Whither the need for faculty development?

‘The students did not receive feedback regarding their clinical performance;’‘the lecture was soul destroying;’‘the assessment strategy did not validly complement the goals of the course.’ These criticisms, among others, are prevalent within the medical education community and each is routinely met with the rejoinder, ‘It is a faculty development problem.’ The implication, which is often more explicit than implied, is that we simply need to do a better job of educating the educators regarding how to best fulfil their teaching responsibilities. Get teachers into workshops and explain how to deliver effective feedback, how to plan entertaining and informative teaching sessions, and how to design assessment strategies that will steer students in the right direction and help students and faculty alike achieve the goals of the course. Provide some practice opportunities and all the educational challenges will be resolved. Faculty development issues are often seen as the root cause of (and solution to) educational dilemmas While this is clearly an oversimplification of reality, this ‘train the trainers’ model of faculty development is described to draw attention to an article in this issue that calls into question the underlying assumption that there is, in fact, a faculty development problem. In a study of medical teachers' knowledge of pedagogic principles, McLeod et al. surveyed 5 groups of clinicians ranging (in terms of their background as educators) from community-based specialists to clinician-educators with advanced education degrees and/or locally recognised expertise.1 Using a 50-item, multiple-choice test, participants were asked to indicate the definitions of criterion referencing, the constructivist theory of learning and principles of self-directed learning, among other things. On average, participants achieved 75% accuracy, leading the authors to conclude that ‘all test-takers possess a good knowledge of the basics of pedagogy.’ Clinician-educators did perform better on this task than other groups (answering about 5 more questions correctly), but even those without formal training in education performed surprisingly well, a finding that replicates the authors' past work using this tool.2 Given that each question in the survey required an explicit response from participants, it is debatable whether or not the knowledge reflected was truly tacit (as indicated by the authors), rather than tacitly developed explicit knowledge or even explicitly developed knowledge gained informally or through formal education (the latter almost certainly being the case in the clinician-educator group). However, with respect to the question ‘Whither the need for faculty development?’ such debate is largely irrelevant. If the test truly measures knowledge of important pedagogic principles and clinicians gain an understanding of these principles by the end of their residency, then why must so many resources be poured into faculty development efforts internationally? It would be remiss not to note that the findings may simply be biased by an increased likelihood of participation among those who understand basic pedagogic principles, but there may also be a more interesting and more fruitful answer lying at the base of George Miller's famous pyramid.3 Miller's pyramid may be required to understand the apparent dissociation between performance on knowledge tests of pedagogical theory and continued desire for more faculty development Miller's pyramid of clinical competence has been broadly adopted by medical educators as a framework from which assessment protocols can be designed.4 While it has been elaborated on by some,5 at its most basic level Miller's proposal declares that knowledge is simply the foundation on which clinical competence must be built. To be able to perform well clinically requires, in addition, that one ‘knows how’, is able to ‘show how’, and that one ‘does.’ As evidence continues to accumulate that what one ‘knows’ can be used as justification to support multiple (and often mutually exclusive) actions,6 the need to assess the varying levels of the pyramid has yielded increased use of objective structured clinical examinations,4 clinic-based in-training evaluations7 and workplace assessments.8 Analogously, but lagging far behind (at least within medical education), is the development and refinement of tools that assess teaching performance by aiming further up Miller's pyramid. Objective structured teaching evaluations9 are becoming increasingly popular and researchers continue to invest in attempting to determine the value (and role) real-world student assessments of teachers should provide.10,11 However, given the arguably lower-stake nature of teaching competence relative to clinical competence, it is not terribly surprising that less effort has been directed towards the assessment of clinical teaching. More elaborate assessments of clinical teaching are required to determine whether or not faculty staff are able to utilise their knowledge of pedagogical principles effectively Nonetheless, if one believes the data that suggest the teacher contributes more to student success than other educational variables,12 then McLeod et al.'s findings should not be overlooked. They suggest that while there is knowledge to be gained from formal training in clinical education, simple experience within an academic teaching environment can enable one to become familiar with most of the principles inherent in modern pedagogical theory. Furthermore, those identified for educational excellence by nomination to the faculty of medicine's honour list showed no greater knowledge of pedagogical theory than their less rewarded colleagues. These results, combined with the prevalence of concerns regarding the need for faculty development, call into question whether or not knowledge necessarily translates into effective teaching practices in this arena. Rather, these findings would suggest that faculty development efforts (and research pertaining to those efforts) might benefit more greatly from focusing directly on the provision of work-based feedback tailored to what one actually does rather than on the simple provision of knowledge regarding various pedagogical strategies. Clinical teachers have done well to recognise that medical students' training should not stop after Year 2, whether or not students are able to prove that they have gained a solid understanding of physiology and biochemistry. It may now be time to focus the spotlight more intensely on ourselves as educators and begin to question how faculty development efforts might be constructed to better enable clinical teachers to actually ‘do’ what they appear to ‘know.

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