By Linda Snell (@LindaSMedEd)
How many times have you heard a teacher say, ‘I just don’t have the time to teach’, or ‘how can I teach when I am not an expert’, or ‘I don’t understand this CBME approach’. These, and similar comments raise a common challenge – how to engage teachers. This issue has perhaps become more evident as competency-based medical education (CBME) has been implemented worldwide. There are many reasons why clinicians may not be engaged in teaching. Some existed prior to the change to CBME: conflicting time commitments for clinicians, the challenge of dealing with a learner in difficulty, insufficient knowledge about teaching, no recognition by teachers or the institution of the importance of teaching, or lack of motivation to teach. Other reasons are new or have become more prominent since the inception of CBME: discomfort giving constructive feedback, lack of skill in coaching, recognition of work-based assessment as a low-stakes evaluation, lack of familiarity using the ‘tools’ used in CBME (e.g., an e-portfolio), not wanting to relinquish control in a patient encounter when observing a trainee, or change fatigue.
So, what can we do to get clinical supervisors to engage in teaching? This will take actions at the institutional level to address a teaching culture, as well as activities aimed at the teacher to motivate them and provide them with needed tools.
A culture change at an institutional level is needed to recognize the importance of teaching. This might include instituting teaching awards, or rewarding ‘best teachers.’ There must also be an acknowledgement that teaching in a CBME world takes time, to observe, provide effective feedback and document work-based assessments; the institution must provide ‘protected time’ for this. Teachers can be motivated if provided with a sense of purpose, e.g., ‘you are transmitting your valuable knowledge and skills’, or ‘we are training a future generation’. Or by appealing to their sense of curiosity or enjoyment, e.g., ‘try out this new teaching approach – it is fun!’
Faculty development is essential for teachers acquire skills and to get buy-in to adapt to change. Given these clinicians will be teaching in a competency-based world, should we consider faculty development loosely modelled after CBME – competency-based faculty development (CBFD)? Could we modify the five components of CBME to CBFD? The CBME components are (1) Outcome-based competencies, (2) Progressive sequencing, (3) Tailored learning experiences, (4) Competency-focused learning and (5) Programmatic assessment.
In CBFD, outcome-based competencies describe the abilities a teacher will need to fulfil their multiple roles. Some are ‘foundational’ and others are likely context-, stage-, or role-related. These could be sequenced progressively, with ‘novice competencies’ being acquired earlier during a teacher’s career. The curriculum of learning experiences could be mapped to competencies, professional development, and personal identity for specific educational roles, in an iterative design, and acquired through experiential, workplace learning, in a multi-modal realistic manner. More formal learning about teaching could be embedded in pre-existing activities e.g., grand rounds or retreats. Feedback on teaching (e.g., from learners and peers) can be compared to a benchmark and provide low stakes ‘assessment for learning’. This would provide an opportunity for reflection and coaching. Programmatic assessment in CBFD is challenging, as many teachers do not wish to be evaluated as faculty. However, personal data on teaching can be collected, collated, and fed back to faculty members as part of a general performance review already required by many institutions.
The systems involved will have to provide institutional support, effect change management strategies, and develop a CQA/CQI evaluation system, and this could also support scholarship and research about CBFD. In some systems, faculty development is part of a clinical teacher’s overall professional development, and may be mandatory.
In summary, to get teachers to engage we must motivate them, prepare them, recognize them, provide resources, and consider competency-based faculty development.
About the author: LINDA SNELL, MD, MHPE, FRCPC, MACP, FRCP (LONDON), FCAHS, IS A PROFESSOR OF MEDICINE AND HEALTH SCIENCES EDUCATION AT MCGILL UNIVERSITY AND SENIOR CLINICIAN EDUCATOR AT THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA.
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