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.
