a confirmation, or reinforcement, of shared goals and values.

고찰

Discussion

의학교육자들은 종종 교수들을 educational task를 위하여 모집하는 것이 어렵다고 말하며, 자유 지원제volunteerism에 이어서 번아웃의 가능성을 어려움으로 꼽는다. 놀라울 정도로 교수의 모집과 번아웃은 OF의 문제가 아니었다. OF라는 이름이 프로그램에 명확한 가치를 부여해주었다. 교수들이 느낀 명예로움과, 이 프로그램에 참여하는 것에 대한 recognition, 그리고 전체 프로그램에 걸쳐 축적된 reconnection의 느낌도 여기에 가치를 더해주었다.

Medical educators often talk about the difficulty of recruiting faculty members for educational tasks or the possibility of burnout secondary to volunteerism.20,21 Surprisingly, neither recruitment nor burnout was a challenge in the Osler Fellowship, For example, the name, Osler Fellow, endowed the program with a clear sense of value. The faculty members’ sense of honor and recognition in participating—as well as their sense of reconnection that accrued over the course of the program—also added value.

OF에 참여하는 것이 connection과 reconnection의 느낌을 가지게 해주었다는 것도 흥미로운 점이다. 학생과 함께 working하는 것이 교사들의 단절disconnect된 느낌을 줄여주었다는 것은 관심을 가질 필요가 있다. Brookfield는 비판적 성찰의 개념을 통해서 교수가 자기자신을 학생의 눈으로 바라보는 것이 리뉴얼에 필수vital적임을 강조하였다.

The observation that participation in the Osler Fellowship led to a sense of connection and reconnection is also of interest. The fact that working with students in a program that addressed teachers’ intrinsic values helped to mitigate this sense of disconnect merits attention Brookfield23 has described the concept of critical reflection, particularly the importance for faculty to see themselves through students’ eyes, as vital for renewal.

의학교육에서 최근 연구는 근무지-기반 학습(learning for work, learning at work, and learning from work)의 장점을 주장한다. 많은 경우 OF의 교수개발프로그램 요소들은 근무지-기반 학습의 예제example가 된다. OFship은 의과대학교수들이 학생들을 멘토링하고 가르치는 동안에 멘토링 스킬과 교육 스킬을 향상시키기 위한 프로그램이다.

Recent advances in medical education have purported the advantages of work-based learning, often defined as learning for work, learning at work, and learning from work.24 In many ways, the faculty development component of the Osler Fellowship is an example of work- based learning,25,26 The Osler Fellowship is a faculty of medicine program designed for participants to improve their mentoring and teaching skills while they mentor and teach medical students.

Situated learning 는 지식은 맥락적으로 존재contextually situated하며, 근본적으로 그것이 활용되는 행동/맥락/문화에 영향을 받는다는 개념에 근거한다. 지식이 authentic context에 situated되어있다는 관점이 OFship의 교수개발프로그램을 이해하는데 중요한 함의를 준다. 특히, OF들은 situated learning의 다수의 요소들을 강조하였다(cognitive apprenticeship, reflection, practice)

Situated learning is based on the notion that knowledge is contextually situated and fundamentally influenced by the activity, context, and culture in which it is used.27,28 This view of knowledge as situated in authentic contexts has important implications for our understanding of the faculty development component of the Osler Fellowship, especially as the participants’ observations highlight a number of the elements of situated learning: cognitive apprenticeship, reflection, and practice.29

situated learning과 밀접한 관련이 있는 것이 실천공동체communities of practice이다. Barab and colleagues의 정의는..“persistent, sustaining, social network of individuals who share and develop an overlapping knowledge base, set of beliefs, values, history and experiences focused on a common practice and/or mutual enterprise.” 이며, Lave and Wenger는 성공적인 실천공동체에게 중요한 다섯가지 요인을 제안하였다.

Closely tied to the notion of situated learning are communities of practice. Barab and colleagues30 define a community of practice as a “persistent, sustaining, social network of individuals who share and develop an overlapping knowledge base, set of beliefs, values, history and experiences focused on a common practice and/or mutual enterprise.” Further, Lave and Wenger31 suggest that the success of a community of practice depends on five factors: the existence and sharing of a common goal, the use of knowledge to achieve that goal, the nature and importance of relationships formed among community members, the relationships between the community and those outside it, and the relationship between the work of the community and the value of the activity.

실천공동체라는 개념은 아리스토텔레스가 phronesis라고 부른 철학적 전통이다. 실천지란, 영어의 prudence(신중, 사려분별)에 해당하는 것으로서, 다음과 같이 정의된다. "특정 개인, 특정 문제, 특정 사례의 구체적인 사항을 다루기 위한 실천적 지혜"이며, 환자-의사 관계가 그와 같다.

실천지(實踐知): 목적과 그 달성 수단을 결정하는 지혜.

The concept of a community of practice is, in part, rooted in a distinguished philosophical tradition dating to the Aristotelian idea of phronesis. Phronesis, often equated to “prudence” in English, has been defined as “practical wisdom in dealing with particular individuals, specific problems and the details of practical cases or actual situations”32— such as in the doctor–patient encounter.

 

Dunne은 이론적 지식과 실천적 지식theoretical knowledge (sophia and episteme) and practical knowledge (techne and phronesis)을 구분하였다. 비록 학자들 사이에는 비이론적 지식의 구인nontheoretical knowledge constructs인 techne와 phronesis를 세밀하게 구분하려는 논쟁이 있으며, 의학에 있어서 각자의 자리place가 무엇인지에 대한 논쟁이 있으나, 의료행위의 phronetic한 특징은 점점 더 인정받고 있다.

Dunne33 has explored the distinction between theoretical knowledge (sophia and episteme) and practical knowledge (techne and phronesis). Although scholars debate the precise difference(s) between the nontheoretical knowledge constructs, techne versus phronesis, and their respective places in medicine, they increasingly recognize the phronetic character of medical practice, most notably in bioethics34 and clinical reasoning.35

 

MacIntyre,36는 신-아리스토텔레스 철학자로서, phronesis 를 핵심적 지적 미덕entral intellectual virtue이라고 부르면서, one that must be acquired through teaching and developed through practice or habitual exercise라 하였다. 또한 그는 이 지적 미덕이 the life of a city, or in other words, a political society or community, as well as in individuals에서 그것의 자리place를 찾을 수 있을 것이라 했다.

MacIntyre,36 a neo- Aristotelian philosopher, has described phronesis as a central intellectual virtue, one that must be acquired through teaching and developed through practice or habitual exercise. He also argued that this intellectual virtue could find its place in the life of a city, or in other words, a political society or community, as well as in individuals.

 

이러한 아이디어가 Physician Apprenticeship의 목표를 서포트해준다. MacIntyre의 실천에 대한 정의는 우리의 고찰과 밀접한 관련이 있다.

This idea is supportive of the goals of Physician Apprenticeship. MacIntyre’s definition of practice is also particularly germane to our discussion:

“[Practice is] any coherent and complex form of socially established cooperative human activity through which goods internal to that form of activity are realized in the course of trying to achieve those standards of excellence...with the result that human powers to achieve that excellence and human conceptions of ends and goods involved, are systematically extended.”36(p187)

 

OF의 경험은 MacIntyre가 말한 실천의 정의와 맞닿아 있다.

The experience of the Osler Fellows parallels MacIntyre’s definition of practice.

OFship에 참여함으로써 전문직으로서의 정체성이 깊어지고 풍부해졌다는 사실은 OF들의 ongoing work뿐 아니라 학생들의 임상행동clinical practice에서도 확인된다. Physician Apprenticeship 과 the Osler Fellowship의 맥락에서, "goods"라는 단어는 외부적인 것이든 내부적인 것이든 다음을 의미한다.

The deepening and enrichment of professional identity that has occurred by participating in the Osler Fellowship is reflected not only in the Osler Fellows’ ongoing work with students but in their clinical practices as well. In the context of Physician Apprenticeship and the Osler Fellowship, the word “goods” refers to purposes or ends, whether

• 외부: 지역사회의 요구 충족
  external (e.g., meeting the needs of a community— provision of professional, ethical, compassionate medical care) or

• 내부: 개인적 성향을 양육하고 증폭시킴
  internal (e.g., nurturing and amplifying personal inclinations and dispositions— self-reflection, renewal, community building).

 

이 정의는 agency and instrumentality라는 개념을 포함한다. 즉, 주체agent는 무엇인가를 하는 과정에서 변화하며, 실천practice그 자체가 practitioner의 수월성을 확장extend시킨다.

This definition also embraces notions of agency and instrumentality; that is, the agent changes in the act of doing and the practice itself extends the practitioner’s excellence.

Conclusions

Sir William Osler는 교수를 “senior student anxious to help his juniors.” 라고 묘사했다. 그는 또한 “When a simple earnest spirit animates a college, there is no appreciable interval between the teacher and the taught—both are in the same class, the one a little more advanced than the others.” 라고 했다. 많은 경우, 우리의 OF들은 교수에 대해서 이와 같은 이미지가 강화되었reinforced으며, 각자의 발달에 있어서 apprenticeship의 가치도 강화되었다.

Sir William Osler38 portrayed the professor as a “senior student anxious to help his juniors.” He believed that “When a simple earnest spirit animates a college, there is no appreciable interval between the teacher and the taught—both are in the same class, the one a little more advanced than the others.” In many ways, our Osler Fellows have reinforced this image of the “professor” and the value of an apprenticeship in their own development.

 

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Acad Med. 2010 Jul;85(7):1242-9. doi: 10.1097/ACM.0b013e3181da760a.

The Osler Fellowship: an apprenticeship for medical educators.

Steinert Y1, Boudreau JD, Boillat M, Slapcoff B, Dawson D, Briggs A, Macdonald ME.

Author information

• 1Centre for Medical Education, Department of Family Medicine, McGill University, Montreal, Quebec, Canada. yvonne.steinert@mcgill.ca <yvonne.steinert@mcgill.ca>

Abstract

PURPOSE:

As part of a renewed focus on the physician as healer and professional at McGill University, faculty members were recruited to teach in a four-year, longitudinal doctoring course called Physician Apprenticeship. The goal of this study was to examine the impact of this experience and the accompanying faculty development program on the teachers, known as Osler Fellows.

METHOD:

An interviewer conducted semistructured interviews with 23 clinicians to understand their experiences as Osler Fellows and ascertain their views on how the workshop-based faculty development program, designed to mirror student experiences, differed from other professional development activities.

RESULTS:

The notion of connection and reconnection with the profession emerged as a major theme, consisting of four subthemes: the joy of working with students, the desire to make a difference, the process of reflection and renewal, and the building of community. Distinctive aspects of the faculty development program included the value of a common purpose, content that corresponded with core values, a sense of continuity, peer mentorship, and the emergence of a community of practice. Teachers also reported a sense of honor in being associated with Osler's name and a feeling of privilege in accompanying students on their journeys of discovery.

CONCLUSIONS:

Participating in the Osler Fellowship, an example of situated and work-based learning, resulted in a sense of connection with students, medical education, core professional values, and colleagues. As medical educators continue to develop longitudinal mentoring programs, the authors hope that these findings will offer insights on faculty development, recruitment, and renewal.

Comment in

• Osler, guilds, and community. [Acad Med. 2011]

PMID:

 

20375831

 

[PubMed - indexed for MEDLINE]