Sunday, 23 September 2012

What's the point of faculty development?

In recent weeks, the GMC have laid out their implementation plan for the recognition and approval of medical educators and trainers working in academic and clinical contexts. In future medical trainers should
  • be ‘appropriately trained’ for their educational roles,
  • evidence their competence against the seven standards originally put forward by the Academy of Medical Educators and
  • engage in appraisal processes specific to educational roles.

The intent behind these new processes is to improve the quality of training and patient safety. Laudable goals, but how confident can we be that investing in trainer approval processes has a direct effect on the quality of training and ultimately patient care? Equally importantly, what does ‘appropriate training’ look like?  

Given the proliferation of masters level courses in medical education and the rise of faculty development activity within deaneries, royal colleges and higher educational institutions, you might imagine we already know what ‘appropriate training’ looks like and the impact it has. However, the research base is very limited and the discourse around faculty development very narrow. The long chain of assumed causal relationships (faculty development leads to better training leads to better learning leads to better clinical practice leads to better patient care) has not, to my knowledge at least, been the subject of any large-scale research study.

I should perhaps declare an interest here! For the past 15 years I have been engaged in a range of work activity, which falls into the loose category of ‘faculty development’ within medicine, dentistry and health. I lead a masters’ programme in medical education and support a range of faculty development activity within and across NHS Trusts and Deaneries. I believe faculty development can ‘make a difference’ – but making a difference starts from having a clear sense of purpose and a repertoire of practices that goes beyond typical generic ‘teaching the teachers’ workshops.

What is the point of faculty development?

This is a question I explored in a study tracing the demise of medical apprenticeship and the rise of faculty development in PGME. In the post MMC era, claims about the transformational potential of faculty development were embedded within the ‘professionalisation of medical education’ discourse. As part of my study I had the opportunity to interview medical educators from within and outside medicine, taking forward the faculty development agenda in one deanery. In these professional dialogues with colleagues, a range of orientations towards faculty development emerged and a rich range of development practices revealed. The ways in which colleagues made sense of faculty development, and the practices they adopted, were shaped by the theoretical and biographical resources they drew upon. In my analysis, I traced a continuum of responses to the professionalisation agenda, ranging from conforming, through reforming, to transforming.

A conforming response was one where the need to professionalise medical education through faculty development went unquestioned. Seen largely as a regulatory need (linked to PMETB initially and GMC more recently), faculty development took the form of short workshops, or e-learning modules, focused on ‘core’ or ‘generic’ teaching skills, that participants could acquire and take back to their own workplaces.   Teaching here was perhaps seen as a technical enterprise or craft.

A reforming response was seen where the professionalisation agenda was accepted, but faculty development practices modified to meet the needs of certain professional groups and to be responsive to particular workplace practices. Here, it was recognized that whilst there are perhaps some generic principles, teaching on a ward round is not the same as teaching in theatre, or in general practice, or out patients. Teaching here is perhaps seen more as a social practice, shaped over time in ways that are sensitive to context and practices. Workshops were adopted, but often for certain professional groups (i.e. for surgeons), but other practices, such as workplace based teaching observations were used. 

A transforming response meant adopting a critical stance to the professionalisation agenda and to faculty development itself. Here there was a recognition that training practices of the past could not be sustained as a result of NHS reform, and that a radical re-think of training practices was required. Here, faculty development involved ‘listening to the voices on the ground’, bringing colleagues together to examine and develop training practices in ways that were sustainable in their local context. Here creative faculty development approaches, such as trainer forums, team based teaching observations (involving trainers and trainees) were being developed in order to find solutions to problems arising following implementation of new PGME curriculum. Here too, doctors were engaging in masters programmes in education and educational leadership in order to have access to theoretical tools that would help craft such solutions.

Which leads me back to the question, what is the point of faculty development? If it is merely to satisfy a regulatory need, processes of approval and recognition will suffice. They put education on the agenda, they raise awareness of educational practices and they make trainers accountable for their actions. If however, it is to develop training practices that are sustainable in a reformed, and reforming, NHS, something more educationally sophisticated and meaningful is required.