How Culture Is Understood in Faculty Development in the Health Professions: A Scoping Review

Factors influencing clinician-educators' assessment practice in varied Southern contexts: a health behaviour theory perspective

In many contexts, responsibility for exit-level assessment design and implementation in undergraduate medical programmes lies with individuals who convene clinical clerkships. Their assessment practice has significant consequences for students' learning and the patients and communities that graduates will serve. Interventions to enhance assessment must involve these assessors, yet little is known about factors influencing their assessment practice. The purpose of this study was to explore factors that influence assessment practice of clerkship convenors in three varied low-and-middle income contexts in the global South. Taking assessment practice as a behaviour, Health Behaviour Theory (HBT) was deployed as a theoretical framework to explore, describe and explain assessor behaviour. Thirty-one clinician-educators responsible for designing and implementing high-stakes clerkship assessment were interviewed in South Africa and Mexico. Interacting personal and contextual factors influencing clinician-educator assessment intention and action were identified. These included attitude, influenced by impact and response appraisal, and perceived self-efficacy; along with interpersonal, physical and organisational, and distal contextual factors. Personal competencies and conducive environments supported intention to action transition. While previous research has typically explored factors in isolation, the HBT framing enabled a systematic and coherent account of assessor behaviour. These findings add a particular contextual perspective to understanding assessment practice, yet also resonate with and extend existing work that predominantly emanates from high-income contexts in the global North. These findings provide a foundation for the planning of assessment change initiatives, such as targeted, multi-factorial faculty development.

Disentangling faculty development: A scoping review towards a rich description of the concept and its practice

BACKGROUND

There is wide variation in how faculty development (FD) is practiced globally and described in the literature. This scoping review aims to clarify how FD is conceptualised and practiced in health professions education.

METHODOLOGY

Using a systematic search strategy, 418 papers, published between 2015-2023, were included for full text review. We extracted data using closed and open-ended questions. Quantitative data were summarised using descriptive statistics and qualitative data synthesised using content analysis.

RESULTS

Faculty development was the most frequently used term encompassing a range of understandings and practices. Many papers focused on educators' enhanced understanding of teaching, learning, and assessment. Several highlighted the social context of collaborative practice and organisational learning. FD formats included workshops, courses, longitudinal programs, and coaching and mentoring. Dominant conceptual frameworks included Kirkpatrick's model of evaluation, communities of practice theory, adult learning theory, and experiential learning.

CONCLUSIONS

Although FD continues to evolve in response to the dynamic HPE landscape, this growth needs to be accelerated. To facilitate meaningful collaboration across professions, contexts, and countries, attention must be paid to terms used and meanings ascribed to them. Those responsible for FD need to think anew about its purpose and practice, demonstrating flexibility as the ever-changing context demands.

Success stories: exploring perceptions of former fellows of a global faculty development program for health professions educators

BACKGROUND

Faculty development programs (FDPs) in health professions education (HPE) are instrumental in supporting, promoting, and improving HPE curricula and activities that target individual- and system-level capacity strengthening. FAIMER, a division of Intealth, has been offering FDPs for global health professions educators in HPE and leadership for over two decades through the International FAIMER Institute in the USA and FAIMER Regional Institutes located globally. This paper explores perceptions of former program participants (Fellows) of FAIMER global FDPs by eliciting their success stories.

METHODS

The study utilized a modified Success Case Method approach. Study participants recruited were 14 FAIMER Fellows nominated as exemplars of success cases by program directors and faculty members from seven global sites, using extreme case sampling technique. Of the 14 Fellows, two were from Africa, nine from Asia and three from Latin America. In-depth interviews were conducted with each Fellow to understand their self-perceived success, and factors from both their local context and FAIMER's FDPs that have contributed to their success. Theoretical thematic analysis method was used to analyze the data.

RESULTS

The top three areas of success perceived by Fellows were career advancement & recognition, professional development, and advancement of HPE. Fellows identified both institutional-level factors and personal attributes as contributing to their success. They also reported that FAIMER global FDPs have substantially contributed to their success by expanding professional networks, fostering academic achievement, and enhancing interpersonal development and leadership skills.

CONCLUSIONS

The findings show that Fellows perceive that there are multiple pathways for them to succeed in advancing the field of HPE. The Fellows' stories highlight the continuing value of FAIMER global FDPs for HPE educators worldwide in professional development and leadership. The study also proposes recommendations for enhancing faculty development activities in HPE.

Developing a programmatic approach to faculty development and scholarship using the ASPIRE criteria: AMEE Guide No. 165

Faculty Development (FD) has become essential in shaping design, delivery and quality assurance of health professions education. The growth of FD worldwide has led to a heightened expectation for quality and organizational integrity in the delivery of FD programmes. To address this, AMEE, An International Association for Health Professions Education, developed quality standards for FD through the development of the AMEE ASPIRE to Excellence criteria. This guide uses the ASPIRE criteria as a framework for health professions educators who wish to establish or expand approaches to FD delivery and scholarship within their institutions.

Cultural Considerations for Patient and Community Education in Global Health: A Qualitative Study in Lesotho

Background: In global health, international nongovernmental organizations (NGOs) frequently hire, train, and partner with host-country clinicians who manage public outreach and patient care. Purpose and Research Design: We conducted a general interpretivist study of Basotho clinicians hired by NGOs and academic affiliates in Lesotho to identify cultural barriers and facilitators to community and patient education. Data Collection and Analysis: We conducted 13 interviews involving 16 participants (one physician, one nutritionist, 14 nurses). Using an inductive and iterative approach, we analyzed interview transcripts through the lens of social cognitive theory and identified 15 themes. Results: Major findings highlighted: 1) patient and community learners may view Basotho clinicians as authority figures; 2) family and community power dynamics affect healthcare access for vulnerable patient groups; and 3) village leaders may refuse community education when excluded from problem-solving and early planning. Conclusions: Although local clinicians and community members may identify with the same cultural group, clinicians can encounter cultural barriers to patient and community education.

Exploring the culture of faculty development: insights from Canadian leaders of faculty development

Background

Although the word culture is frequently mentioned in research on faculty development (FD), the concept is rarely explored. This research aimed to examine the culture of FD in Canada, through the eyes of leaders of FD in the health professions. Studying culture can help reveal the practices and implicit systems of beliefs and values that, when made explicit, could enhance programming.

Method

FD leaders from all Canadian medical schools were invited to participate in semi-structured telephone interviews between November 2016 and March 2017. The researchers used a constructivist methodology and theoretical framework located within cultural studies, borrowing from phenomenological inquiry to move beyond descriptions to interpretations of participants' perceptions. Constant comparison was used to conduct a thematic analysis within and across participants' interview transcripts.

Results

Fifteen FD leaders, representing 88% of medical schools (15/17) in Canada, participated in this study. Four themes characterized the culture of FD: balancing competing voices and priorities; cultivating relationships and networks; promoting active, practice-based learning; and negotiating recognition.

Conclusion

Although the culture of FD may vary from context to context, this study revealed shared values, practices, and beliefs, focused on the continuous improvement of individual and collective abilities and the attainment of excellence.

Common content, delivery modes and outcome measures for faculty development programs in nursing and midwifery: A scoping review

BACKGROUND

Globally, there is a call for urgent investment in nursing and midwifery education as high-quality education leads to quality care provision. This call for investment includes a 'focus on faculty', that is, development of those who teach. However, challenges in the preparation and development of faculty have been identified and include lack of recognition of ongoing development, limited pathways for career progression, inadequate provision of, or access to, faculty development opportunities and a lack of research evaluating sustained impact of programs.

OBJECTIVES

The aim of this review was to identify, synthesise and report on common program content, modes of delivery and evaluation processes of faculty development programs in nursing and/or midwifery.

METHODS

A scoping review was conducted following Joanna Briggs Institute guidance. A comprehensive search strategy was developed and conducted in six health and/or education focussed databases. Peer-reviewed articles, published in English in the last decade and with a primary focus on nursing and/or midwifery faculty were included in the review. References lists of included studies were searched and a search to identify relevant grey literature was conducted. Using systematic review software, titles and abstracts were reviewed by two reviewers with a third reviewer used to resolve discrepancies. Data were extracted and recorded, key characteristics were mapped and content analysis used to synthesise, analyse and report findings.

RESULTS

Seventeen articles were included in the review and identified common content provided in nursing and midwifery faculty development programs. The predominant content was approaches for learning and teaching. Other common content was leadership, research and assessment practices. Modes for program delivery were most often a blend of online and face-to-face. Program evaluation was reliant on participants' self-reported measures of satisfaction and confidence and did not examine impact over time.

CONCLUSIONS AND RECOMMENDATIONS

Commonalities in program content primarily focussed on learning and teaching, but also included content linked to expected professional nursing and midwifery educator competencies such as leadership and research. However, a lack of content on the key faculty activity of curriculum design was noted and should be addressed in future program development. In addition, there was a lack of evaluation on the impact of different modes of delivery. Furthermore, an over-reliance on self-reported evaluation measures and a lack of longitudinal evaluation of impact on education practice and on student experience and outcomes. Future research should include evaluation of modes of delivery and impact on faculty practice over a sustained period.

A model for design of online health professions education faculty development courses in sub-Saharan Africa

The design of faculty development courses requires a contextually aware theoretical foundation. Therefore, the study aimed to determine the feasibility of a specific conjecture map as a model for designing online health professions education faculty development courses in sub-Saharan Africa through a heuristic evaluation approach. The authors hypothesise that using heuristic evaluation strengthens an educational model's theoretical basis and feasibility.Twenty-five health professions educators from nine sub-Saharan African countries participated in this multi-phased study. In the first phase, the participants completed a survey evaluating the model and the accompanying author-generated heuristics. Then, participants' recommendations were used to make revisions. In the subsequent phase, participants reviewed these revisions and commented on the feasibility of the model within their local context.All six heuristics were revised following the initial phase, where 80 problems had been identified. Upon revision, the model was deemed feasible by all except one participant. There was a strong relationship and inter-rater agreement of feasibility between 0.84 and 0.95 regarding the model's practicality, demand, acceptability, and adaptability. Revisions to the final model and guidance documents incorporated all changes the participants recommended, confirming the model's feasibility.Theoretical models are often developed through a top-down approach, omitting the practice-based considerations that could change the formulation of the model. This study demonstrates the convergence of a theoretical and process model with theoretical, expert and end-user data triangulation. Further research is needed to test this empirically developed model.

The social construction of teacher and learner identities in medicine and surgery

INTRODUCTION

There are growing concerns about the quality and consistency of postgraduate clinical education. In response, faculty development for clinical teachers has improved formal aspects such as the assessment of performance, but informal work-based teaching and learning have proved intractable. This problem has exposed a lack of research into how clinical teaching and learning are shaped by their cultural contexts. This paper explores the relationship between teacher-learner identity, educational practice and the workplace educational cultures of two major specialties: internal medicine and surgery.

METHODS

This was a secondary analysis of a large dataset, comprising field notes, participant interviews, images and video-recordings gathered in an ethnographic study. The lead author embedded himself in four clinical teams (two surgical and two medical) in two different hospitals. The authors undertook a critical reanalysis of the observational dataset, using Dialogism and Figured Worlds theory to identify how teachers and postgraduate learners figured and authored their professional identities in the specialty-specific cultural worlds of surgery and internal medicine.

RESULTS

Surgery and internal medicine privileged different ways of being, knowing and talking in formal and informal settings, where trainees authored themselves as capable practitioners. The discourse of surgical education constructed proximal coaching relationships in which trainees placed themselves at reputational risk in a closely observed, embodied practice. Internal medicine constructed more distal educational relationships, in which trainees negotiated abstract representations of patients' presentations, which aligned to a greater or lesser degree with supervisors' representations.

CONCLUSIONS

Our research suggests that clinical education and the identity positions available to teachers and learners were strongly influenced by the cultural worlds of individual specialties. Attempts to change work-based learning should be founded on situated knowledge of specialty-specific clinical workplace cultures and should be done in collaboration with the people who work there, the clinicians.

Online faculty development in low- and middle-income countries for health professions educators: a rapid realist review

BACKGROUND

Health professions educators require support to develop teaching and learning, research, educational leadership, and administrative skills to strengthen their higher education role through faculty development initiatives. Where administration has pursued face-to-face and online faculty development initiatives, results have positively influenced health professions educators. There is limited evidence demonstrating how online faculty development works for health professions educators in low- and middle-income countries who engage in online health professions education (HPE) faculty development.

METHODS

A Conjecture Map for online HPE faculty development courses identified candidate theories for a rapid realist review. The Conjecture Map and candidate theories, Community of Inquiry and the Conversational Framework guided the development of search terms and analysis for this review. Three searches using EbscoHost databases yielded 1030 abstracts. A primary and secondary research team participated in a multi-reviewer blinded process in assessing abstracts, selecting full-text articles, and data extraction. The primary research team analysed eight articles for this rapid realist review to answer the research question: How do online HPE faculty development courses work, or not work, in low- and middle-income countries? Data were analysed and mapped to the initial Conjecture Map and the research question.

RESULTS

The research references US-based organisations forming partnerships with low- and middle-income countries, and who provide funding for online HPE faculty development initiatives. These initiatives design courses that facilitate learning through engagement from which participants report beneficial outcomes of professional and career development. The review does not clarify if the reported outcomes are generalisable for facilitators from low-and middle-income countries. The findings of this review demonstrate the role of a community of practice as the dominant mechanism through which the outcomes are achieved, based on a design that incorporates six triggering events. The design aligns the triggering events with the three categories of the Community of Inquiry-a theory for designing online learning environments.

CONCLUSION

Health professions educators in low- and middle-income countries can develop professional and interpersonal skills through a well-designed, specifically constructed online community that prioritises active discussion.

Scoping reviews in medical education: A scoping review

OBJECTIVES

Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities.

METHOD

The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review.

RESULTS

One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal.

CONCLUSIONS

Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.

Assessing Asian Medical Students' Readiness for Diversity: Localizing Measures of Cross-Cultural Care Competence

Phenomenon: There is now broad acceptance that the development of cross-cultural competence (CCC) supports the delivery of appropriate care to diverse groups and is an essential component in medical education worldwide. CCC training in East Asian contexts has been constrained by the fact that "cultural diversity" training globally has focused primarily on the needs of racial and ethnic communities, to the relative neglect of other groups. The present study explores Taiwanese students' perceptions of CCC provision to identify gaps in local medical education and thus facilitate a more systematic delivery of CCC. Approach: Using an adapted and translated version of the Cross-Cultural Care Survey developed by Harvard Medical School, we collected 1567 student responses from four geographically-distributed Taiwanese medical schools between 2015 and 2017. In addition to student responses, we also collected 122 clinical teacher responses from two of the four medical schools that were surveyed to cross-examine the students' self-perceived competence. The data were analyzed with SPSS and ANOVA was employed with student data to compare the differences among different stages. The analysis focuses on CCC in 4 stages of training: general education, basic pre-clinical and integrated clinical sciences, clerkship, and internship. Findings: The findings show that students felt unprepared to deal with health disparities and the needs of diverse groups and there was no evidence of an increased sense of preparedness in the development of relevant skills in the analyses of the pre-clinical to clinical stages of the curriculum. Similarly, teachers also perceived students across the different stages of training to be unprepared in dealing with the health disparities and needs of diverse groups. However, although findings from teachers' responses parallel those from students, teachers tend to perceive students to be even more unprepared than they perceive themselves to be. The training for CCC appeared inadequate from both set of data and students perceive CCC training to be less explicitly evident in the medical program as it advances from the foundation stage to the pre-clinical stage. Insights: The study raises some crucial issues in terms of diversity and CCC training in medical education programs. The fact that increased awareness of health disparities and the needs of diverse groups fails to be aligned with a sense of preparedness and skillfulness confirms that CCC has not been explicitly and sufficiently addressed in the medical curriculum, particularly in the pre-clinical stage when the focus is on acquiring scientific and technical knowledge. This study shows how a questionnaire designed by and for an American medical institution situated in a highly diverse society can be adapted so that its findings serve as a baseline for medical education programs in Taiwan, and perhaps in other countries that are beginning to acknowledge hitherto "hidden" diversity. This study also has implications which indicate that CCC is crucial in the delivery of appropriate care by members of the medical profession to diverse patients.

Exploring the Impact of Health Care Provider Cultural Competence on New Immigrant Health-Related Quality of Life: A Cross-Sectional Study of Canadian Newcomers

Introduction:

New immigrants underutilize health care because of multiple barriers. Although culturally competent health care improves access, it is typically assessed by providers, not newcomers whose perceptions matter most.

Methodology:

Surveys that included measures of cultural competence and health-related quality of life (QOL) were completed by 117 new immigrants in Windsor, Ontario, Canada. A series of stepwise linear regression analyses were conducted to identify independent predictors of QOL and its four domains: physical health, psychological, social relationships, and environment.

Results:

Our adjusted results suggest that experiences of discrimination was negatively associated with overall QOL (β = −.313; p < .001) and its psychological (β = −.318; p < .001), social (β = −.177; p = .048), and environmental (β = −.408; p < .001) domains.

Discussion:

Discrimination negatively influences new immigrant QOL. Provider cultural competency training should emphasize the influence of provider discrimination on immigrant health and explore learners’ values and biases.

An international study on teachers' conceptions of learning and teaching and corresponding teacher profiles

Introduction: Teachers' conceptions of learning and teaching (COLT) affect their teaching behaviour. The 18 item COLT instrument has been developed in the Netherlands and comprises three scales, 'teacher centredness', 'appreciation of active learning' and 'orientation to professional practice'. Previously we found five teacher profiles. The aim of this study was to find out if the COLT instrument can be used in an international setting.Methods: Data were collected with the web-based COLT. Cronbach's alphas of the three COLT scales were calculated. Subsequently a cluster analysis was conducted to identify different teacher profiles, followed by a split half validation procedure.Results: Respondents (n = 708) worked in 28 countries. Cronbach's alphas were 0.67, 0.54, and 0.66. A six-cluster solution fitted best, based on meaning and explained variance. The sixth teacher profile scored high on 'teacher centredness', average on 'appreciation of active learning' and low on 'orientation to professional practice'. The split half validation resulted in a Cohen's kappa of 0.744.Discussion: Cronbach's alphas indicated acceptable reliablities for all three subscales. The new, sixth profile was labelled 'neo-transmitter'.Conclusion: We found evidence supporting the validity of the use of COLT in an international context and identified a new, sixth teacher profile.

Identification of capacity development indicators for faculty development programs: A nominal group technique study

BACKGROUND

Although there have been many research studies of the effectiveness of faculty development in health profession education, the contribution of these programs to organizational development through capacity development has not been studied. Further understanding of capacity development requires appropriate indicators and no previous indicators for faculty development of health profession educators were identified. The aim of the study was to identify indicators of capacity development in the context of faculty development programs at Tehran University of medical sciences (TUMS).

METHODS

A nominal group technique session was conducted with key informants from faculty development program providers to generate and prioritize a list of capacity development indicators.

RESULTS

A list of 26 indicators was generated and five categories were identified: Development and innovation in teaching and learning process, Development and innovation in communication and collaboration at different levels, Development and sustaining faculty development programs, Development of educational leadership and management, Development in scholarship.

CONCLUSIONS

Capacity development for faculty development interventions of health profession educators is a process of engagement within a wider system, including individual and collective action, and involves the socialization of the teachers into suitable roles through professional identity development and participation within the wider system.