Yvonne Steinert

Innovation and Change in Professional Education 11
Yvonne Steinert Editor
Faculty
Development
in the Health
Professions
A Focus on Research and Practice
Faculty Development in the Health Professions
Innovation and Change in Professional Education
VOLUME 11
Series Editor:
W.H. Gijselaers, School of Business and Economics, Maastricht University,
The Netherlands
Associate Editors:
L.A. Wilkerson, David Geffen School of Medicine, University of California,
Los Angeles, CA, USA
H.P.A. Boshuizen, Center for Learning Sciences and Technologies, Open
Universiteit Nederland, Heerlen, The Netherlands
Editorial Board:
T. Duffy, School of Education, Indiana University, Bloomington, IN, USA
K. Eva, UBC Faculty of Medicine, Center for Health Education Scholarship,
Vancouver, BC, Canada
H. Gruber, Institute of Educational Science, University of Regensburg, Germany
R. Milter, Carey Business School, Johns Hopkins University, Baltimore, MD, USA
SCOPE OF THE SERIES
The primary aim of this book series is to provide a platform for exchanging experiences
and knowledge about educational innovation and change in professional education and
post-secondary education (engineering, law, medicine, management, health sciences, etc.).
The series provides an opportunity to publish reviews, issues of general significance to theory
development and research in professional education, and critical analysis of professional
practice to the enhancement of educational innovation in the professions.
The series promotes publications that deal with pedagogical issues that arise in the context
of innovation and change of professional education. It publishes work from leading
practitioners in the field, and cutting edge researchers. Each volume is dedicated to a specific
theme in professional education, providing a convenient resource of publications dedicated
to further development of professional education.
For further volumes:

http://www.springer.com/series/6087
Yvonne Steinert
Editor
Faculty Development
in the Health Professions
A Focus on Research and Practice
Editor
Yvonne Steinert
Centre for Medical Education
and Department of Family Medicine
Faculty of Medicine
McGill University
Montreal, QC, Canada
ISBN 978-94-007-7611-1 ISBN 978-94-007-7612-8 (eBook)

DOI 10.1007/978-94-007-7612-8
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Preface
In May 2011, educators from around the world gathered in Toronto for the 1st
International Conference on Faculty Development. Organized by McGill
University and the University of Toronto, this conference was designed to
encourage the exchange of best practices and research findings, and to build a
global community of leaders dedicated to the professional development of faculty
members in a variety of settings. Convinced of the importance of faculty devel-
opment to achieve the goals of medical education in a global context, interna-
tional faculty development leaders and educators in the health professions came
together to explore how faculty development can prepare health professionals
for their multiple roles as teachers and educators, leaders and managers, and
researchers and scholars.
This book, which is a natural outgrowth of this conference and the deliberations
that took place in large group plenaries, workshops, research presentations, and
social events, aims to continue the dialogue that took place in 2011. By exploring
the scope and practice of faculty development in the health professions, we hope to
stimulate discussion about the current status of faculty development, ensure that
research (and evidence) informs ongoing practice, and highlight future directions
for research and practice.
Palmer (1998)1 has said that the ‘growth of any craft depends on shared practice
and honest dialogue among the people who do it’ (p. 144). In multiple ways, that is
the goal of this book: to make sense of the practical experience and research find-
ings that have accumulated in this community of practice in order to help move the
field of faculty development forward.
Faculty development has become an increasingly common enterprise in health
professions faculties and schools (and their affiliated hospitals), specialty societies,
regulatory bodies, and national and international associations. As a result, this book
1
Palmer, P. J. (1998). The Courage to Teach. San Francisco, CA: Jossey-Bass.
v
vi Preface
marks a moment in time where we can look back at past accomplishments and begin
to chart future directions. While there is still much to be accomplished, it is hoped
that the ideas and concepts in this book will help to inform future growth and
development.
This book is divided into six parts. Following a discussion of what we mean by
‘faculty development’ and the core concepts and principles that underlie the design
and implementation of diverse faculty development initiatives, we will describe the
capacity of faculty development programs and activities to enhance teaching and
education, leadership and management, research and scholarship, academic career
development, and organizational change. Based on the available literature and expe-
rience in the field, we will then discuss a number of approaches to faculty develop-
ment, including work-based learning and communities of practice, peer coaching
and mentorship, workshops and seminars, fellowships and other longitudinal pro-
grams, and online learning, In addition, we will highlight practical applications and
describe how faculty development initiatives can be used to promote role modeling
and reflective practice, competency-based teaching and assessment, interprofes-
sional education and practice, and international collaboration and partnerships. The
design and development of a comprehensive faculty development program will also
be addressed, as will the role of research, scholarship, and knowledge translation in
faculty development. The final part of this book will draw upon lessons learned in
each chapter and try to develop a road map for the future.
It is hoped that this portrait of faculty development will be of interest to different
stakeholders, including faculty developers, educational leaders and administrators,
teachers, students, researchers, and policy makers in all of the health professions
who are interested in pursuing their own professional learning and that of their col-
leagues. Although many of the examples in this book are drawn from medicine, the
general principles and strategies apply to the professional development of all health
professionals. Similarly, although this book is designed for health professionals in
particular, many of its concepts and insights are relevant to individuals interested in
faculty development in other fields.
Each chapter in this volume is meant to review what we know about faculty
development in a designated area, discuss avenues for further development and
innovation, and where appropriate, provide a case example. Those who read the
book from cover to cover will obtain a comprehensive overview of what faculty
development can achieve. However, each chapter can also stand alone and appeal to
readers with specific interests.
This book represents the collective efforts of a team of international scholars and
educators who accepted the challenge of forging new territory and pushing the
boundaries in their thinking and writing about faculty development. Synthesizing
the current ‘state of the art’ and extending the reach of faculty development is no
easy feat; however, each of the authors, who represent a broad range of clinical and
educational backgrounds, has risen to this challenge, bringing meaningful insights
to faculty development based on their experiences in a variety of interprofessional
and international contexts.
Preface vii
This Springer Series focuses on innovation and change in professional education.

In this case, it is the professional development of faculty members that we are
addressing. We hope that this collection, which includes content that is not otherwise
available, will facilitate program planning, implementation, and evaluation, move the
scholarly agenda forward, and promote dialogue and debate in this important field of
practice and scholarship.
Montreal, QC, Canada Yvonne Steinert, Ph.D.

April 2013
Editor’s Bio
Yvonne Steinert is a clinical psychologist and Professor of Family Medicine in the

Faculty of Medicine at McGill University, Montreal, Quebec, Canada. She is the
Director of the Centre for Medical Education, the Richard and Sylvia Cruess Chair
in Medical Education, and the founding Associate Dean for Faculty Development in
the Faculty of Medicine (1993–2011). Dr. Steinert has been engaged in medical
education and faculty development for over 25 years in a variety of settings and is
actively involved in undergraduate and postgraduate medical education, educational
research, and the design and delivery of interprofessional faculty development pro-
grams and activities. Her research interests focus on teaching and learning in the
health professions, curriculum development and program evaluation, the impact of
faculty development on the individual and the organization, and the continuing pro-
fessional development of faculty members. She has written extensively on the topic
of faculty development and medical education, is frequently invited to address
health professionals and medical educators in academic and scientific settings, and
has been a driving force in promoting faculty development in local, national, and
international contexts. Dr. Steinert is a Past-President of the Canadian Association
for Medical Education and the recipient of several honors and awards in recognition
of her contributions to faculty development and health professions education.
ix
Acknowledgements
It has been said that medical education is a team sport. So is faculty development
and writing a book. I am deeply grateful to each and every one of the authors for
their commitment to this project and for their understanding of the centrality of
faculty development in promoting excellence in the health professions.
I would also like to acknowledge Ivan Silver, co-chair of the 1st International
Conference on Faculty Development in the Health Professions. I remain indebted to
him for his vision, his wisdom, and his friendship. I am also grateful to both series
editors, Wim Gijselaers and LuAnn Wilkerson, for having invited me to edit this
book and for having recognized the importance of faculty development in the health
professions.
Peer review is one of the hallmarks of academic writing, and this book is no
exception. Each chapter was reviewed by two of the book’s authors, or colleagues
in the field, and I would like to acknowledge the following individuals for their
constructive feedback on specific chapters: Miriam Boillat, Diana Dolmans,
Michelle Elizov, Stacey Friedman, Carol Hodgson, David Irby, Brian Jolly,
Karen Leslie, Karen Mann, Judy McKimm, Peter McLeod, Willemina Molenaar,
Clare Morris, Catherine O’Keeffe, Patricia O’Sullivan, Ivan Silver, Linda Snell,
John Spencer, Tim Swanwick, and Aliki Thomas. The accuracy of references is
another challenge in academic writing, and I am indebted to Robert Zhu, Monika
Krzywania, and Cristina Torchia, for their help with reference checking, formatting,
and making sure that we all cited our colleagues correctly.
Each of us works with a community of teachers, educators, leaders, and scholars.
I am deeply grateful to mine: the leadership of the Faculty of Medicine at McGill
University, who provided me with a professional home to explore new ideas, take
risks, and develop a faculty development program that evolved over 18 years; the
academic and administrative members of the Faculty Development Team at McGill,
who value learning and professional development and embarked on this journey
with me; the faculty members who participated in our faculty development offer-
ings and are committed to excellence in all that they do; and the members of the
Centre for Medical Education (another venue for faculty development), who have
stimulated my curiosity, challenged my thinking, and engaged in our joint pursuit
xi
xii Acknowledgements
of innovation, scholarship, and excellence. Without this ‘community of practice’,

my own understanding of this complex process would not have been possible.
Lastly, I would like to acknowledge and thank my family for their ongoing
support and encouragement. My husband, Ron, and my daughters, Elana, Shelley,
and Danna, have been my best teachers and coaches, educating me about the joys of
teaching and learning and inspiring me to pursue my dreams.
Contents
Part I Introduction
1 Faculty Development: Core Concepts and Principles ......................... 3

Yvonne Steinert
Part II The Scope of Faculty Development
2 Faculty Development for Teaching Improvement ................................ 29

Carol S. Hodgson and LuAnn Wilkerson
3 Faculty Development for Leadership and Management ..................... 53
Tim Swanwick and Judy McKimm
4 Faculty Development for Research Capacity Building ........................ 79
Brian Hodges
5 Faculty Development for Academic and Career Development ........... 97
Karen Leslie
6 Faculty Development for Organizational Change................................ 119
Brian Jolly
Part III Approaches to Faculty Development
7 Learning from Experience: From Workplace Learning

to Communities of Practice .................................................................... 141
Yvonne Steinert
8 Peer Coaching and Mentorship ............................................................. 159
Miriam Boillat and Michelle Elizov
9 Workshops and Seminars: Enhancing Effectiveness ........................... 181
Willem de Grave, Anneke Zanting,
Désirée D. Mansvelder-Longayroux, and Willemina M. Molenaar
xiii
xiv Contents
10 Intensive Longitudinal Faculty Development Programs ..................... 197

Larry D. Gruppen
11 Faculty Development Online .................................................................. 217
David A. Cook
Part IV Practical Applications
12 Faculty Development to Promote Role-Modeling

and Reflective Practice ........................................................................... 245
Karen V. Mann
13 Faculty Development for Curriculum Change: Towards
Competency-Based Teaching and Assessment ..................................... 265
Linda Snell
14 Faculty Development for Interprofessional
Education and Practice........................................................................... 287
Liz Anderson, Sarah Hean, Cath O’Halloran,
Richard Pitt, and Marilyn Hammick
15 International Faculty Development Partnerships ................................ 311
Stacey Friedman, Francois Cilliers, Ara Tekian, and John Norcini
16 Starting a Faculty Development Program ............................................ 331
Ivan Silver
Part V Research and Scholarship in Faculty Development
17 Faculty Development Research: The ‘State of the Art’

and Future Trends................................................................................... 353
John Spencer
18 Promoting Scholarship in Faculty Development:
Relevant Research Paradigms and Methodologies .............................. 375
Patricia S. O’Sullivan and David M. Irby
19 Knowledge Translation and Faculty Development:
From Theory to Practice ........................................................................ 399
Aliki Thomas and Yvonne Steinert
Part VI Conclusion
20 Faculty Development: Future Directions .............................................. 421

Yvonne Steinert
Contributors
Liz Anderson Department of Medical and Social Care Education, University of

Leicester, Leicester, UK
Miriam Boillat Centre for Medical Education and Department of Family Medicine,
Faculty of Medicine, McGill University, Montreal, QC, Canada
Francois Cilliers Education Development Unit, Faculty of Health Sciences,
University of Cape Town, Cape Town, South Africa
David A. Cook Division of General Internal Medicine and Office of Education
Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
Willem de Grave Department of Educational Development and Research,
Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht,
The Netherlands
Michelle Elizov Centre for Medical Education and Department of Medicine,
Stacey Friedman Foundation for Advancement of International Medical Education
and Research (FAIMER), Philadelphia, PA, USA
Larry D. Gruppen Department of Medical Education, University of Michigan
Medical School, Ann Arbor, MI, USA
Marilyn Hammick The Best Evidence Medical Education Collaboration,
Dundee, Scotland, UK
Sarah Hean In-2-Theory: Interprofessional Theory and Scholarship Network,
School of Health and Social Care, Bournemouth University, Bournemouth,
Dorset, UK
xv
xvi Contributors
Brian Hodges Department of Psychiatry, University of Toronto, Toronto, ON, Canada

University Health Network, Toronto, ON, Canada
Wilson Centre for Research in Education, Health Professions Education Research,
University of Toronto, Toronto, ON, Canada
Carol S. Hodgson Faculty of Medicine and Dentistry, Division of Studies in
Medical Education, University of Alberta, Edmonton, AB, Canada
David M. Irby Department of Medicine and Office of Research and Development
in Medical Education, University of California San Francisco School of Medicine,
San Francisco, CA, USA
Brian Jolly Medical Education, School of Medicine and Public Health, Faculty of
Health, The University of Newcastle, Callaghan, NSW, Australia
Australian Society for Simulation in Healthcare and Health Division of Simulation
Australia, Adelaide, SA, Australia
Karen Leslie Department of Paediatrics and Centre for Faculty Development,
Li Ka Shing International Health Education Centre, University of Toronto, Toronto,
ON, Canada
Karen V. Mann Division of Medical Education, Faculty of Medicine, Dalhousie
University, Halifax, NS, Canada
Désirée D. Mansvelder-Longayroux Faculty Development Programmes, Centre
for Innovation in Medical Education, Leiden University Medical Centre, Leiden,
The Netherlands
Judy McKimm College of Medicine, Swansea University, Swansea, West
Glamorgan, UK
Willemina M. Molenaar Institute for Medical Education, University of Groningen
and University Medical Center Groningen, Groningen, The Netherlands
John Norcini Foundation for Advancement of International Medical Education
and Research (FAIMER), Philadelphia, PA, USA
Cath O’Halloran Department of Health Sciences, School of Human and Health
Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
Patricia S. O’Sullivan Department of Medicine and Office of Research and
Development in Medical Education, University of California San Francisco School
of Medicine, San Francisco, CA, USA
Richard Pitt Interprofessional Learning, Law and Ethics Interest Group for Health
and Social Care, School of Nursing, Midwifery and Physiotherapy, Queens Medical
Centre Campus, University of Nottingham, Nottingham, UK
Ivan Silver Department of Psychiatry, Centre for Addiction and Mental Health,
Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Contributors xvii
Linda Snell Centre for Medical Education and Department of Medicine, Faculty
of Medicine, McGill University, Montreal, QC, Canada
Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
John Spencer Primary Care and Clinical Education, School of Medical Sciences
Education Development, Faculty of Medical Sciences, Newcastle University,
Newcastle upon Tyne, UK
Yvonne Steinert Centre for Medical Education and Department of Family
Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
Tim Swanwick Postgraduate Medical Education, Health Education North Central
and East London, London, UK
Ara Tekian Department of Medical Education, College of Medicine, University of
Illinois at Chicago, Chicago, IL, USA
Aliki Thomas Occupational Therapy Program, School of Physical and Occupational
Therapy and Centre for Medical Education, Faculty of Medicine, McGill University,
Montreal, QC, Canada
LuAnn Wilkerson Center for Educational Development and Research, David
Geffen School of Medicine at University of California Los Angeles, Los Angeles,
CA, USA
Anneke Zanting Centre for Education and Training, Ikazia Hospital Rotterdam,
Rotterdam, The Netherlands
Part I
Introduction
Chapter 1
Faculty Development: Core Concepts
and Principles
Yvonne Steinert
1.1 Introduction
Faculty development has become an increasingly important component of health

professions education, and most faculties and schools (and their affiliated hospi-
tals), specialty societies, regulatory bodies, and health professions organizations
now offer formal faculty development programs and activities. In fact, diverse fac-
ulty development initiatives have been reported in the health professions (Alteen
et al. 2009; Hendricson et al. 2007; McLean et al. 2008; McNamara et al. 2012;
Mitcham et al. 2002; Rothman and Rinehart 1990; Scudder et al. 2010), and there is
a burgeoning interest in both research and practice. The goal of this chapter is to
highlight common goals and definitions, the rationale for faculty development, and
the context in which faculty development occurs. We will also address the scope of
faculty development, common approaches and practical applications that respond to
educational and health care priorities, and the need for research, scholarship, and
knowledge translation in this emerging field. Whitcomb (2003) observed that ‘the
medical school’s faculty is its most important asset’ (p. 117). Although this observa-
tion was made over a decade ago, this belief still underscores much of what we do
in faculty development, as we try to nurture and sustain faculty members’ curiosity,
creativity and commitment.
Y. Steinert, Ph.D. (*)

Centre for Medical Education and Department of Family Medicine,
e-mail: [email protected]
Y. Steinert (ed.), Faculty Development in the Health Professions: A Focus 3

on Research and Practice, Innovation and Change in Professional Education 11,
DOI 10.1007/978-94-007-7612-8_1, © Springer Science+Business Media Dordrecht 2014
4 Y. Steinert
1.2 Common Goals and Definitions
Faculty development, or staff development as it is often called, refers to that broad

range of activities that institutions use to renew or assist faculty in their multiple
roles (Centra 1978). In the past, faculty development has traditionally been defined
as a planned program designed to prepare institutions and faculty members for their
various roles (Bland et al. 1990) and improve an individual’s knowledge and skills
in the areas of teaching, research, and administration (Sheets and Schwenk 1990).
However, although faculty development has historically been linked with planned
programs, we have recently observed that health professionals engage in both for-
mal and informal faculty development to enhance their knowledge and skills
(Steinert 2010a, c) and that much of their professional development is self-directed
and linked to experiential and workplace learning. As a result, and for the purpose
of this book, faculty development will refer to all activities health professionals
pursue to improve their knowledge, skills, and behaviors as teachers and educa-
tors, leaders and managers, and researchers and scholars, in both individual
and group settings.
It has been said that the goal of faculty development is ‘to teach faculty mem-
bers the skills relevant to their institutional and faculty position and to sustain
their vitality, both now and in the future’ (Steinert 2009, p. 391). With this goal in
mind, faculty development can provide individuals with knowledge and skills
about teaching and learning, curriculum design and delivery, learner assessment
and program evaluation, leadership and administration, and research and scholar-
ship. It can also reinforce or alter attitudes or beliefs about multiple aspects of
faculty members’ roles and responsibilities, provide a conceptual framework for
what is often performed on an intuitive basis, and introduce health professionals
to a community of individuals interested in common goals and pursuits (Steinert
2009). In its broadest sense, faculty development should target all faculty mem-
bers’ roles (as outlined above) and not be limited to a focus on teaching and edu-
cation, as is often the case.
It is also important to note that faculty development can serve as a useful instru-
ment in the promotion of organizational change (Jolly Chap. 6; Steinert et al. 2007).
For example, faculty development can try to influence the institutional culture by
addressing the formal, informal, and hidden curriculum (Hafferty 1998), setting
policy, or enhancing organizational capacities (Bligh 2005). In addition, by building
consensus, generating support, transmitting core content, and promoting skill acqui-
sition, faculty development can help to support curricular change (Snell Chap. 13)
and build educational capacity for the future (Swanwick 2008).
As the reader will note, the literature is replete with diverse definitions of
faculty development (McLean et al. 2008; Jolly Chap. 6; Silver Chap. 16). The
meaning of this term also differs across cultures and languages. For example, the
Dutch term, docentprofessionalisering, loosely translates as the professionaliza-
tion of teaching (Steinert 2012, p. 32). This emphasis on professionalization, of
both teachers and teaching, is appealing and aligns well with the more recent
1 Faculty Development: Core Concepts and Principles 5
proliferation of standards for teaching (Purcell and Lloyd-Jones 2003). The term
is limited, however, in its emphasis on teaching at the exclusion of other roles
and responsibilities. In some ways, the French expression, formation professo-
rale, is more inclusive by referring to the formation of the ‘professorial’ role, as
is the German phrase, personal- und organisationsentwickelung, which high-
lights both individual and organizational development. However, irrespective of
the nomenclature used, it is important to be aware of the meaning that faculty
development conveys in different languages and how this form of professional
development unfolds in different contexts and cultures.
Another question that arises from careful scrutiny of the term faculty develop-
ment relates to the meaning of ‘faculty’. Although the notion of faculty is often
considered to be synonymous with ‘academic faculty’, in this book, faculty refers
to all individuals who are involved in the teaching and education of learners at
all levels of the continuum (e.g. undergraduate; graduate; postgraduate; con-
tinuing professional development), leadership and management in the univer-
sity, the hospital, and the community, and research and scholarship, across the
health professions (e.g. communication sciences; dentistry; nursing; rehabili-
tation sciences). In some ways, the UK term, staff development, avoids a potential
bias towards the academic environment. However, it does not distinguish between
professional and administrative staff. Importantly, and in the context of this discus-
sion, the term faculty is meant to be inclusive of all health professionals working in
a variety of settings.
Health professionals frequently question the difference between faculty develop-
ment and continuing professional development (also known as continuing medical
education [CME] in some settings). This potential distinction can become even
more confusing as faculty development is a form of continuing professional devel-
opment. However, the distinction that we make, both in practice and for the purpose
of this book, is that faculty development refers to the enhancement and reinforce-
ment of faculty roles, which include education, leadership, and research, whereas
continuing professional development (or CME) refers to the maintenance and
improvement of health professionals’ clinical expertise (i.e. as health care
providers).
Lastly, it is important to note that in some jurisdictions, faculty development is
closely aligned with undergraduate health professions education; in other countries and
settings, it is often embedded within postgraduate medical education (Swanwick 2008).
For the purpose of this book, faculty development is seen as integral to all levels of
the educational enterprise – across all disciplines.
1.3 The Rationale for Faculty Development
In the last decade, we have witnessed a significant growth in faculty development

activities world-wide (e.g. Adkoli et al. 2009; Anshu et al. 2010; Cornes and
Mokoena 2004; Wong and Agisheva 2007). This increase in activity is due, in part,
6 Y. Steinert
to the realization that health professionals are often not prepared for their faculty
roles. As Westberg and Jason (1981) have said:
The one task that is distinctively related to being a faculty member is teaching; all the others
can be pursued in other settings. Paradoxically, the central responsibility of faculty mem-
bers is typically the one for which they tend to be least prepared (p. 100).
The proliferation of formal faculty development programs is also linked to a growing

sense of public accountability, the changing nature of healthcare delivery, an ongoing
pursuit of excellence, and the professionalization of teaching and medical education
(Gruppen et al. 2006; Swanwick 2008). An emphasis on quality assurance in healthcare,
and a desire to offer quality training programs for students and residents (Schofield et al.
2010), also drives the need for faculty development, as do many emerging educational
priorities (e.g. the teaching and learning of professionalism; cultural awareness and
humility; interprofessional education and practice). At the same time, we cannot ignore
the influence of regulatory and international bodies that have started to pay attention to
the accreditation of teachers and teaching (General Medical Council 2006; World
Federation for Medical Education 2007), and in so doing, have highlighted the impor-
tance of faculty development in the certification of educators (Eitel et al. 2000). As
McLean et al. (2008) have stated, referring specifically to the role of teacher and educa-
tor, ‘with demands on medical faculties to be socially responsible and accountable, there
is increasing pressure for the professionalization of teaching practice’ (p. 555). In the
UK, for example, the General Medical Council (2006) states that ‘if you are involved in
teaching, you must develop the skills, attitudes and practices of a competent teacher’
(p. 14), and the role of teacher is increasingly recognized as a core professional activity
for all doctors that ‘cannot be left to chance, aptitude or inclination’ (Purcell and Lloyd-
Jones 2003, p. 149). In North America, the Liaison Committee on Medical Education
(2012) requires that members of a medical school have the ability to be effective teach-
ers, and in Canada, the Maintenance of Certification Program recognizes faculty devel-
opment as a critical element in maintaining professional standards (Royal College of
Physicians and Surgeons of Canada 2011). Interestingly, although faculty members’
roles as leaders and researchers have not yet come under the same scrutiny, it would not
be surprising if standards for all faculty roles will emerge in the next decade, and not
only in the health professions.
1.4 The Context in Which Faculty Development Occurs
Faculty development in the health professions takes place in an ever-changing

(and complex) environment, including universities and health professions schools,
teaching hospitals and community sites, and national and international associations
and organizations (Hueppchen et al. 2011). In all of these contexts, faculty develop-
ment programs and activities must be responsive to changes in health care delivery,
educational practice, and the ever-changing roles of health professionals. It has been
said that medical education needs to align its goals and objectives with societal
needs (Nora 2010); faculty development must do the same.
1.4.1 Healthcare Delivery
Health care, and the context in which it is delivered, has changed dramatically in
the last decade. We have witnessed significant changes in disease profiles (e.g. an
aging population; more complex illnesses; a shift from acute to chronic disease),
sites of health care delivery (e.g. from single institutions to networks of care), and
health care providers (e.g. from a single professional to teams of health profes-
sionals). Patients’ (and families’) knowledge and expectations have also changed,
as has their involvement in health care. Technological developments have created
new hopes and expectations, leading to the potential of personalized medicine and
increasing costs. In fact, preoccupations with rising costs and performance have
led to increased government intervention and reform in much of the Western
world, and it is in this environment, of increased complexity and uncertainty,
interdependency and change (Mamede and Schmidt 2004), that faculty develop-
ment must unfold.
1.4.2 Clinical and Academic Environments
The clinical and academic environments in which faculty development occurs are
also changing. For example, Swanwick and McKimm (2010) describe a number of
challenges in the clinical environment that affect all health professionals: the need to
balance busy clinical, teaching, and research workloads; a perpetual lack of time;
feelings of isolation; increasing numbers of patients and students at all levels of the
continuum; and the stress of keeping up-to-date. The academic setting is also marked
by changing structures and growing interdependence (Nora 2010), an increase in
workload, greater competition for grant funding, and new demands for scholarly
productivity. How then do health professionals find the time to engage in faculty
development? Steinert et al. (2010b) explored the reasons why faculty members par-
ticipate in structured faculty development activities and identified four factors: the
perception that faculty development enables personal and professional growth; the
value that is placed on learning and self-improvement; the opportunity to network
with colleagues; and initial positive experiences that encourage ongoing involve-
ment. Awareness of these and other motivators can be very helpful in the design and
delivery of faculty development initiatives.
1.4.3 Educational Trends and Opportunities
Emerging educational trends and innovations also create new challenges – and oppor-
tunities – for faculty members. On the one hand, we are experiencing a changing
student body, marked by increased diversity and high expectations, and greater calls
8 Y. Steinert
for institutional accountability (Dankoski et al. 2012). On the other hand, we are
exploring new (and renewed) educational frameworks (e.g. competency-based educa-
tion; interprofessional education and practice), alternative venues for learning (e.g.
community-based education), and novel pedagogical methods (e.g. simulation and
other advanced technologies). All of these developments require a different skill set,
as do growing demands from regulatory bodies (as described above). The globaliza-
tion of health care, as described by Friedman et al. (Chap. 15), also poses new oppor-
tunities, and it is in this context that educational leaders and faculty developers
must remain responsive and flexible, helping faculty members to balance competing
demands and priorities.
1.4.4 The Role of Context
As is evident in this section, no discussion of faculty development would be

complete without addressing the role of the environment in which faculty mem-
bers learn and practice. The context in which faculty members work, and the
institutional norms and policies that reward and regulate their behavior, clearly
influence their professional growth (Lieff 2010). For example, some health pro-
fessions schools and organizations provide professional development opportu-
nities and encourage experimentation with new ideas. Others may discourage
such behaviors and may not lend administrative support to innovation and
scholarship. It is surprising how little has been written about the role of con-
text – and the institutional environment – in reports on faculty development.
However, as highlighted by Silver (Chap. 16), faculty developers must be sensi-
tive to institutional and environmental needs and priorities, especially as they
will influence the form and focus of various programs and activities. The culture
in which faculty development occurs must also be recognized and acknowl-
edged, and we must remain cognizant of the fact that what we do is shaped by
the cultures in which we work.
1.5 The Scope of Faculty Development
As stated earlier, faculty development can promote change at the individual and
organizational level. Moreover, although faculty development initiatives tend to pri-
marily focus on teaching and instructional effectiveness (Steinert et al. 2006), there
is a critical need for these activities to address all faculty members’ roles, including
that of leader and manager and research and scholar (Steinert 2011). Faculty devel-
opment’s role in career development and organizational change can also not be
ignored, and each of these areas will be discussed in Part II.
1.5.1 Teaching Effectiveness
As outlined by Hodgson and Wilkerson (Chap. 2), the birth of faculty development
can be traced to early efforts to enhance instructional effectiveness in higher
education and the health professions. In fact, the desire ‘to teach teachers to
teach’ has been at the root of this movement, which came to the fore in the early
1990’s. Activities and programs in this area have been designed for all health
professionals teaching in the university, the hospital, and the community setting,
at undergraduate, graduate, and postgraduate levels of education. Common areas
of focus have included large and small group instruction, feedback and assess-
ment, and enhanced teaching and learning in the clinical setting. More recently,
specific content areas (e.g. alcoholism and substance abuse; medical errors) have
become part of the faculty development agenda (Skeff et al. 2007). Surprisingly,
however, the majority of faculty development programs have not grounded their
work in a theoretical (or conceptual) framework (Steinert 2011) or framed their
initiatives around expected outcomes or competencies for teachers. However,
Hodgson and Wilkerson (Chap. 2) do just that, situating the literature on fac-
ulty development for teaching improvement in the context of the Academy of
Medical Educators’ (2012) professional standards. Irrespective of whether we
adopt this teaching framework, or those of other colleagues (e.g. Milner et al.
2011; Molenaar et al. 2009; Srinivasan et al. 2011), it remains important to have
a working blueprint. As Purcell and Lloyd-Jones (2003) have observed, in many
countries ‘there is a plethora of teacher training programmes for medical teach-
ers. But what is good medical teaching? Unless we know what it is, how can we
develop it?’ (p. 149). Outcomes-based education for faculty members seems as
important as it is for students at all levels of training, as long as we attend to
personal goals, priorities, and passions.
1.5.2 Leadership Development
As mentioned previously, health care delivery, clinical practice, and medical

education are all in a state of flux. To deal with the rapid changes and shifting
paradigms that are occurring in all three domains, health professionals need to
demonstrate diverse – and effective – leadership and management skills. As
Swanwick and McKimm (Chap. 3) highlight, ‘effective leadership is considered a
pre-requisite for the delivery of high quality health care and professional prac-
tice’. Leadership development can also be a critical factor in assuring educational
innovation and excellence, scholarly output, and a successful research career.
Although the possibilities are vast (Steinert et al. 2012), faculty development ini-
tiatives addressing leadership and management can address a number of topics,
including personal and interpersonal effectiveness, leadership styles and change
10 Y. Steinert
management, conflict resolution and negotiation, team building and collaboration,

and organizational change and development. To date, the faculty development
literature has primarily focused on educational leadership (Spencer and Jordan
2001). However, we need to think more broadly and equip ourselves and our col-
leagues with leadership capabilities that will enable us to cope with complexity
and change at multiple levels (Steinert 2011).
1.5.3 Research and Scholarship
Frontera et al. (2006) have stated that, ‘the advancement of medical science
depends on the production, availability and use of new information generated by
research’ (p. 70). As these colleagues suggest, ‘a successful research enterprise
not only depends on a carefully designed agenda that responds to clinical and
societal needs but also on the research capacity necessary to perform the work’
(Frontera et al. 2006, p. 70). Faculty development has a critical role to play in
developing research capacity, as outlined by Hodges (Chap. 4). We therefore need
to ask ourselves to what extent we are preparing health professionals to be schol-
arly. Boyer (1990) identified four categories of scholarship: the scholarship of
discovery; the scholarship of integration; the scholarship of application; and the
scholarship of teaching. Although many faculty members will agree that the pro-
motion of scholarship is an important aspect of the professional development of
health professionals, this area has not been fully developed. Programs designed to
promote scholarship can focus on definitions of scholarship, ways of promoting
scholarship among colleagues and peers, methods of disseminating scholarly
work, and ‘moving from innovation to scholarship’ (Steinert 2011). Programs
designed to build research capacity can focus on asking good research questions,
developing knowledge or skills in a focal area (e.g. developing a research team;
grantsmanship), understanding principles of research design, data collection and
analysis, and academic writing (Hodges Chap. 4). In addition, a wide range of
modalities, including workshops or other modular programs, longitudinal pro-
grams and graduate degrees, can achieve these objectives.
1.5.4 Career Development
The academic environment is increasingly complex. As Leslie (Chap. 5) points out,

faculty development for academic and career development includes the:
… explicit provision of guidance, learning opportunities and resources that enable individu-
als to reflect on their careers and those of others, to identify goals and required resources,
to implement appropriate plans and activities and to assess the processes and outcomes of
their work. The goal is for faculty to experience success and fulfillment within their con-
texts and cultures of practice.
Other authors have described faculty development as an ‘organized, goal-directed

process to achieve career progression and growth’ (Hamilton and Brown 2003, p. 1334).
From this perspective, faculty development represents a conscious effort to help faculty
members succeed in their career path, often (but not exclusively) in the academic
setting (Duda 2004; Hamilton and Brown 2003). Faculty development for career devel-
opment can address a wide range of topics, including the alignment of values between
individuals and their organizations, the processes, structures, and resources within
institutions that relate to academic roles and responsibilities, and career planning. It
can also consist of formal programs (including workshops and seminars), informal
approaches (including coaching and mentoring), or the provision of materials and
resources that can guide and advance career development. It is surprising that faculty
development programs to support career development have not been more frequently
described, especially in light of Kanter’s (2011) view that career progression can be
seen as an overarching framework for faculty development.
1.5.5 Organizational Change
As stated earlier, faculty development can play an important role in promoting orga-
nizational change and development. For example, faculty development can promote a
culture of change by helping to develop institutional policies that support and reward
excellence, encourage a re-examination of criteria for academic promotion, recognize
innovation and scholarship, and provide learning opportunities and resources for
junior and senior faculty members (Steinert 2011). In the educational arena, faculty
development can serve as a useful instrument in the promotion of curricular change
(e.g. Snell Chap. 13; Steinert et al. 2007), the acknowledgement of excellence in
teaching (Brawer et al. 2006), and the overall profile of teaching and learning. It can
also help to promote an environment that fosters critical inquiry and play a role in
post-change accommodation, adaptation and growth (Jolly Chap. 6). That is, faculty
development can help to move organizations into more post-modern frameworks
(and demonstrate a greater diversity of institutional goals and structures), promote
leadership and management (and encourage team development and role identifica-
tion), and assist in culture change in the workplace (with an emphasis on professional
rewards and incentives). In many ways, it is time for us to capitalize on the benefits of
faculty development in producing organizational change and remember that the insti-
tution (as well as the individual faculty member) can be the ‘client’.
1.6 Approaches to Faculty Development
Health professionals develop their competence as faculty members in a number of

ways. For some, this development includes participation in formal workshops or
courses; for others, learning occurs in informal ways, often through role modeling
and practical experiences in the work place. Figure 1.1 illustrates this perspective on
12 Y. Steinert
Formal
Online Learning Workshops & Seminars

Peer Coaching Fellowships & Other
Faculty Development Approach
Peer & Student Feedback Longitudinal Programs
Mentorship
Reflecting on Experience
Work-Based Learning
Learning by Observing
Communities of Practice
Learning by Doing
Informal
Individual Group
Context for Learning
Fig. 1.1 Approaches to faculty development (This figure was originally prepared for a chapter on
‘Becoming a Better Teacher: From Intuition to Intent’ (Steinert 2010a); it also appeared in Medical
Teacher (Steinert 2010c) and Academic Medicine (Steinert 2011). Re-printed with permission by
the American College of Physicians © 2010)
faculty development and provides a pictorial description of how faculty development

can move along two dimensions: from individual (independent) experiences to group
(collective) learning, and from informal approaches to more formal ones (Steinert
2010a, c). Individual approaches to faculty development include: learning from expe-
rience, which includes learning by doing, by observing, and by reflecting on experi-
ence; learning from peers and students (at all levels of the continuum); and online
learning. Group learning includes structured activities such as workshops and semi-
nars, fellowships and other longitudinal programs, as well as workplace learning and
learning in a community of practice. As can be noted in Fig. 1.1, mentorship (which
can be both formal or informal) has been placed in the center, as any strategy for self-
improvement can benefit from the support and challenge that an effective mentor
can provide (Steinert 2010a). These, and other approaches to faculty development, are
described in Part III.
1.6.1 Learning from Experience
Health professionals often become adept at what they do by the ‘nature of their
responsibilities’ and ‘learning on the job’ (Steinert 2010b; Chap. 7). Although
most of the published literature in the health professions focuses on formal

(structured) faculty development activities (Steinert et al. 2006), informal learn-
ing, often in the workplace, is equally important. This form of learning, which
incorporates role modeling, reflection, and learning from peers, can also lead to a
community of practice (Wenger 1998). O’Sullivan and Irby (Chap. 18) consider
the role of work-based learning and communities of practice in proposing new
ways to investigate the effectiveness of faculty development programs and activi-
ties. Clearly, these approaches to learning should be considered in the design and
delivery of faculty development activities, for learning at work is critical in the
development of all health professionals. We should also strive to render this
learning as visible as possible so that it can become recognized as a legitimate
form of professional development.
1.6.2 Peer Coaching and Mentorship
Peer coaching and mentorship are two additionally powerful approaches in the
development of faculty members. As Boillat and Elizov (Chap. 8) describe, they are
both highly personalized, learner-centered approaches that require a safe environ-
ment, mutual trust and collegiality, and reflection. Peer coaching has particular
appeal in the health professions because it can occur in the practice setting and
fosters collaboration (Steinert 2009). Mentorship builds on these same principles
and is often used to facilitate the socialization and career development of faculty
members. Given the ability of mentors to provide guidance, support, direction, and
expertise, it is surprising that this approach to faculty development has not been
described more frequently (Morzinski et al. 1996).
1.6.3 Workshops and Seminars
Workshops and seminars (or short series of seminars) are popular because of their
inherent flexibility and provision of active learning. Moreover, although they are
most commonly used to promote skill acquisition related to educational roles and
responsibilities, they can be equally effective for leadership development and
research capacity building. As outlined by de Grave et al. (Chap. 9), the challenge
in using this approach to faculty development is articulating the principles underly-
ing their design, incorporating theories of learning into their construction, and inte-
grating strategies to promote transfer to the workplace. Varying in duration, content,
and instructional methods, workshops and seminars represent an important aspect
of modular learning that can be incorporated into other approaches such as fellow-
ships and other longitudinal programs.
14 Y. Steinert
1.6.4 Intensive Longitudinal Programs
Fellowships and other longitudinal programs, which vary in length, format, and
emphasis, are most frequently used to develop educational skills (in teaching,
assessment, and curriculum design), leadership, and scholarship. However, this for-
mat is also effective in developing more generic leadership and research skills. As
Gruppen (Chap. 10) points out, intensive longitudinal programs are not just an
investment in individual faculty members; they are an investment in the health of the
institution. These programs, which have demonstrated the ability to achieve their
educational objectives, promote educational leadership and scholarly productivity,
and build a sense of community, have been seen as a critical factor in buttressing
education as a scientific discipline. Other approaches that complement longitudinal
programs include certificate programs and advanced degrees (Hodges Chap. 6;
Tekian and Harris 2012).
1.6.5 Online Learning
An underutilized approach to learning in faculty development is online learning.

Although interaction and social networks are highly valued by faculty members,
faculty development online offers a number of benefits that should not be over-
looked. As Cook (Chap. 11) suggests, online learning enables flexible access and
opportunities for individualized learning, assessment and feedback, and when
blended with more traditional approaches, can capitalize on the strengths of both.
Online learning can also be accomplished in a variety of ways (e.g. through online
tutorials, computer-supported collaborative learning or computer simulations), and
keys to success (beyond adherence to fundamental principles of instructional design
and use of multi-media) include focusing on a perceived need, careful planning,
clear communication, and creating a sense of community.
In considering the different approaches to faculty development outlined in this
book, it is important to remember that faculty development can provide health pro-
fessionals with knowledge and skills about teaching and learning, leadership and
management, research and scholarship, and career development. Faculty develop-
ment can also be a powerful tool in developing a community of practice, at the same
time as a community of practice can lead to the growth and development of faculty
members (Steinert et al. 2010a).
1.7 Re-conceptualizing Faculty Development
In an interesting study of teachers’ professional growth, Clarke and Hollingsworth

(2002) observed that ‘models of teacher professional development have not matched
the complexity of the process we seek to promote’ (p. 947). This observation can
apply equally to faculty development in the health professions, as most of the

literature has described formal programs and activities, continuing to reinforce an
event-based approach to faculty development when, in fact, we know that much
of our development occurs in informal (and unstructured) ways. As Clarke and
Hollingsworth (2002) have noted, it is time to shift our focus ‘from earlier concep-
tions of change as something that is done to teachers … to change as a complex
process that involves learning’ (p. 948). A similar sentiment has been expressed by
Webster-Wright (2009), who argues for a reconceptualization of professional devel-
opment that moves us away from learning that occurs in ‘discrete, finite episodes’ to
a focus on continuous and authentic professional learning. More specifically, she
suggests that we move towards the notion of promoting learning that occurs in
authentic contexts rather than the development of colleagues, which in many ways
implies a deficit model, reinforces the notion that we ‘do something to’ our col-
leagues, and ignores a critical venue for skill acquisition.
In further describing the process of ‘teacher change’, Clarke and Hollingsworth
(1994, p. 948) identify six inter-related perspectives on how teachers change, all of
which could apply to the professional growth of faculty members in the health pro-
fessions. These interrelated perspectives include:
• Change as training – i.e. change is something that is done to teachers…
• Change as adaptation – i.e. teachers change (or adapt) in response to changed
conditions…
• Change as personal development – i.e. teachers seek to change in an attempt to
improve performance or develop new skills.
• Change as local reform – i.e. teachers change something for reasons of per-
sonal growth.
• Change as systemic restructuring – i.e. teachers enact the change policies of
the system.
• Change as growth or learning – i.e. teachers change through professional activity.
Interestingly, the current view of faculty development activities in the health pro-
fessions seems to align primarily with the notion of change as ‘training’ and ‘per-
sonal development’. However, the other perspectives highlighted above should be
examined and considered in the design and delivery of faculty development in the
health professions.
This discussion also brings to the fore the importance of using theoretical
frameworks in faculty development. Silver (Chap. 16) summarizes a number of
conceptual approaches that can be used in the design and delivery of faculty devel-
opment programs, including principles of adult learning, self-directed learning, and
reflective practice. Sociocultural and constructivist theories are also described
(Cobb and Yackel 1996; Rogoff 1990; Steffe and Gale 1995). Central to this per-
spective is the view that individuals construct knowledge and meaning through
their experiences and interaction with others. In many ways, this frame, and that of
situated learning (Brown et al. 1989; McLellan 1996), which views learning as a
socially mediated and constructive process, is particularly helpful in understanding
the process of faculty development. Situated learning is based on the notion that
16 Y. Steinert
knowledge is contextually situated and fundamentally influenced by the activity,

context, and culture in which it is used (Brown et al. 1989). This view of knowledge
has important implications for our understanding of faculty development and the
design and delivery of instructional activities for faculty members. Some of the key
components of situated learning include: cognitive apprenticeship, collaborative
learning, reflection, practice, and articulation of learning skills (McLellan 1996),
elements that will be discussed further in Chap. 7.
1.8 Practical Applications That Respond to Educational

and Health Care Priorities
As stated earlier, faculty development must address educational and health care
needs in order to remain relevant and responsive. Faculty development also has a
significant role to play in many spheres, including change at the level of the indi-
vidual (e.g. increased awareness and explicit modeling of appropriate behaviors),
the curriculum (e.g. the teaching and assessment of core competencies), clinical
practice (e.g. interprofessional education and practice), and international collabora-
tion. Part IV addresses each of these areas as well as the critical question of how to
start a faculty development program.
1.8.1 Promoting Role Modeling and Reflective Practice
Role modeling and reflective practice have been increasingly recognized as impor-
tant elements in teaching and learning (Kenny et al. 2003; Schön 1983). Although
both elements are equally important in all faculty roles, the literature to date has
primarily focused on their importance in the educational realm. As Mann (Chap. 12)
suggests, faculty development for role modeling necessitates an awareness of the
power of this teaching and learning strategy, attention to personal and professional
behaviors, and a focus on the environment in which professional practice unfolds.
Reflective practice is closely tied to role modeling and incorporates the ability to
think critically about what we do. It is encouraging to know that reflective skills can
be learned, that reflective practice can take many forms, and that increased reflec-
tion enhances role modeling in all faculty roles (Mann Chap. 12). It is also not sur-
prising that brief, one-time interventions are unlikely to significantly influence role
modeling or reflective practice. However, both formal and informal approaches that
promote authentic and meaningful learning can promote change.
1.8.2 Enhancing Curriculum Change
Faculty development can both support and drive curricular change and renewal,
and in fact, the two processes are inextricably linked. As Snell (Chap. 13) points
out, faculty development has a critical role to play in promoting buy-in, addressing
resistance to change, enabling knowledge acquisition and skill development, and
attending to the organizational culture in which curricula unfold. Faculty develop-
ment for educational leadership and management, educational scholarship, and
outcomes evaluation is also needed. Problem-based learning and competency-
based education are examples of curricular initiatives that require faculty develop-
ment to ensure that faculty members are prepared to lead educational reform.
These experiences also demonstrate that different approaches to professional
development can help faculty members to master new content areas as well as
methods of teaching and assessment.
1.8.3 Advancing Interprofessional Education and Practice
Anderson et al. (Chap. 14) state that interprofessional education and practice is a
response to specific changes in health care delivery that aim to promote integrated,
patient-centered care. Moreover, as these authors suggest, the development of
interprofessional curricula (which aim to foster interprofessional practice) face a
number of significant challenges: the crossing of professional boundaries; integrat-
ing interprofessional curricula into each profession’s existing curricula; paying
attention to the theoretical rigor and evidence base of interprofessional education;
and recognizing the fact that interprofessional learning is complex and different
(Anderson et al. Chap. 14). For faculty development to be effective in this arena,
formal approaches must address existing barriers to teaching and learning, at
both the individual and organizational level, and prepare faculty members to design
and facilitate interprofessional experiences in both the classroom and the clinical
environment.
1.8.4 Creating International Faculty

Development Partnerships
The need to extend beyond national borders in faculty development is increasingly

apparent in the health professions. In fact, as Friedman et al. (Chap. 15) demon-
strate, international faculty development partnerships arise in response to a range of
needs and opportunities, including issues related to health care priorities, educa-
tional imperatives, and the professional development of faculty members globally.
As these authors illustrate, international partnerships differ in structure and purpose
as well as the degree of organizational independence and interdependence. However,
different models can achieve similar goals, and the benefits of these relationships
can be experienced at many levels, including that of the individual, the institution,
and the system at large. The relationship itself can also be a source of pride and
accomplishment, leading to new initiatives and collaborations (Friedman et al.
Chap. 15). Well-functioning partnerships allow for exposure to methods, materials,
18 Y. Steinert
opportunities, and networks that may not otherwise be available, and cultural
bridging, effective communication, and mutual goal-setting are critical ingredients
for sustainability.
1.8.5 Starting a Faculty Development Program
The design and development of a faculty development program is no easy feat.

Moreover, once the challenge to undertake such an enterprise is accepted, it involves
a number of steps, as outlined by Silver (Chap. 16): understanding the institutional
and organizational culture; developing a change strategy; forming a guiding coali-
tion; conducting an environmental scan; establishing the vision and values of the
program; and defining clear goals and objectives. Determining the faculty develop-
ment curriculum and method of delivery, based on available evidence and pertinent
conceptual frameworks, forms the next important step, to be followed by the devel-
opment of an evaluation rubric as well as a plan for sustainability. The old adage
that ‘one size does not fit all’ must also be remembered in this context, as each set-
ting and culture will determine its own pathway to success.
1.9 Faculty Development Research, Scholarship

and Knowledge Translation
Research, scholarship, and knowledge translation are vitally important in moving

the field of faculty development forward. Although each chapter in this book is
based on the current literature and available evidence, we need to continue to expand
the research base in this area by systematically evaluating our diverse programs and
activities, assessing outcomes at multiple levels, and examining how faculty mem-
bers develop. We must also ensure that research informs practice – and that practice
informs research – as highlighted in Part V.
1.9.1 The ‘State of the Art’
Research on the impact of faculty development activities designed to improve teach-

ing effectiveness has shown that overall satisfaction with programs is high and that
participants recommend these activities to colleagues (Steinert et al. 2006). More
specifically, health professionals report a positive change in attitudes towards teach-
ing as well as self-reported changes in knowledge about educational principles and
specific teaching behaviors. Other benefits include increased personal interest and
enthusiasm, improved self-confidence, a greater sense of belonging to a community,
and educational leadership and innovation. In a more recent review of faculty
development initiatives designed to enhance leadership (Steinert et al. 2012), very

similar results were found. Participants reported a positive change in attitudes
toward their own organizations, leadership abilities and leadership roles, positive
gains in knowledge and skill related to leadership concepts, principles and strate-
gies, and changes in leadership behavior, including new roles and responsibilities.
In examining these and other systematic reviews of faculty development in
higher education (Amundsen and Wilson 2012; Stes et al. 2010), Spencer (Chap. 17)
concludes that although we have a preliminary understanding that faculty develop-
ment ‘works’, we still need to understand ‘how and why change occurs’. In addi-
tion, despite numerous program descriptions, few programs have conducted rigorous
evaluations to ascertain what effect the program is having on faculty members, and
conclusive data to support the efficacy of these initiatives, on both the individual
and the organization, have been lacking. Of the studies that have been conducted in
this area, most have relied on the assessment of participant satisfaction; some have
evaluated changes in cognitive learning or performance, whereas others have exam-
ined the long-term impact of these interventions. However, most research studies
have relied on self-report rather than objective outcome measures or observations of
change. There is clearly a need for more rigorous research designs and a greater use
of qualitative and mixed methods to capture the complexity of faculty development
interventions. The use of newer methods of performance-based assessment, incor-
porating diverse data sources, as well as process-oriented studies comparing differ-
ent faculty development strategies and the maintenance of change over time, is also
needed (Spencer Chap. 17; Steinert et al. 2006).
1.9.2 Research Paradigms and Methodologies
Building on the available evidence, O’Sullivan and Irby (Chap. 18) suggest that this
area of scholarship has been over-reliant on a positivist research paradigm and rec-
ommend a consideration of post-positivist, interpretivist, and critical theory para-
digms. These authors also propose the use of alternative research methods, including
design research (Collins et al. 2004), success cases (Brinkerhoff and Dressler 2003),
and sustainability narratives (Swart et al. 2004). Each of these methods can provide
new insights into the process and value of faculty development. O’Sullivan and Irby
(2011, Chap. 18) also put forth a new conceptual framework for conducting faculty
development research, locating faculty development within two separate but related
communities: (1) the faculty development community and (2) the community of
teaching practice in the workplace. As the authors suggest, the faculty development
community refers to the real and virtual environments where faculty members dis-
cuss their concerns and challenges as educators, and learn new roles and skills; the
second community is situated in the workplace, be it in the classroom or the clinical
setting, where teaching, research or leadership takes place. For the faculty develop-
ment community, four key elements include: the participants; the faculty develop-
ment program; the facilitator; and the context in which the program occurs. For the
20 Y. Steinert
workplace community, there are four additional components: the relationships and
networks of associations that participants have with colleagues and learners; the
educational tasks and activities that must be completed in the work setting; the men-
toring that is available to help accomplish specific goals and objectives; and the
organization and culture of the workplace. Given the social nature of faculty devel-
opment (D’Eon et al. 2000) and an increasing emphasis on communities of practice
(Wenger 1998), we believe that this conceptual framework offers a rich menu of
possibilities to advance scholarship in the field.
1.9.3 Knowledge Translation and Faculty Development
The creation of knowledge – and the transfer of knowledge to practice – remains a

challenge for faculty development. As a result, Part V concludes with a discussion
of knowledge translation and its applications to faculty development. Knowledge
translation has been defined as an iterative, interdisciplinary process used to move
knowledge into practice, primarily in the clinical setting (Graham et al. 2006).
However, as Thomas and Steinert (Chap. 19) postulate, the implications of knowl-
edge translation for faculty development can include a number of options:
… (1) basing faculty development programs on the best available knowledge and/or scien-
tific evidence; (2) using educational and other knowledge translation strategies that are
known to be effective; (3) recognizing that, in the absence of scientific evidence to support
faculty development activities or when scientific knowledge is not congruent with existing
practices or values, alternative sources of knowledge are needed; and (4) conceptualizing
faculty development activities as knowledge translation interventions in their own right.
It is hoped that applying a lens of knowledge translation to faculty development

will help to accomplish two objectives: a more systematic use of evidence in the
design, delivery, and evaluation of both formal and informal approaches to faculty
development, and a more concerted effort in creating new knowledge in the field.
1.10 Conclusion
The chapters in this book represent the work of a scholarly community of interna-
tional health professions educators, leaders, and researchers. They also portray the
scope, diversity of approaches, practical applications, and research opportunities
that this aspect of professional development encompasses.
The discussions in this book touch on a number of themes that will need
greater attention in the future. For example, although this book is entitled Faculty
Development in the Health Professions, the majority of examples are drawn from
medicine due to the current ‘state of the art’. Moreover, although there is a growing
consensus that faculty development is meant to target all faculty roles, most of the
literature to date focuses on faculty development for educational improvement,
often in an academic setting. Shifting our focus to include faculty members as

leaders and managers and researchers and scholars, and conceptualizing the breadth
of faculty development outside of the academic milieu, remains a challenge. So
does the recommendation that we re-orient our emphasis from faculty development
to faculty learning. Part VI summarizes future directions for faculty development,
based on what has been presented in the preceding pages.
Faculty vitality has been defined as ‘those essential, yet intangible positive quali-
ties of individuals and institutions that enable purposeful production’ (Clark et al.
1985, p. 3). The goal of faculty development is to nurture, promote, and reinforce
the vitality of faculty members and the institutions in which they work (within and
outside the academic setting), so that we can facilitate the development of future
health professionals and, ultimately, improve patient care.
1.11 Key Messages
• Faculty development includes both formal and informal activities that address the
multiple roles and responsibilities of faculty members in a variety of settings.
• Faculty development has a role to play in nurturing and sustaining health profes-
sionals as teachers and educators, leaders and managers, and researchers and
scholars. It can also help to enhance academic and career development as well as
organizational change.
• Common approaches to faculty development include experiential learning in the
workplace, peer coaching and mentoring, workshops and seminars, longitudinal
programs, and online learning.
• Practical applications of faculty development can include change at the level
of the individual (e.g. role modeling and reflective practice), the curriculum,
clinical practice (e.g. interprofessional education and practice), and interna-
tional collaboration.
• Research, scholarship, and knowledge translation are needed to move the field of
faculty development forward in the health professions.
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Part II
The Scope of Faculty Development
Chapter 2
Faculty Development for Teaching
Improvement
Carol S. Hodgson and LuAnn Wilkerson
2.1 Introduction
Faculty development to improve teaching is the most common type of faculty

development activity reported in the health professions literature. Although its
North American roots can be traced back to the 1950s, it is now an ongoing activity
in medical schools around the world and is growing in importance in other health
professions schools. In this chapter, we will consider the emergence of teaching
improvement programs in health professions education and then review several
competency frameworks, each designed to identify what teachers in the health pro-
fessions need to know and be able to do in order to promote learning. Several best
practice examples demonstrate how these teaching competencies might be devel-
oped and illustrate essential features of teaching improvement programs.
2.2 Historical Perspective
The birth of faculty development as a critical tool for improving teaching in the
United States has been tracked to the Project in Medical Education. This collabora-
tive venture, funded by the Commonwealth Foundation at the University of Buffalo
in 1955 under the collaborative leadership of George Miller, MD, from the School
C.S. Hodgson, Ph.D. (*)

Faculty of Medicine and Dentistry, Division of Studies in Medical Education,
University of Alberta, Edmonton, AB, Canada
L. Wilkerson, Ed.D.
Center for Educational Development and Research, David Geffen School
of Medicine at University of California Los Angeles, Los Angeles, CA, USA

30 C.S. Hodgson and L. Wilkerson
of Medicine, and Stephen Abrahamson, PhD, from the School of Education, was
focused on bringing the findings of research in education to bear on the design and
delivery of teaching in the medical school (Miller 1980). A medical student who
joined the Project and completed both an M.D. and an Ed.D. in education, Hilliard
Jason (1962), is credited by many as the founder of teaching improvement pro-
grams in medical education (Wilkerson and Anderson 2004). A seminal report
of the results of a survey of faculty members from medical schools from across
the United States published in 1977 indicated that most faculty members felt
ill-prepared for their roles as teachers and welcomed opportunities to learn more
about how to teach (Association of American Medical Colleges 1977; Jason and
Westberg 1982). Through the Association of American Medical Colleges (AAMC),
Jason subsequently developed workshops, videos, and reading materials on learn-
ing to teach, with a particular emphasis on small group discussion and clinical
teaching opportunities.
At this same time in higher education in the United States, the increasing use of
student evaluations of teachers led to the emergence of programs to improve the
teaching of college and university faculty members (Centra 1976). Similarly, in the
Netherlands during the 1970s, the first faculty development programs to improve
teaching in higher education began (Metz et al. 1996). Prior to the 1970s, sabbati-
cals and professional conferences in specific disciplinary fields were the usual
approach to the improvement of teaching, reflecting the assumption that content
expertise was the critical requirement for university teachers. Stimulated by the
work of Allen and his colleagues at the University of Massachusetts in the Clinic
to Improve University Teaching, the Handbook for Faculty Development by
Bergquist and Phillips (1975) and Toward Faculty Renewal by Gaff (1975), a focus
on the improvement of teaching skills and methods was born (Sorcinelli et al.
2006). The Professional and Organizational Development Network (http://www.
podnetwork.org/) was created in 1975 to provide training in and support for faculty
development professionals, many of whom were engaged in providing workshops
and conducting individual consultations to faculty members interested in teaching
improvement.
The focus of teaching improvement programs in higher education has changed
as the understanding of how students learn has evolved over the years (Wilkerson
and Irby 1998). Behaviorist theories of learning guided the earliest days of teach-
ing improvement programming, creating an emphasis on observable teacher behav-
iors and discrete teaching skills, often using faculty development approaches such
as individual consultation and video-recorded microteaching sessions. For exam-
ple, typical faculty development sessions addressed setting the objectives of a lec-
ture, asking questions, and responding to students’ answers. In the 1980s, a growing
interest in cognitive theories of learning was associated with the creation of teach-
ing improvement programs focused on the design of courses and the use of learn-
ing methods that stressed students’ cognition and information processing, including
a growing emphasis on the teacher’s ability to translate his or her content expertise
in ways to meet the identified needs of learners (Shulman 1986) and the ability to
‘reflect in practice,’ described by Schön (1987). In the 1990s, concurrent with a
2 Faculty Development for Teaching Improvement 31
growing interest in social constructivist theories of learning, teaching improvement

activities included the use of extended seminars and longitudinal workshops in
which faculty members would learn from and with one another, using interactive
exercises, peer coaching, and the formation of ‘learning communities’ composed
of teachers with common interests and concerns for the purpose of learning from
one another. In Great Britain during the 1990s, Peyton (1998) introduced a ‘teach-
the-teacher’ program for clinical teachers using a train-the-trainer model to extend
the reach of typical teaching improvement programs to include physicians who
teach in the workplace rather than in the academy. All of these types of teaching
improvement topics and activities continue to be offered today as part of compre-
hensive teaching improvement programs in both higher education and health pro-
fessions education. To this mix, the use of online interactive modules and social
media have been added to further increase accessibility of teaching improvement
programming.
2.3 A Competency Framework for Teaching
Central to the design of teaching improvement programs is the question of what

knowledge, skills, and attitudes are needed by the well-prepared faculty member
engaged in health professions education (Irby 1994). Medical education for stu-
dents and residents depends on the readiness of faculty members to execute their
role as teachers. For example, in 2012, at the two medical schools of this chapter’s
authors, more than 200 new faculty members (primarily clinical) and more than 200
new residents and fellows began teaching trainees. The relatively large number of
new faculty and residents entering medical schools each year makes it imperative
that we develop a faculty development strategy for training new faculty and resi-
dents for their role as teachers in addition to maintaining and updating teacher com-
petencies for our established teachers. What competencies are needed for new
faculty members? Once initially prepared, how do we continue to help teachers
continue to improve as they progress from instructor to professor? For decades,
much has been written about competency-based education for learners in health
professions education. Are there competencies we should consider or require of our
teachers? A number of competency frameworks have been proposed for educators
in higher education and specifically in the health professions that can be used to
answer the question of what teachers in the health professions need to know and be
able to do.
In 2004, a national quality assurance system for teaching was implemented at all
14 research-intensive universities in the Netherlands (van Keulen 2006). As one
example, at Utrecht University both junior and senior teachers are required to docu-
ment their attainment of a series of qualifications (written as objectives) using a
portfolio system. Staff development is offered at Utrecht, but not required as part of
the quality assurance system. What is required is evidence of having attained the
desired teaching competency. Medical education in the Netherlands followed suit.
Deans at the eight Dutch medical schools joined with the Netherlands Association
for Medical Education and formed a taskforce to develop a set of competencies for
medical teachers that would constitute a similar teacher qualification system
(Molenaar et al. 2009). The taskforce grew to encompass dentistry and veterinary
medicine as well. The description of each teaching competency and the overall
framework were published online for feedback and discussion by stakeholders
nationally.
The resulting framework included six teaching domains that cover the contin-
uum of education with five sub-domains at three teaching levels (‘micro,’ ‘meso,’
and ‘macro’). The three levels constitute increasing responsibility from (1) ‘micro,’
the level of the individual teacher, to (2) ‘meso,’ the faculty member coordinating
part of a curriculum, to (3) ‘macro’ leadership of a course or program. The three
levels of the framework (‘micro,’ ‘meso,’ and ‘macro’) allow for assessing faculty
members’ level of responsibility and providing distinctions between ‘teacher’ and
‘master teacher’ and ‘educator’ and ‘master educator’ (i.e. teacher vs. educational
leader) (Molenaar et al. 2009). The framework, domains, and sub-domains were
adopted nationally, but institutions were left to develop specific local descriptors of
those teaching domains. This very systematic process, that allowed vetting by all
stakeholders at multiple points in time, helped to develop a national climate for buy-
in of the process and expectation that teachers across professions would meet a set
of core competencies.
Around the same time in the United States, Hand (2006) used a modified Delphi
method to query dental schools deans, faculty developers in dentistry, and members
of the American Dental Education Association on the competencies needed for den-
tal teachers – both continuing and new. The underlying framework for this set of
competencies used the redefinition of teaching as a form of scholarship (Boyer
1990) as its foundation.
In 2009, the Academy of Medical Educators (AoME) in Great Britain estab-
lished a set of professional standards for clinical and non-clinical medical (i.e. den-
tal, veterinary, and medical) educators (Academy of Medical Educators 2012). The
overall goal underpinning the development of the Professional Standards and the
educator assessment system was to improve patient-centered care through medical
training and practice. A ‘key performance target’ was to ‘assure greater recognition
of the central role of medical educators in the delivery of high quality patient care.’
(Academy of Medical Educators 2008, p. 5). Members of the Professional Standards
Committee consulted a wide range of stakeholders and engaged numerous national
organizations in the development of the standards and domains. All of these groups
were invited to comment on the proposed standards and more than 100 responses
were received. (Academy of Medical Educators 2012).
Central to the AoME Professional Standards are seven core values: (1) profes-
sional integrity; (2) educational scholarship; (3) equality of opportunity and
diversity; (4) respect for the public; (5) respect for patients; (6) respect for learn-
ers; and (7) respect for colleagues. Each medical educator who wishes to apply
for membership must first demonstrate a commitment to the core values. Along
with these core values are five competency domains central to medical education:
(1) design and planning of learning activities; (2) teaching and support of learners;
(3) assessment and feedback to learners; (4) educational research and evidence-
based practice; and (5) educational management and leadership (Academy of
Medical Educators 2012). Each domain is further broken down into a list of ele-
ments and standards (see Appendix A). Just as with the competencies developed
in the Netherlands, there are three levels, again very similar to those described by
Molenaar et al. (2009). Attainment of the Standards at a particular level provides
evidence for membership in the AoME at the level of ‘Member’ (evidence at
levels 1–2) or as a ‘Fellow’ (evidence at level 3) (Academy of Medical Educators
2012, p. 11). These standards are now part of the United Kingdom’s General
Medical Council Framework for the Accreditation of Educational Supervisors
(Academy of Medical Educators n.d.).
In the United States, several specialties have worked to define teaching compe-
tencies relevant to their particular fields. The Alliance for Academic Internal
Medicine (AAIM) has put forward a set of skills for internal medicine. Hueppchen
et al. (2011) proposed ‘seven habits of highly effective medical educators’ in obstet-
rics and gynecology, and Harris et al. (2007), using the Faculty Future Initiative in
Family Medicine, developed a broad range of competencies meant for all faculty
members, ranging from clinical teachers to education deans.
The work to describe a set of teacher competencies builds on the early work
to define and evaluate effective clinical teaching (Harden and Crosby 2000; Irby
1978; Price and Mitchell 1993; Skeff et al. 1992). In the 1990s, the Stanford
Faculty Development Program developed and disseminated a framework for the
improvement of clinical teaching (Skeff et al. 1992) composed of seven specific
teaching competencies: (1) establishing a positive learning climate; (2) control
of the teaching session; (3) communicating goals; (4) promoting understanding
and retention; (5) evaluation; (6) feedback; and (7) promoting self-directed
learning. In 2006, Skeff and a group of colleagues held a 2-day conference on
Teaching as a Competency with the goal of developing and implementing a
skills-development framework (Srinivasan et al. 2011). The group described a
set of four core values or principles for teaching in medical education: (1) learner
engagement; (2) learner-centeredness; (3) adaptability; and (4) self-reflection;
they also proposed six core medical educator competencies for all medical edu-
cators (see Table 2.1).
There is a great deal of overlap between the various competency frameworks
proposed thus far (and outlined in Table 2.1), including those identified for pri-
mary and secondary education in the United States by the National Board for
Professional Teaching Standards (2002). The terms used in the various reports
may be slightly different, or a new concept may be introduced, such as profes-
sionalism and role modeling (Srinivasan et al. 2011) or medical informatics
(Harris et al. 2007); however, the overall set of competencies for teaching in the
health professions is quite consistent and relatively well defined. Moreover, com-
petency models such as the AoME domains for teaching can be used as a frame-
work for developing a comprehensive faculty development program for health
professions teachers.
Table 2.1 Relationship between various teaching competency frameworks 34
AoME Netherlands Academic Competencies for Dental Carnegie

domainsb competenciesc competenciesd medical educatorse competenciesf task forceg
Design & planning of learning activities X X X X X
Teaching & supporting learnersa X X X X X X
Assessment & feedback to learners X X X X X X
Educational research X X X
Management/Administration X X X X X
Leadership X X
Evidence-based/Practice-based teaching X X X
Systems-based learning X
Medical informatics X
Care management X
Evaluation X
Content knowledge X X
Professionalism & role modeling X
Multiculturalism X
Members of learning communities X
Teach in a variety of settings X
a
Includes learner-centeredness and communication skills
b
AoME Domains: (1) design and planning of learning activities; (2) teaching and supporting learners; (3) assessment and feedback to learners; (4) educational
research and evidence-based practice; and (5) educational management and leadership
c
Domains in the Netherlands framework (Molenaar et al. 2009): (1) development; (2) organization; (3) execution; (4) coaching; (5) assessment; and (6) evaluation
d
Competencies for specific Family Medicine roles (Harris et al. 2007): (1) leadership; (2) administration; (3) teaching; (4) curriculum development; (5)
research; (6) medical informatics; (7) care management; and (8) multiculturalism
e
Core teaching competencies (Srinivasan et al. 2011): (1) medical/content knowledge; (2) learner centeredness; (3) interpersonal and communication skills; (4)
professionalism and role modeling; (5) practice-based reflection and improvement; and (6) systems-based learning
f
Competencies in Dentistry (Hand 2006): (1) foundational competencies; (2) plan and evaluate teaching/learning experiences; (3) teach in a variety of settings
(large group, small group, one-on-one, preclinical, clinical, laboratory, distance/continuing); (4) assess student performance; (5) plan and evaluate curriculum;
and (6) competencies for the scholarship of discovery (foundational, formulate research question, design studies, write a proposal, conduct and manage
research projects, collect and manage data, manage data analysis, evaluate and discuss findings, and publish)
g
Competencies for primary and secondary educators (National Board for Professional Teaching Standards 2002): (1) teachers are committed to students and
C.S. Hodgson and L. Wilkerson
their learning; (2) teachers know the subjects they teach and how to teach those subjects to students; (3) teachers are responsible for managing and monitoring
student learning; (4) teachers think systematically about their practice and learn from experience; and (5) teachers are members of learning communities
2.4 Faculty Development to Meet Teaching

Competencies – Selected Examples
2.4.1 Choosing a Competency Framework
It is not the goal of this chapter to define a competency framework for health profes-
sions teachers, but instead to assist those persons planning teaching improvement
programs in identifying a set of competencies for the teachers that will be involved
in the resulting program. Milner et al. (2011) suggest three methods for defining
faculty competencies: (1) use of the characteristics described by Bland and Schmitz
(1986) for successful faculty members; (2) use of an established competency frame-
work; or (3) expert consensus developed during workshops and conferences. For the
remainder of this chapter, we will use the AoME Professional Standards to demon-
strate the range of objectives that might be addressed in a comprehensive faculty
development program designed to prepare faculty members to be competent teach-
ers: (1) designing and planning learning activities; (2) teaching and supporting
learners; and (3) assessing and providing feedback to learners. Although longitudi-
nal teaching scholar or fellowship programs usually cover all of the five AoME
competencies, we will leave the discussion of this specific type of faculty develop-
ment program to the authors of Chap. 10. Faculty development approaches to devel-
oping the remaining two AoME competencies – educational leadership and
scholarship – will be discussed in Chaps. 3 and 4.
2.4.2 Competency Domain 1: Design and Planning

of Learning Activities
AoME Domain 1 is focused on the following standards for ‘educational design

and learning development processes’ (Academy of Medical Educators 2012, p. 15):
(1) using learning principles in the development of curricula; (2) developing and
using needs assessment; (3) defining learning objectives; (4) selecting learning
methods/activities linked to objectives; and (5) evaluating learning outcomes
(see Appendix A for the specific standards). These elements are very similar to
those described by Kern et al. (1998) in Curriculum Development for Medical
Education: A Six-Step Approach:
Step 1 – Problem identification and general needs assessment; Step 2 – Targeted needs
assessment; Step 3 – Goals and objectives; Step 4 – Educational strategies; Step 5 –
Implementation; Step 6 – Evaluation (Kern et al. 1998, p. 5).
The two faculty development programs described below follow the Kern et al.
(1998) model for curriculum development and therefore are useful examples of fac-
ulty development programs to achieve AoMe Domain 1.
Snyder (2001) describes a component of a 1-year Family Medicine faculty devel-
opment fellowship consisting of a series of workshops on curriculum development
for 3 h per month for 10 months. The teaching format for the workshops included
readings, short lectures, group discussions, and the development of a curricular
project. Evaluation included participant satisfaction, peer-ratings of the quality of
written curricular projects, and evidence of actual implementation of the curricu-
lum. Each written curriculum project was rated with respect to the six steps in the
Kern et al. (1998) model described above. Eight projects were produced: seven
included a targeted needs assessment; all had goals and learning objectives; six had
teaching strategies matched to those objectives, but only five had an evaluation plan.
Most importantly, six of the eight curricula were implemented.
Windish et al. (2007) describe 16 years of experience in offering a faculty devel-
opment program on curriculum design at Johns Hopkins University School of
Medicine using the Kern et al. (1998) model:
The goals of the program are for participants to: (1) develop the knowledge, attitudes, and
skills to design, implement, evaluate, and disseminate a curriculum in medical education;
and (2) design, pilot, implement, evaluate, write-up, and present a curriculum (Windish
et al. 2007, p. 656).
The 10-month program consisted of a weekly half-day session with interactive

workshops, readings, a mentored curriculum development project, and in-progress
reporting sessions. Over a period of 16 years, 145 faculty members completed the
program. For cohorts two through nine, each participant identified a peer who could
serve as a control in terms of demographic characteristics, training, and professional
status. Participants and controls were asked to complete pre- and post-test surveys
on their demographic characteristics, academic activities, curriculum development
experience, self-assessment of curriculum development skills, implementation of
curricula, evaluation of curricula, and enjoyment in curricular activities. Participants
also responded to open-ended questions regarding their satisfaction with the faculty
development program. At baseline, non-participants rated their curriculum/program
development skills and curriculum/program implementation skills significantly
higher than the participants. However, the program participants rated their enjoy-
ment of curriculum/program development higher than their peer comparison group.
At post-test, the results were reversed with program participants rating their skills in
all areas higher than the control group. When pre- to post-test differences were
tested, the participants increased from pre- to post-test in all areas except curricu-
lum/program evaluation skills and enjoyment. The peer comparison group also
changed from pre- to post-test, but in the opposite direction, with all values decreas-
ing from pre- to post-test. Across all cohorts of participants, 84 % partially or fully
implemented a curriculum. Approximately 20 % published an article about their
curriculum in a peer-reviewed journal. The vast majority of participants (86 %)
worked on their projects in either pairs or teams and reported that the collaboration
was an important part of the experience. Of those who worked alone, three quarters
wished they had worked collaboratively. Program participants and peer control
group members from cohorts two through nine were also followed longitudinally
for 6–13 years after the initial post-test (Gozu et al. 2008). At long-term follow-up,
participants were significantly more likely to report proficiency in developing cur-
ricular programs, implementing/administering curricular programs, and evaluating
curricular programs. Participants were also more likely than controls to report
implementing one or more curricula in the last 5 years; they also reported conduct-
ing a needs assessment more frequently. Only one area was not significantly differ-
ent between the participants and the peer control group, ‘using different educational
strategies based on the objectives of the curriculum and the needs of the learners’
(p. 689). These results indicate that not only were there immediate self-reported
differences between participants and non-participants, but that those differences
were maintained over many years.
These two programs are interesting in that they both use the Kern et al. (1998)
model for curriculum development within a single institution; however, the first
program evaluated the actual curricula developed to determine if the preferred pro-
cess was followed by participants, and the second program relied on self-report,
albeit over an extended period of time. Mitcham and Gillette (1999) report on a
national faculty development program offered by the American Occupational
Therapy Association to recruit, train, and retain newly qualified occupational ther-
apy (OT) faculty members with a focus on curriculum design and evaluation. The
program started as an intensive week-long in-person 3-credit course offered at the
Medical University of South Carolina (MUSC) for new OT faculty from any institu-
tion. After completion of the course, participants returned to their home institutions
and developed and implemented a curriculum or new instructional materials for a
course, which were submitted for grading as part of their MUSC course. This
allowed participants in the program to implement what they had learned and receive
feedback via a grade for their efforts. Although this course was well received, feed-
back from participants led to the evolution of the week-long course to a 3-day work-
shop in which curriculum development remained a key focus that was offered as
part of an existing OT conference. Over a 5-year period, ten workshops were offered
with 354 participants. A retrospective pre-to-post survey on their perceived mastery
of 17 teaching elements revealed self-reported improvement in curriculum develop-
ment areas: ‘construction of a syllabus,’ ‘construction of teaching plans,’ and ‘cre-
ativity in presentation of content’ (Mitcham et al. 2002, p. 337). In addition,
participants were asked to share if there were any changes in student evaluations of
their teaching. Of those who reported having teaching evaluations, ‘48 % reported
improvements in their evaluations after attending one or more of the ten workshops
(Ten percent of respondents had not yet been evaluated…)’ (p. 338). An open-ended
question asked respondents to indicate the three most important principles that they
had learned and used in their own teaching. The most common responses were
improved objectives, better exams, and improved congruence between objectives
and test items. They also indicated that these principles were commented on by their
students in their course/instructor evaluations.
Very few faculty development programs devoted to curriculum development can
be found in the health professions education literature. Participants in each of the
three examples above met the core objective of the faculty development program –
to develop and implement a curriculum. These programs provide evidence that fac-
ulty development can be used successfully to improve the curriculum development
skills if a significant amount of time and support is available for the faculty develop-
ment program.
2.4.3 Competency Domain 2: Teaching

and Supporting Learners
Core elements of AoME Domain 2 include: (1) teaching/learning methods; (2) the
learning environment; (3) feedback on teaching; (4) active learning; and (5) reflec-
tion (see Appendix A). Faculty development programs to meet these competencies
are the most common type of faculty development described in the literature.
A prime example in this domain is the Stanford Faculty Development Program,
which has focused on the teaching of a variety of special topics based on under-
standing and responding effectively to the ways in which content, learners, teach-
ers, and context interact to promote learning. The Stanford Program was first
implemented in 1985 (Skeff et al. 1992), and through its graduates, it has been
implemented in medical schools across North America and in other countries,
notably China (Wong and Fang 2012) and Russia (Wong and Agisheva 2007). The
month-long Stanford Faculty Development Program has trained more than 300
clinical and basic science faculty members from 141 institutions since its initial
implementation in 1986 (Stanford Faculty Development Center for Teachers
2012). Faculty members from other institutions travel to the Stanford School of
Medicine for a month of training, and then return to their home institutions to
implement the teaching improvement program with their own colleagues. The
Stanford Program consists of seven 2 h seminars, readings, discussion, video-taped
practice teaching of one of the seminars with feedback, and additional practice
teaching sessions to prepare to teach the program at their home institution. This
train-the-trainer dissemination concept builds on the idea that ‘change agents with
characteristics of their target audience have strong credibility for disseminating
new ideas to their colleagues.’ (Skeff et al. 1992, p. 1156).
The most important goal of the Stanford Faculty Development Program is to
prepare participants to effectively implement the program at their home institution
and to evaluate its impact by using a retrospective pre-post assessment format in
which institutional participants report on changes in their clinical teaching behav-
iors (Skeff et al. 1992). However, when the program was implemented in China,
there were challenges; ‘although this project was an adaption from a well-studied
and successful model, it remains a great challenge to successfully overcome differ-
ences in culture, language, and educational systems’ (Wong and Fang 2012, p. 357).
Even so, there was a significant increase in scores on the retrospective pre-post
assessment on the overall portion and on the Specific Teaching Skills portion of the
survey instrument. Comments from participants most frequently described improve-
ment of the learning climate, promoting understanding and retention, feedback, and
promoting self-directed learning (Wong and Fang 2012). In another study of the
Stanford Program, Berbano et al. (2006) evaluated the implementation of the
Stanford program with eight faculty members using a direct measure of teaching
behaviors with an Objective Structured Teaching Evaluation (OSTE). Each partici-
pant completed three OSTE stations before and 1 month after completing the pro-
gram, discussing a case with a third-year medical student, an intern, and an internal
medicine resident. From pre- to post-test, participants changed the types of questions
asked and the type of feedback given. The total number of questions decreased
significantly at post-test. During the case discussion, factual questions decreased
(80–59 %) and the number of higher-level questions requiring analysis/synthesis
increased (10 to 34 %, respectively). This study adds to the evidence that the
Stanford Program is effective given the direct evaluation of teaching skills versus
the use of self-report that is found in most studies.
While workshops and presentations are the most common methods used to help
faculty members and residents to improve teaching skills, programs using guided
reflection, coupled with practice and feedback, suggest that a broader array of
approaches can be effective (Alteen et al. 2009; Branch et al. 2009; Cole et al. 2004;
Kumagai et al. 2007; Rabow et al. 2007; Steinert et al. 2010; Tang et al. 2009). A
multi-institutional study of a longitudinal faculty development program to improve
clinical teaching using reflection deserves special note. Five medical schools in the
United States collaboratively developed and implemented a program to foster
the teaching of humanistic values and behaviors during the process of patient care
(Branch et al. 2009). This 18-month program used self-reflective discussion and
narrative writing as core teaching methods. The authors studied outcomes of the
program using a quasi-experimental post-test only control group design. Students
and residents of program participants and faculty members willing to serve as con-
trols were surveyed regarding their teachers’ effectiveness in teaching the human
dimension of care. Participants were scored significantly higher on all ten items on
the Humanistic Teaching Practices Effectiveness Questionnaire than were controls.
Some sample items included: inspires me to grow personally and professionally
(88 % vs. 76 %); actively uses teaching opportunities to illustrate humanistic care
(86 % vs. 73 %); serves as an outstanding role model (89 % vs. 77 %); explicitly
teaches communication and relationship-building skills (83 % vs. 72 %); and
inspires me to adopt caring attitudes toward patients (90 % vs. 80 %). The strength
of this study is that a standard faculty development curriculum was implemented at
multiple medical schools and was evaluated by comparing participants’ and con-
trols’ teaching behaviors as reported by their trainees. Although selection bias could
contribute to these results, at one of the participating medical schools, an historical
pre-test compared evaluations by residents of participants and controls and found no
significant differences at baseline.
Kumagai et al. (2007) and Tang et al. (2009) describe a novel approach to teach-
ing improvement using interactive theater to stimulate reflection and to provide a
venue for practical experience with new teaching behaviors. Forum Theater is a type
of interactive theater ‘in which the traditional barrier between the actors and the
audience is broken down, and the audience becomes directly involved in determining
the course of the play’ (Kumagai et al. 2007, p. 336).
At the University of Michigan, first- through third-year students work on longi-
tudinal cases in small groups. These cases may contain controversial and conten-
tious issues that should be discussed sensitively and not avoided. In fact, the
facilitators are ‘expected to assure a safe and respectful environment for everyone in
the group, and to raise questions, identify contradictions, and stimulate discussion
that encourages individual and shared reflection of these issues and their
consequences’ (Kumagai et al. 2007, p. 336).
In order to prepare the small group facilitators for this task, a 3.5 h faculty devel-
opment session using Forum Theater was introduced in 2004. The University Center
for Research on Learning and Teaching (CRLT) has members (i.e. the Players) who
are trained in acting and how to reflect upon their own and others’ biases, especially
with respect to gender, ethnicity, sexual orientation, and socio-economic status. For
the Forum Theater faculty development program, the CRLT Players enacted a sce-
nario based on the discussion observed in an actual small group in the course. After
the scenario was performed, the faculty development participants (15 at each of two
sessions) could ask questions of the Players, all of whom responded within their
scenario role. The participants then engaged in a discussion of possible resolutions
to the problems demonstrated in the scenario. Then the CRLT Players re-enacted
the scenario using the suggestions from the faculty development participants.
Participants were surveyed about the experience upon the conclusion of the work-
shop and also 9–15 months later. A week after the survey, participants were invited
to a focus group. The results indicated that the Forum Theater experience led the
facilitators to reflect upon their own teaching and have more awareness of the issues
affecting women and minorities; it also provided new strategies for dealing with
difficult conversations within the small groups. The survey item with the highest
rating was ‘led me to reflect on how my actions in the classroom affect students’
(Kumagai et al. 2007, p. 338). At the focus group, one facilitator shared that the
workshop had made him/her ‘more sensitive to the cultural aspects of our discus-
sions’ (Kumagai et al. 2007, p. 338). The authors felt that the Forum Theater work-
shop had been quite successful in leading facilitators to reflect on their teaching in
a new way that would ultimately improve the discourse within their small groups,
especially around sensitive cultural issues.
These examples are meant to illustrate a range of approaches and contexts in which
faculty members can be helped to develop improved teaching skills. Of particular
interest in two of these examples is the power of collaboration among institutions in
the design, implementation, and evaluation of teaching improvement programs.
2.4.4 Domain 3: Assessment and Feedback to Learners
The last AoME area to be addressed in this chapter, Domain 3, focuses on assess-
ment and feedback to learners. Faculty development programs in this domain gener-
ally focus on (1) test development; (2) general training in the use of a variety of
assessment methods; and (3) feedback. The range of assessment tools used in health
professions education includes various forms of knowledge examination types,
tools for evaluating competencies during clinical care, and performance evaluation
exercises in simulated clinical settings (Wass and Archer 2011). However, this area
of teaching improvement has been less well described in the literature, which may
reflect that it is less often being addressed in faculty development programs.
There are few studies of faculty development programs in the health professions
that focus on improvement of test development and standard setting. Jozefowicz
et al. (2002) showed that untrained test item writers are not as good at writing exam
items as those who are trained using a standard method, such as the one outlined in
the National Board of Medical Examiners (NBME) text on item-writing,
Constructing Written Test Questions for the Basic and Clinical Sciences (Case and
Swanson 1998). Naeem et al. (2012) implemented a 1-week full-time faculty devel-
opment program to teach faculty members to write multiple-choice questions,
short-answer questions, and to develop checklists for an Objective Structured
Clinical Examination (OSCE). To evaluate the effects of the program, the authors
asked participants to submit an example of their ‘best’ item for each of the item
categories prior to the start of the program. Participants then rewrote their test items
after each phase of the intervention. The test items were scored at pre-test, at mid-
point, and after the second intervention. There was a significant increase in scores
from pre-test to mid-point assessment and from mid-point to post-test with strong
effect sizes. These results, along with the study by the NBME, provide evidence that
the quality of test items can be improved through faculty development.
The Medical College of Wisconsin’s (MCW) longitudinal fellowship program
evolved over 10 years into a modular system – Excellence in Clinical Education and
Leadership (ExCEL). In this system, faculty members can complete one module on
a specific topic or string together a set of modules to complete a longitudinal pro-
gram of learning (Simpson et al. 2006) This modular system allows faculty mem-
bers to create their own individualized learning plan that meets their own needs and
the needs of their departments. The MCW modular faculty development system
includes an ‘assessment of learner performance’ module. This assessment module
includes practical and fun exercises, such as the ‘Wisconsin State Fair Chocolate
Judging’ in which faculty members learn about measurement theory by developing
criteria to describe the best chocolate. The work culminates in the judging of a vari-
ety of chocolates, some well-known and others submitted for competition at the
Wisconsin State Fair. Faculty members learn about bias and measurement error
using their taste buds. In another assignment, faculty members work in small groups
to development an OSCE station. This exercise includes all aspects of an OSCE,
from the development of the case objectives, the writing of the standardized patient
script, the development of the checklist, and even producing the door signs for the
station. During the exercise, faculty members are reminded to consider the issues of
reliability and measurement error. The assessment module also requires faculty
members to develop their own assessment tool based on a real educational need.
They then pilot test the assessment instrument and determine the measurement
characteristics. Each of these assessment exercises employ active learning methods,
are practical for the learner, and employ elements of fun while learning. Evidence
of the success of the ExCEL program is its ongoing enrollment levels. These
exceeded the planners’ expectations with 23 primary care faculty members partici-
pating per module with an 85 % completion rate. Retrospective self-report of change
from pre-to-post completion of the modules indicates that the program objectives
were met. In addition, between 2002 and 2005, the 30 participants ‘averaged five
accepted peer-reviewed presentations at regional national meetings and published

more than 20 articles and 50 abstracts. Ten of their durable products were accepted
to the AAMC’s MedEdPORTAL between May and November 2005’ (Simpson
et al. 2006, p. 950).
Although giving effective feedback is often the skill that faculty members list as
one in which they would like to become more skilled, there are few reported stud-
ies that focus on training in the art of feedback, especially ones that provide evalu-
ation data beyond participant satisfaction. Walsh et al. (2009) evaluated the
outcome of a 2 h workshop on giving feedback using case discussions, role play-
ing, and reflection on how to change teaching practices. A pre-test survey of par-
ticipants consisted of items on what constituted effective feedback and possible
barriers to effective feedback. An immediate post-test survey asked participants to
indicate anticipated changes in their teaching practices. Three to four months after
the workshop, participants were asked to complete a follow-up survey indicating if
they had made the planned changes to their teaching behavior or any unplanned
changes. Only 20 % at pre-test felt that effective feedback should be timely or
constructive. At immediate post-test, 76 % reported that they planned to make ‘a
definite change in their teaching practices’ (Walsh et al. 2009, p. 48) and 41 %
indicated a specific change. The 4-month follow-up survey indicated that approxi-
mately 75 % of respondents had interacted with a learner since the workshop and
all reported that they had made at least one of their planned changes to the way
they gave feedback. Some (37 %) even reported unplanned changes to their teach-
ing. Other studies of programs to train faculty members in feedback skills exist, but
a number have resulted in negative results (McAndrew et al. 2012; Stone et al.
2003). Each of these programs to develop skills in providing feedback were short
workshops. Development and evaluation of more extensive faculty development
programs in this area will likely be needed as medical education moves quickly
into competency-based and developmental (i.e. achievement of milestones along
the educational continuum) educational models (Dath and Iobst 2010; Holmboe
et al. 2011; Ross et al. 2011).
2.5 Designing Teaching Improvement Activities
Evaluation studies of specific teaching improvement interventions provide limited

guidance on the most powerful design for teaching improvement activities. Most
programs have largely relied on participants’ ratings of quality or usefulness. Others
have relied on self-reports of changes in knowledge, attitudes and beliefs about
learning and teaching and sometimes actual change in teaching practices. Few eval-
uation studies have included control groups or focused on changes in students’ rat-
ings of the teaching behaviors or actual learning outcomes (Steinert et al. 2006).
Those few studies associated with actual changes in teaching behaviors or learner
outcomes suggest that certain teaching improvement formats are more effective
than others (Chism and Szabo 1997; Steinert et al. 2006; Wilkerson and Irby 1998).
In a systematic review of studies in faculty development, Steinert et al. (2006)

concluded:
Key features of effective faculty development contributing to effectiveness included the use
of experiential learning, provision of feedback, effective peer and colleague relationships,
well-designed interventions following principles of teaching and learning, and the use of a
diversity of educational methods within single interventions (p. 497).
New approaches to teaching improvement activities will likely capitalize on the

growing use of social media and other methods of brief electronic communication,
such as those already being used in clinical teaching to ‘push’ information to learn-
ers (Boulos et al. 2006), but there is little in the literature currently that describes or
evaluates the use of these tools for teaching improvement purposes, although Web-
based modules on teaching skills have been available for many years (e.g. Practical
Doc, http://www.practicaldoc.ca/teaching/practical-prof/). In one new approach
using e-mail, Matzie et al. (2009) used a spaced education approach for teaching
residents to give feedback in a general surgery program. The 55 participating resi-
dents were stratified by year of training and whether they had attended a 1 h didactic
program on giving feedback; they were randomized to either receive or not receive
a weekly email for 9 months containing one succinct tip on giving feedback (e.g.
keep feedback focused and avoid trying to accomplish too much). Students rotating
on the surgery clerkship were asked to evaluate the feedback frequency and quality
provided by residents with whom they had worked over the previous 2 weeks.
Residents in the spaced practice intervention were rated as providing significantly
more feedback and feedback that was more useful than those in the control arm.
Spaced education uses repetition and time to reinforce knowledge and skills learned,
as opposed to massed or one-time learning. Use of e-mail reminders, or in the future
possibly the use of Twitter to serve as an adjunct to faculty development, may
become more common. As more millennial students become faculty members, we
may need to examine how we deliver faculty development to a generation that is
accustomed to receiving bits of information through texting and Twitter and using
social media for communication.
Whatever the methods employed in teaching improvement programs, it is impor-
tant to focus on the critical goal – change. O’Sullivan and Irby (2011) have sug-
gested that we need a more complex model of faculty development in order to better
understand the features that lead to desired changes in teachers, learners, organiza-
tions, and patients. The authors suggest the need to include a focus on the faculty
development community of participants and the workplace community rather than
focusing only on the individual participants. They suggest four components essen-
tial to the planning and evaluation of faculty development – the participants, the
program content, the skills and attitudes of the facilitators, and the organizational
contexts in which participants actually teach in order to extend our understanding of
essential faculty development features. In the book, Influencer: The Power to
Change Anything, Patterson et al. (2008) suggest that the likelihood of change is
increased when individual and organizational ‘six sources of influence’ are included:
making the undesirable desirable; capitalizing on peer pressure and developing
organizational rewards and accountability measures; building the individual’s

personal commitment to change; reinforcing new abilities through the engagement
of others; and structuring the environment so that the targeted behaviors are
rewarded. This interplay of personal, social, and structural sources of influence are
drawn from social psychology and organizational change. The development of com-
petencies for teachers at the school, institution, and national level is changing how
we prepare and reward competent teachers. There is a long history of faculty devel-
opment for teaching improvement. How we as faculty developers design, imple-
ment, and disseminate our successful programs should help us move the field
forward to meet the needs and challenges put forth to us by our stakeholders – the
trainees, patients, faculty members, and accreditation bodies – who will demand of
us the tools and training to make our faculty the most competent teachers possible.
2.6 Implications for Teaching Improvement

Activities in Faculty Development
As teaching as a scholarly activity and educational scholarship (Boyer 1990)

become more valued faculty activities in health professions education and assume
a more influential place in the promotion and tenure process, it is likely that more
institutions, and perhaps more governments, will follow the lead of the Netherlands.
We believe that a competency framework, such as the one developed by the AoME,
is a useful guide for faculty developers in creating programs to train faculty mem-
bers to meet teaching standards. In this chapter, we have described a number of
successful faculty development programs that trained faculty to develop curricula,
to teach, and to assess and provide feedback to learners. In some areas, such as
curriculum development and assessment, there is a paucity of published studies
that go beyond student satisfaction as an outcome. A challenge for us is to docu-
ment and rigorously study the work that we are doing. A number of the studies
described went beyond self-report of behavioral change following participation in
a faculty development program. Examples of these are evaluating a curriculum for
quality (Snyder 2001), assessing teaching behaviors via an objective structured
teaching evaluation (Berbano et al. 2006), or evaluating test items (Jozefowicz
et al. 2002; Naeem et al. 2012).
Resources get scarcer all the time. Budgets are smaller and time seems to be ever
shrinking. If we as faculty developers are to justify our continued existence within
our professional schools, we will likely need to meet greater scrutiny to demonstrate
that our programs are worthwhile to our faculty members and institutions in gen-
eral. Can we do that by designing comprehensive faculty development programs
that train our faculty members to meet specific measureable competencies, just as
students and other trainees must do? Should we also consider a developmental
model (Dreyfus and Dreyfus 1986; Green et al. 2009) that will demonstrate that we
can train our faculty members to achieve varying levels of competency and maintain
their competency over time? O’Sullivan and Irby (2011) suggest that participants
identify a knowledge gap and then develop their own methods to demonstrate that
they have filled that gap. The use of a competency framework should inform faculty
members about the values and expectations of the institution, allowing them to eval-
uate their own needs to meet identified standards as teachers. Using the competency
framework within a comprehensive faculty development program could inform not
only the individual faculty member but also the larger community of faculty mem-
bers, affecting the context in which they teach and work. This is consistent with
O’Sullivan and Irby (2011) who suggest that this is the ultimate goal of faculty
development. They contend that the system is complex and requires us to consider
the various communities of practice that are affected by our programs and where our
programs are situated. Is a successful faculty development program one that only
affects the participant or is the program successful when it affects the larger com-
munity and context of the institution? One may also ask if making expectations for
our teachers more explicit, such as using a competency framework, is the first step
in influencing the community of practice. If faculty members know what is expected
of them to demonstrate that they are effective teachers, must we provide the tools
for them to improve their teaching in a way different from what we do today? At the
Medical College of Wisconsin (Simpson et al. 2006), the longitudinal faculty devel-
opment program was changed to a modular system to better meet the needs of par-
ticipants. Is a more individualized system the future of faculty development? If
O’Sullivan and Irby’s approach (2011) is correct, this may be the case if we can also
create community within these smaller units of instruction. Only time and the use of
rigorous outcome measures will inform us if this new approach to improving teach-
ing is successful.
2.7 Conclusion
In the 1950s, faculty development to improve teaching was one of the first types of
faculty development to emerge in higher education. Today, it is still the most com-
mon form of faculty development in the health professions. In this chapter, we
reviewed a number of competency frameworks to improve teaching for health pro-
fessions teachers. We found that most of these frameworks had considerable overlap
with each one including: (a) skills in curriculum design; (b) teaching and supporting
learners; and (c) assessment and feedback. Several best practice examples from the
faculty development literature demonstrate how these three competencies might be
learned and illustrate what is known about the effectiveness of a variety of teaching
improvement activities. The literature is limited in the quality of evidence available
about what works for teachers, their students, and the systems in which both educa-
tion and patient care occur. As faculty developers, we will need to continue to inno-
vate in defining and teaching the competencies necessary for our health professions
teachers as they progress from novice to master teachers.
2.8 Key Messages
• Faculty development to improve teaching is the most common type of faculty

development activity reported in the health professions literature.
• Many competency frameworks for improving the teaching of health professions
teachers exist; most of these include: (a) skills in curriculum design; (b) teaching
and supporting learners; and (c) assessment and feedback.
• The competency framework developed by the Academy of Medical Educators in
Great Britain is a useful guide for faculty developers who wish to create pro-
grams to train faculty members to meet teaching standards.
• Many successful faculty development programs have trained faculty members to
develop curricula, to teach, and to assess and provide feedback to learners. Many
have also gone beyond self-report of behavioral change following participation
in a faculty development program and have included more rigorous evaluation
methods.
• In the future, faculty developers should consider developing comprehensive fac-
ulty development programs that train our faculty members to meet specific mea-
sureable competencies.
Appendix A
First three Domains of the 2012 Professional Standards of the Academy of Medical
Educators (Re-printed with permission from the Academy of Medical Educators
(2012) Professional Standards.)
Domain 1: Design and Planning of Learning Activities
This domain outlines the expected standards for medical educators involved in edu-
cational design and learning development processes. Applicants must demonstrate
and referees must corroborate these capabilities.
Element Standard level 1

Learning and teaching principles 1.1.1 Shows how the principles of learning and teaching
are incorporated into educational developments
1.1.2 Is aware of different ways of learning and teaching
Learning needs 1.1.3 Shows how the needs of learners are considered
Learning outcomes 1.1.4 Is aware of the need to define what is to be learned
Learning and teaching methods 1.1.5 Is aware of a range of learning methods, experiences
and resources and resources and how they may be used effectively
Evaluation of educational 1.1.6 Responds appropriately to feedback and evaluation
interventions of educational interventions
Standard level 2 Standard level 3

1.2.1 Applies learning and teaching 1.3.1 Applies learning and teaching principles in the
principles in the design of a unit, design of a curriculum for a whole course or
module or subject area degree program
1.2.2 Matches course design to support
different ways of learning and teaching
1.2.3 Gathers and interprets basic 1.3.2 Conducts complex learning needs analyses
information on the needs of learners including those of learners, groups, professions
or healthcare systems
1.2.4 Constructs appropriate learning 1.3.3 Defines learning outcomes within theoretical
outcomes that can be measured or frameworks
judged
1.2.5 Matches learning methods, experi- 1.3.4 Is adaptive and effective in securing resources
ences and resources to intended and dealing with constraints
outcomes
1.2.6 Develops learning resources for
planned courses
1.2.7 Evaluates and improves educational 1.3.5 Conducts, interprets, acts on and disseminates
interventions evaluations of learning programs
Domain 2: Teaching and Supporting Learners
This domain outlines the expected standards for medical educators in relation to
teaching and facilitating learning. Applicants must demonstrate and referees must
corroborate these capabilities.

Delivering teaching 2.1.1 Appropriately uses a range of learning and teaching
methods and technologies
Maintaining an effective 2.1.2 Is aware of the importance of establishing a safe and
learning environment effective learning environment
Learning and teaching methods 2.1.3 Is aware of a range of learning methods that may be used
and resources in learning and teaching activities
Feedback on learning 2.1.4 Understands the importance of seeking, receiving and
responding to feedback about learning and teaching
Participation 2.1.5 Describes ways of involving learners in actual practice
e.g. experiential learning opportunities
Reflection 2.1.6 Is aware of the importance of reflection on practice

2.2.1 Appropriately uses a broad range 2.3.1 Is adaptive and innovative in respect to learning
of learning and teaching methods and and teaching
technologies 2.3.2 Supports others to innovate
2.2.2 Establishes an effective learning 2.3.3 Monitors and manages complex learning
environment environments
(continued)
(continued)
2.2.3 Provides educational, personal and 2.3.4 Proactively seeks to improve the learning
professional support in relevant environment
contexts
2.2.4 Applies learning and teaching 2.3.5 Adapts learning and teaching methods to
methods that are relevant to unexpected circumstances
programme content
2.2.5 Uses learning resources 2.3.6 Develops innovative learning resources
appropriately
2.2.6 Develops self-awareness in 2.3.7 Develops self-awareness in learners and teachers
learners
2.2.7 Listens actively and provides 2.3.8 Interprets, synthesizes and deals with conflicting
effective feedback to learners using a information arising from feedback from learners
range of methods and educators
2.3.9 Effectively demonstrates to learners the rationale
for changing or not changing teaching and
learning activities in response to feedback
2.2.8 Engages learners in reflective 2.3.10 Actively seeks to incorporate learners into a
practice community of practice
2.2.9 Uses systems of teaching and 2.3.11 Demonstrates a commitment to reflective
training that incorporate reflective practice in self, learners and colleagues
practice in self and others
Domain 3: Assessment and Feedback to Learners
This domain outlines the expected standards for medical educators in making and
reporting judgments that capture, guide and make decisions about the learning
achievement of learners. Applicants must demonstrate and referees must corrobo-
rate these capabilities.

The purpose of the assessment 3.1.1 Is aware of the general purpose of assessment
The content of the assessment 3.1.2 Is aware that assessment should align with the course
learning outcomes
The development of assessment 3.1.3 Is aware that good assessment practices are integral to
course development
Selecting appropriate 3.1.4 Is aware that assessment methods are chosen on the
assessment methods basis of the purpose, content and level of the assessment
3.1.5 Uses a basic range of methods to assess learners
Maintaining the quality 3.1.6 Is aware that assessment practices require continuous
of assessment monitoring and improvement

3.2.1 Relates the purposes of assess- 3.3.1 Designs complex assessment strategies and
ments to the context of the course or blueprints
programme
3.2.2 Demonstrates that the contribu- 3.3.2 Maintains and manages assessment blueprints for
tion of any assessment addresses the one or more courses or levels
learning outcomes and the
assessment blueprint
3.2.3 Contributes to the construction of 3.3.3 Leads design and development of assessments
assessment items utilising accepted good practice such as in the
determination of reliability, validity, acceptability,
cost effectiveness and educational impact
3.2.4 Selects assessment methods that 3.3.4 Assesses learners using a wide range of methods
match the purpose, content and level
of the learner
3.2.5 Uses a broad range of methods to
assess learners
3.2.6 Interprets accurately assessment 3.3.5 Contributes under guidance to standard setting
reports in relation to educational processes
quality management 3.3.6 Applies standard setting procedures most relevant
to particular methods and format
3.3.7 Interprets technical data about effectiveness of
assessment practices
3.3.8 Prepares assessment reports for learners,
examination boards and external stakeholders
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Chapter 3
Faculty Development for Leadership
and Management
Tim Swanwick and Judy McKimm
3.1 Introduction
When we think of leadership in health professions education, it is tempting to be

drawn to images of medical school deans, principals of colleges and heads of
academic departments. Institutional leadership. Ivory tower. Arcane. But the vast
majority of those involved in educational leadership (particularly at postgraduate
levels) work primarily in hospitals and community settings, are practicing clinicians,
and deliver care to patients while carrying the responsibility for systems of
education and training that must prepare the professionals of the future. And all
of this occurs within a rapidly changing healthcare context that is increasingly
challenging and uncertain.
The foregrounding of leadership as an essential ‘non-technical skill’ (Fletcher
et al. 2002) for health professionals is emphasized in standards frameworks and core
curricula around the world (e.g. Royal College of Physicians and Surgeons of
Canada 2010; General Medical Council 2009). Effective leadership is widely
considered a prerequisite for the delivery of high quality healthcare (Institute of
T. Swanwick, MA, MBBS, FRCGP, MA, FAcadMEd (*)

Postgraduate Medical Education, Health Education North Central and East London,
London, UK
J. McKimm, MBA
College of Medicine, Swansea University, Swansea, West Glamorgan, UK

54 T. Swanwick and J. McKimm
Medicine 2011; King’s Fund 2011) and a range of publications cite leadership as a
fundamental underpinning of professional practice (e.g. van Mook et al. 2012).
Nowhere is this more true than for those health professionals who have the
challenge of working in the dual contexts of the academic institution (which awards
professional qualifications) and the clinical environment in which much of the
learning takes place.
As a result, faculty development plays a vitally important role in ensuring that
those who lead and manage the education and training of health professionals
have the knowledge, skills and attitudes appropriate to their role and organiza-
tion. In this chapter, we use the term ‘educational leadership’ – as opposed to the
‘clinical leadership’ of teams, departments, units and specific clinical situations – to
include the leadership and management of organizations, departments, resources,
research studies, projects, curricula, assessment and innovations. Common to
both the educational and clinical contexts, leadership can be found at ‘all levels’,
distributed or dispersed, throughout the organization. And both clinical and
educational leadership involve autonomous professionals with their own profes-
sional identities, with the consequence that leadership often requires the mobili-
zation of both positional and professional power. We explore these issues later in
the chapter.
For some professions, such as medicine, learners will be engaged in training
programs for anything up to 15 years. Ensuring that curricula and competency
frameworks genuinely help prepare learners for independent professional practice
is a huge challenge given the slow pace of change in academic organizations.
Alongside these pedagogic issues, educators (particularly in academic institutions)
are increasingly required to perform more administrative and management func-
tions, respond to demands from regulators and funding bodies around quality
assurance, carry out research activities, and teach more students within increasing
economic constraints. Delivering a high quality learning experience on this
‘crowded stage’ challenges educators across all health professions more than
keeping up to date with subject discipline and educational knowledge and skills
(McKimm and Swanwick 2011).
Such challenges also raise some specific issues for faculty members as many
come through a vocational clinical route into education or research and, in doing
so, have to make career transitions from clinician to teacher, and then from
teacher/researcher to manager and leader. Other educators from academic, biomedi-
cal or social science environments are required to make similar transitions. And
whilst (in high income countries at least) the professionalization of teachers in
higher education and clinical settings is becoming embedded, with a plethora of
courses and programs available for health professionals to help develop their
understanding and skills as teachers (see Chap. 2), faculty development targeted
specifically at leadership and management is relatively new. This chapter sets
out the rationale for introducing such provision and describes some of the ways
in which healthcare and academic organizations and individuals might ‘learn
leadership’.
3 Faculty Development for Leadership and Management 55
3.2 Models, Concepts and Theories of Leadership
Concepts of leadership have developed over the last 60 years as leaders and leadership
emerge in response to preoccupations of the time and socio-cultural change. In
trying to describe ‘what works’ (and what doesn’t), a range of theoretical models
have been generated. It is important to note, however, that the emergence of a
new model does not mean that older models are discarded; rather, they are recon-
ceptualized. A Google™ search on ‘leadership’ brings up over 120,000,000 sites,
and so we can only just touch on some of the main theories and concepts about
leadership in this section.
Leadership models and theories can be categorized in a number of ways.
Although there is clearly some overlap between theories, for the purposes of this
chapter, which discusses the faculty development of health professions educators,
we will group them as follows:
1. Those which focus on the personal qualities or personality of the leader as an
individual.
2. Those which relate to the interaction of the leader with other people.
3. Those which seek to explain leadership behaviors in relation to the environment
or system.
Considering the theories from these perspectives enables faculty development
activities to be tailored to achieve the desired outcomes of the individual, the
team or the organization. Table 3.1 lists some of the commonly described theories,
concepts and models that can be found in the vast literature on leadership. The
numbers in brackets (i.e. 1, 2 or 3) relate to how the theories relate to the three
categories described above.
Kouzes and Posner (1995) suggest that leadership is an observable, learnable set
of practices. Leadership is not something mystical and ethereal that cannot be
Table 3.1 Some commonly described leadership theories, concepts and modelsa
Leadership theories, concepts and models
Adaptive leadership (3) Engaging leadership (2)
Affective leadership (1, 2) Followership (2)
Authentic leadership (1, 2) Leader-member-exchange (LMX) theory (2)
Charismatic leadership (narcissistic) (1) Ontological leadership (1)
Complex adaptive leadership (3) Relational leadership (2)
Collaborative leadership (2, 3) Servant leadership (1, 2, 3)
Contingency theories (2, 3) Situational leadership (2, 3)
Dialogic leadership (2) Trait (‘great man’) theory (1)
Distributed, dispersed, shared leadership (2, 3) Transactional leadership (2, 3)
Eco-leadership (3) Transformational leadership (1, 2, 3)
Emotional intelligence (EI) (1, 2) Value led, moral or wise leadership (1, 2)
a
For those interested in exploring leadership theories and concepts in more depth, Northouse
(2012) provides a useful starting point
understood by ordinary people. Given the opportunity for feedback and practice,
those with the desire and persistence to lead – to make a difference – can sub-
stantially improve their abilities to do so (p. 386). Taking the idea that leaders and
leadership can be developed, how can faculty developers use these theories or
models to help explain why certain leadership approaches might work best in the
context of healthcare education and training? Let us consider each in turn.
3.2.1 Theories Focusing on Leaders’ Personal

Qualities or Personality
Trait theories have a long history in that ‘great’ leaders were often seen as endowed
with certain characteristics, which sometimes related to their position (e.g. religious
leaders or monarchs). Such characteristics or qualities include being consistent,
trustworthy, inspiring and authentic, and displaying appropriate emotion, values and
moral courage (Avolio and Gardner 2005; Kouzes and Posner 2002). Despite the
doubt cast on such ‘great man’ theories, personality traits appear to be an important
pre-condition of effective leadership with positive, if weak, correlations found
between the personalities of those in leadership positions and the ‘Big Five’ factors
of extraversion, openness to new experience and conscientiousness and a negative
correlation with neuroticism or anxiety (Judge et al. 2002). Such individualistic
approaches have been criticized for venerating the ‘hero leader’ (King’s Fund 2011).
However, concepts such as servant leadership (Greenleaf 2002), in which the leader
‘serves first’, ontological leadership (Erhard et al. 2010; Souba 2010), which is about
‘being’ a leader rather than ‘doing leadership,’ or the ‘incomplete’, fallible leader
(Ancona et al. 2007), who is authentic in their behaviors, all seem very relevant to
leadership in the health professions, where professional behaviors and role modeling
are vitally important. The idea of leaders being in tune with their emotions as they
engage in ‘people work’ (affective leadership) also resonates well with educators’
primary role of developing the next generation of health professionals (Held and
McKimm 2012). Nonaka and Takeuchi (2011) suggest that leaders need to develop
practical wisdom or ‘phronesis’, which Hilton and Slotnick (2005) suggest is a core
component of medical professionalism. These wise leaders are able to:
… assess what is good; quickly grasp the essence of situations; create contexts for learning;
communicate effectively; exercise political power to bring people together; and encourage
the development of practical wisdom in others through apprenticeship and mentoring
(Nonaka and Takeuchi 2011, p. 61).
Based on these perspectives, faculty development activities would aim to primar-

ily develop the individual’s leadership behaviors, competencies and potential over
the long-term. Strategies and activities that have been found to be helpful in devel-
oping individuals’ self-insight and understanding of their impact on others
include personal development planning, analysis of strengths and areas for devel-
opment, mentoring and coaching, workplace based feedback (e.g. multisource
feedback) and the use of psychometric tests such as the Myers-Briggs Type Indicator
(Myers et al. 1998) or Hogan Personality Inventory (http://www.hoganassessments.
com/hogan-personality-inventory).
3.2.2 Theories Relating to the Interaction

of Leaders with Others
Most leadership theories understandably offer explanations of how leaders can best
work with others to engage and influence them and facilitate change. Early models,
such as transactional leadership (Burns 1978) and leader-member-exchange theory
(Seibert et al. 2003), looked at how leaders worked with others reciprocally to
improve organizational performance by offering rewards, imposing sanctions and
enabling participation in the leaders’ ‘in-group’ (Heifetz and Linsky 2004). Models
such as Goleman’s work on Emotional Intelligence (EI) and leadership styles (2000)
can be helpful in offering a framework for leaders to consider different contexts and
situations and adopt an appropriate style or approach to motivate others and regulate
disruptive emotions. Goleman (2000) suggests that the emotionally intelligent
leader requires competencies in self-awareness, self-regulation/management, social
awareness, empathy and relationship management.
The idea that leaders can adopt different approaches, behaviors or styles from
some sort of ‘menu’ suggests that (a) leadership can be learned and developed
through training and feedback, and (b) that leadership behaviors are contingent on
situations or those involved (i.e. contingency theories, situational leadership). This
perspective also moves us away from the idea of leadership being primarily rooted
in personality. Team development activities (very pertinent to the health professions
where much of the work is carried out in teams) and developing understanding of
erred ways of working in teams can be helpful. Faculty development activities that
focus on working with whole (often multidisciplinary) teams to develop and hone
leadership and team working skills can also be very powerful. Such activities might
include simulated scenarios of clinical or managerial difficult situations which may
involve manikins or actors simulating others or case study scenarios around service
redesign using role play.
Unlike some management activities which might be carried out in isolation
(such as writing a report or strategy document), leadership is relational and dia-
logical and therefore primarily involves working with people (Isaacs 1999; Lieff
and Albert 2010; Souba 2011; Uhl-Bien 2006). We explore the distinctions between
leadership and management later in the chapter. Leaders need ‘followers’ and there
is a growing literature considering the concept of ‘followership’. Grint and Holt’s
(2011) typology of followership is based on authority, certainty and uncertainty
in considering the complexity and types of problems (‘wicked’ or ‘tame’) that orga-
nizations face. Other writers (e.g. Kellerman 2007; Kelley 1988) consider the nature
of power relations between leaders and followers, highly relevant to healthcare
and health professions education in which there are longstanding power and status
differentials between professional groups, hierarchically structured organizations,
and students, patients and teachers.
Faculty development activities building on these perspectives would focus on
developing the leader’s competence in relation to others, through team-based
activities or multi-source feedback supported by the acquisition of a knowledge
base to provide frameworks which the leader can use in work situations.
3.2.3 Theories Explaining Leadership in Relation

to the Environment or System
These theories are probably the most recent in terms of the business and health
environments, considering the organization (or subsets thereof) as complex and
dynamic social systems, and the leader as ‘adaptive’ (Doll and Trueit 2010; Fullan
2005; Mennin 2010). A leader’s role here is to understand the internal system
(formal and informal structures and processes) and its relationship with the external
environment, From this perspective, change is effected through alignment of people
and processes and pushing the system towards emergent change. Bolman and Gallos
(2011) suggest that the use of metaphor or ‘frames’ is helpful in assisting academic
leaders to conceptualize the organization from the different perspectives of those
working and learning within it.
A primary leadership role is that of ‘change agent’ and leaders need to work with
followers to effect lasting and transformational change (Fullan 2007; Kellerman
2008). The concept of ‘transformational leadership’ (Bass and Avolio 1994)
has been highly influential in public services, in which leaders work with others to
motivate and inspire them to higher order thinking and value–based change.
Although transformational leadership enshrines elements of all three categories, it
has been criticized for focusing too much on the individual ‘charismatic’ (poten-
tially narcissistic and dangerous) leader rather than focusing on system-wide inter-
ventions and the building of ‘social capital’ (Bolden et al. 2009). Many organizations
have been led into failure by a combination of the charismatic, powerful leader
operating without effective governance and monitoring systems. The concepts of
shared, distributed, dispersed and collaborative leadership (King’s Fund 2011) are
now starting to come to the fore, replacing concepts primarily vested in individuals.
Not only does this approach sit more comfortably with health professionals’
values and ways of working, but it also enables organizations to spread risk
and build organizational resilience. More recently, echoing a focus on sustainability
as a key feature of all systems, the concept of eco-leadership has been described as
an emerging discourse within these post-heroic paradigms (Western 2011). Eco-
leadership emphasizes connectivity, inter-dependence and an ethical, socially
responsible stance – similar in some ways to servant leadership.
Seen through this lens, faculty development therefore needs to focus on system-wide
interventions, developing organizational capacity to adapt to the changing environ-
ment, building sustainable leadership at all levels and empowering health professionals
to collaborate interprofessionally and transprofessionally to effect meaningful
and lasting change. Leadership development is most effective when linked with
organizational development and although it may prove costly, taking a holistic
organizational approach to leadership development (e.g. employing external consultants
to work with all departments and individuals) can help deliver long-standing and
deep-rooted cultural change.
In the above, we have discussed leadership as if it exists as a discrete entity.
In reality however, health professionals are appointed to managerial positions or
given managerial responsibilities from which they are expected to lead, so they must
be able to understand management, and possess managerial skills as well as
those of leadership. Described further below, the implications of this for faculty
developers is that they must fully understand leadership and management theory as
applied to the healthcare professions education context, so that the most relevant
theoretical approaches can be taken. The ever-changing dynamic between rapidly
evolving leadership theory and health services in constant flux means that faculty
developers who deliver leadership development need to be fully aware of both
the academic and health service contexts, so that theory can be closely aligned and
applied appropriately.
3.3 Management, Administration and Leadership
In the past (and currently in more traditional settings) academics were seen as
primarily responsible for the academic content and structure of programs, for ensuring
appropriate program delivery, for designing assessments, and for evaluating educa-
tional effectiveness and quality. Academics also carried out research as well as
teaching, and conducted some administrative tasks such as chairing committees,
managing budgets or collating examination results. University administrators were
seen as providing support for academic endeavors and programs and ensuring that
appropriate management systems and processes were in place. Today, educational
leaders are increasingly required to demonstrate effective managerial skills,
blurring the boundary between the academic and the administrative. This in itself
can cause tension and a need to negotiate responsibilities for all those involved in
planning, delivering and evaluating educational programs; however, the reality is
that the educational leader (at whatever level) needs to have many more skills
than before, ranging from business management and entrepreneurship to program
administration and evaluation.
Mirroring the merging of academic and administrative functions, the lines
between leadership and management described in the literature are also less
clearly drawn than they once were. Until relatively recently, leadership was seen
Table 3.2 Traditional distinctions between leadership and management

Management Leadership
Produces order and consistency through Produces change and movement through
Planning and budgeting Setting direction
Problem solving Problem defining
Organizing and staffing Building commitment
Controlling and monitoring Motivating and sustaining
Adapted from Northouse (2012)
as a sub-set of management and much of the business literature focused on

management rather than leadership. More recently, leadership has become the
ascendant term, promoted in almost all walks of life as a panacea for most world
problems.
Typologies that distinguish between leadership and management abound and a
typical description is provided in Table 3.2. But these are entwined, complementary
and mutually dependent activities and a number of writers (Bolman and Deal 1997;
Covey et al. 1994; Gosling and Mintzberg 2003; Kotter 1990a, b) highlight that
separating leadership from management at best simply does not reflect the real
world and is, at worst, dangerous. Leaders who cannot manage effectively risk
alienation and disconnection from those who work with them and from their orga-
nization’s goals and priorities. This can potentially cause destruction and damage
through, for instance, financial mismanagement or ignorance of legal or human
resource processes. Conversely, management without wise and visionary leadership
can result in dispirited organizations, unable to respond to change. What organiza-
tions, teams and groups need is a combination of effective leadership and good
management: leadership that aligns, empowers and inspires people and creates
vision, change and movement, and management that ensures stability, consistency
and order.
In Sect. 3.2 we discussed differing models and concepts of leadership. Depending
on the theoretical framework selected, each naturally infers their own (broadly simi-
lar) sets of leadership competencies. Indicative curriculum content in relation to
leadership development is also provided later on in the chapter, but at this point it
seems appropriate to surface the many (sometimes seen as less glamorous) skills
that educators need to develop that clearly fall under the umbrella of ‘management’.
Table 3.3 describes some common management activities, summarizes why these
are important in the context of health professions education and suggests some
work-based development activities that might help educators acquire and develop
these skills. Most organizations will have courses available to senior educators,
although these are typically offered once a person has attained a management posi-
tion and not offered as a routine part of development or succession planning. We
discuss below how taking a ‘whole organization’ approach to embedding leadership
development at all levels can help better prepare people for management positions
and strengthen the organization.
3
Table 3.3 Management activities for educators in the health professions

Management activities Why is this important? Development activities
Understanding, Vital to stay within budgets, to do this you need to know what the Find out who is responsible for what budget and how the
controlling and budget allocation is and be able to actively manage it through planning and budgeting cycle works
managing budgets setting priorities and sensible procurement Ask to be involved in budget setting and management
You can make educational changes once you know the budget, to fund for your area of work
new initiatives or change priorities in response to internal or Get involved in (or offer to chair) finance committees and
external changes other resource allocation groups
Education and training budgets are often amongst the first to be Find out about how budgets for clinical placements and
cut – stay ahead of the game training are allocated, nationally, regionally and locally
Budgets that support clinical teaching and training at all levels are
often very complex
Human resource Organizations invest most of their time and money in people Learn about the formal processes in place in your
(people) Being able to delegate and work with people is vital to get tasks done organization
management (and done well) Get feedback on the way you work with others, through
Faculty Development for Leadership and Management
Understanding formal processes (recruitment, appraisal, performance multisource feedback or more informally
management, etc.) will help you support and develop your team Practice delegating, don’t take on everything yourself
Offer to get more involved with recruitment (e.g. writing
job descriptions, interview panels) and appraisal
Physical resources Classrooms, equipment, laboratories, clinical placements/appropriate Find out how facilities are planned for, allocated
and facilities case mix, simulation, communication and IT facilities are all vital and managed; is there a teaching resources/
to deliver high quality experiences but are expensive facilities plan?
As teaching/learning experiences and students and other stakeholder’s Visit other establishments, and find out what the
expectations change, learning resources need to adapt requirements of future education are going to be
Faculty development is required to keep pace with technological or Discuss internally whether your facilities are appropriate
educational changes for current and future learning and what new facilities
might be needed
61
(continued)
62
Table 3.3 (continued)

Business planning These set out organizational and lower level goals, priorities Look at your organization’s strategic plan (which should
(e.g. strategic, and a strategy so that everyone is working in the same direction be in the public domain) and also departmental plans
departmental and Aims and goals help determine the strategy (what needs to be done Set out a plan for your team, program or initiative in line
operational plans) to achieve the goals) with organizational plans
Without a plan, you can’t set priorities or allocate budgets and other Find out about some basic management tools (e.g. SWOT
resources, recruit and retain people and develop new initiatives analysis)
Reviewing plans enables evaluation of activities and planning of next steps
Curriculum/program A beautifully designed program that won’t work in practice will fail Find out about how curricula/programs are managed in
management and falter your organization
Need to work out to the finest detail how a curriculum will be Are roles and responsibilities clearly stated, how do
operationalized with clear systems and processes academic and administrative staff work together, how
Managing requires everyone to know their responsibilities and do committees function?
resources to be allocated appropriately Get involved in curriculum planning, management and
Effective program management reassures internal and external review, take on a key responsibility
stakeholders and provides a basis for review and change
Project management All short term activities can benefit from a project management Find out about basic project management techniques (e.g.
approach GANTT charts, critical path analysis) project planning
Project managing helps identify and manage risks, options, key and put them into practice with a project or initiative
stakeholders, budget, time and other resources required Get involved in projects and look at the project plan (often
Many healthcare organizations have formal project planning required for funding bodies)
processes in place
Understanding the Understanding the formal structures, processes, roles and Find out about your organization: managerial hierarchy/
internal responsibilities of your organization is essential for good organizational tree; committee structures and terms of
environment management and to effect change reference; departmental structure; etc.
Understanding the ‘shadow side’ (the informal rules, rituals, power Consider the informal side – who wields influence, do you
struggles and ways of working) can also help you influence know the key players, how would you get things done,
change and make things happen what are the rules and rituals in your organization?
T. Swanwick and J. McKimm
3
Understanding the Because health professions education is carried out in multiple Find out about the key external organizations that your
external contexts, understanding the external environment, systems, program/organization interacts with and their own
environment stakeholders and processes is essential internal structures and processes
Use tools such as PESTLE (political, economic, socio-
demographic, technological, legal, environmental) to
assess the key factors in the external environment and
how these might impact on your organization/program
Understanding and Educational management is increasingly IT based Learn to use (or use better) the management and educa-
developing Effective management systems improve quality and data handling tional IT systems that support your program delivery
management and support a range of activities and evaluation
systems (including The technical system should not drive the educational process – but it See what other organizations have in place – is there
IT) and processes often does anything you might use
Make sure you understand the basics of data protection
legislation
Educational quality, Quality assurance, management and enhancement mechanisms and Find out what the QA requirements are for your program/
evaluation reports are required by internal higher stakeholders (e.g., universities) as curriculum and from whom
well as external bodies (funders, regulators, professional bodies) Look at reports from stakeholders (internally and in the
Thorough and robust QA mechanisms enable issues to be identified public domain)
and addressed early and for longer-term program review and reform What internal processes are in place
Faculty Development for Leadership and Management
Get involved with preparing reports and internal and

external evaluation reviews
Time management Effective time management makes best use of everyone’s time and gets Agree priorities (for yourself and others) and review
(self and others) more done regularly
It is the basis of many other management activities (e.g. projects, Make a plan, write lists (and stick to them)
chairing meetings etc.) Build in time for interruptions and dealing with adminis-
tration and emails (all part of work, not an add on)
Chairing or being Committees are the formal ways in which organizational decisions are Get involved, offer to participate or chair committees,
involved in made project groups and working parties
committees Understanding how committees work can help you get your ideas Learn how to set an agenda (it will differ in different
discussed and make effective changes contexts), chair effectively (by observing others) and
produce good minutes/records (reading minutes for
sense making and clarity)
63
3.4 General Approaches to Leadership Development
So when it comes to leadership, what is the best way to approach the development
of this range of complex social processes?
Across the board, there is a dearth of high quality evidence to support a growing
range of leadership development practices. Indeed, this was one of the findings of a
recent BEME review which looked at the evidence for interventions used in the
leadership development of faculty members in the health professions (Steinert et al.
2012), as outlined in Table 3.4. The key, then, may be to go back to the object of the
activity. Leadership, management and organizational development can be seen as
being part of the same process, that of ‘increasing the capacity of organizations and
the people within them to better achieve their purpose’ (Bolden 2010, p. 117). This
takes us beyond historical, but continuingly pervasive conceptions of leadership
development that focuses on training individuals to take on increasingly responsible
and complex roles and involves a shift in emphasis from the development of
Table 3.4 Faculty development initiatives designed to promote leadership in medical education:
Key findings of a BEME systematic review
Review of the evidence identified:
41 studies of 35 different interventions
Lack of methodological rigor and sophistication of research design
Most evaluation data were collected post-intervention and consisted of participants’ responses to
questionnaires and interviews
Participants reported:
High satisfaction with faculty development programs, finding them useful, and of personal and
professional benefit
Positive changes in attitudes toward their own organizations as well as their leadership
capabilities
An increased awareness of, and commitment to, their institution’s vision and challenges
A greater self-awareness of personal strengths and limitations, increased motivation, and
confidence in their leadership roles
A greater sense of community and appreciation of the benefits of networking
Increased knowledge of leadership concepts, principles, and strategies
Gains in specific leadership skills
Increased awareness of leadership roles in academic settings
Changes in leadership behavior
Limited changes in organizational practice
Features contributing to positive outcomes included the use of:
Multiple instructional methods within single interventions
Experiential learning and reflective practice
Individual and group projects
Peer support and the development of communities of practice
Mentorship
Institutional support
Adapted from Steinert et al. (2012)
individual leaders to that of leadership development. Leadership development is an

investment in social capital which builds the organization’s leadership capacity at
all levels as well as the human capital of individual competence and capability.
Within this shifting paradigm, a number of secondary themes in the wider
leadership development literature can be identified, summarized as an evolution in
thinking about:
• The educational approach: moving from the provision of training to a focus
on ongoing leadership development embedded in systems and organizational
processes (e.g. appraisal).
• Where learning is situated: relocating from the classroom to the workplace.
• How career development is considered: reprioritizing from organizational
requirements to a consideration of individual needs.
These trends point us in the direction of some particular strategies for program
design and the selection of appropriate faculty development interventions.
3.4.1 From Training to Development
At the centre of the argument about the effectiveness of leadership development lie
some fundamental questions about whether or not leadership can be learned. As we
discussed earlier, trait theories of leadership suggest that there are innate qualities
that mark our leaders, whereas behaviorist and competency-based movements
maintain that leadership behaviors can be acquired. The truth probably lies
somewhere in between. More recently, along with the development of how we
think about leadership, has come about a paradigm shift in leadership development
from instructor-centered teaching to learner-centered personal transformation.
Antonacopoulou summarizes:
The transformation paradigm, with intellectual roots in constructivism, social constructiv-
ism and interactionism, emphasizes co-creation, interpretation, discovery, experimentation
and a critical perspective. Rather than learning leadership as it is known by others, learners
make sense of their own experiences, discover and nurture leadership in themselves and in
each other, not in isolation but in community (Antonacopoulou 2004, p. 82).
The rationale for such an approach, argues Antonacopoulou (2004), is that if

leadership’s prime purpose is to make sense to others of a constantly changing world,
then the crucial question in leadership development becomes not what to learn but
how to learn (i.e. how to remain receptive and adaptable to new situations, new con-
texts and new configurations of human and organizational relationships). Conversely,
as Hodgson (1999) highlights, ‘People who have learned leadership as a series of
rules will have an inherent inflexibility which will eventually be their downfall…
telling people how to lead is roughly equivalent to painting by numbers’ (p. 129).
A useful taxonomy that exposes some of these underlying assumptions of lead-
ership development is proposed by Holman (2000). Each of Holman’s four ‘models
of management education’ highlights differing philosophical beliefs about learning
Academic liberalism Experiential vocationalism

Aims to pursue objectivity in order to Aims to equip managers with the skills
produce the management ‘scientist’. De- they need for ‘the job’. Competence-based
livery occurs through lectures, case stud- approaches, including short courses, as-
ies, seminars. signments and e-learning, predominate.
Experiential liberalism Experiential/critical

Aims to create the reflective practitioner Aims to foster a more reflexive approach
capable of applying theory thoughtfully and a higher order of criticality resulting in
to practice. Delivery is grounded in ac- a practitioner able to challenge established
tion-learning and self-development forms of action. What is the delivery?
Fig. 3.1 Models of management education (From Holman 2000)
and the nature of management (see Fig. 3.1). As advice to program designers,
Holman counsels that an over-reliance on either theory (‘academic liberalism’), or
action (‘experiential vocationalism’) is unlikely to achieve the desired results, favoring
instead interventions that are built around critical reflection and action learning.
3.4.2 From the Classroom to the Workplace
Mintzberg argues that ‘using the classroom to help develop people already practicing
management is a fine idea, but pretending to create managers out of people who
have never managed, is a sham’ (Mintzberg 2004, p. 5). Mintzberg’s jibe at the
proliferation of classroom-based MBAs concords with a growing consensus that
leadership development should be both drawn from, and embedded in, work-based
activities. McCall et al., at the Center for Creative Leadership, summarized this
neatly as far back as 1988 (cited in Lombardo and Eichinger 2000), proposing
that in effective leadership development programs, 70 % should be work or project-
based; 20 % should occur through personal development as a result of, for example,
working and interacting with others, multisource feedback and coaching; and 10 %
can be provided through formal training programs such as attendance at courses.
The following principles for best practice in leadership development, summa-
rized in a review by Gosling and Mintzberg (2004), further emphasize the primacy
of work-based learning:
• Leadership development only makes sense for people who have current leadership
responsibilities.
• While the staff of development programs should be clear about what they want to
teach, participants should be able to weave their own experience into the process.
• Leadership development should leverage work and life experience as fully as
possible.
• The key to learning is thoughtful reflection. This means allowing time for it.
• Leadership development should be embedded and result in organizational
development.
• Leadership development becomes a process of interactive learning.
• Every aspect of the education should aim to facilitate learning and development.
What these principles also, paradoxically, suggest, is that to reap the benefit of
management and leadership development requires the design of ‘appropriate
approaches for specific situations rather than the adoption of a universal model
of best practice’ (Burgoyne et al. 2004, p. 49). So, a program that aims to develop
research leadership skills may involve new principal investigators (i.e. they have
leadership responsibilities); use case examples from good and failing research
projects; include skills such as budget and project management and team building;
and utilize relevant leadership theory (e.g. collaborative leadership for multi-centre
projects). Alternatively, a program geared to develop health professions leaders
in developing countries deliver public health strategies would focus on health
management case studies, include strategic health systems management skills, and
explore the impact of organizational structures, processes and culture on delivering
effective healthcare. A wide range of leadership theories would also be included, as
these leaders need a broad repertoire from which to draw.
3.4.3 Balancing Organizational Requirements

with Individual Needs
Finally, in any leadership development program the career aspirations of individuals

need to be considered. Indeed the goal of any successful program of continuing
professional development is the alignment of organizational goals with individual
needs. This balance is illustrated by a range of approaches identified in business
leadership development by Clarke et al. (2004). In considering the ‘who’ and ‘what’
of leadership development, the authors develop four distinguishable approaches to
how such programs may be presented within an organization. The resulting four
approaches, which we can see at play in programs across the higher education and
health sectors, are summarized in Fig. 3.2.
However, in contrast to the corporate universe of business and enterprise, in the
increasingly complex world of health professions education, portfolio-working (i.e.
having a number of different roles, jobs or employers) is the norm, and faculty
members more often than not, maintain a clinical commitment as ‘the day job’. Add
to that, the impact of an increasingly feminized healthcare workforce with its atten-
dant family and lifestyle decisions and ‘organisations can no longer assume that
those with identifiable potential will aspire to the management positions they would
like them to occupy’ (Sturges 2004, p. 263). For example, there is currently a severe
shortage of clinical (medical) academics in the UK with some disciplines and
specialties particularly affected. This affects not only research and educational
Who? Leadership development Leadership development

targeted at individuals offered across the
organisation
What?
High performing individuals are Open opportunities provided for

Individualized nurtured through tailored pro- development but left to self-
Content grammes direction of the individual
Planned activities for specific Organisation-wide provision is

Consistent groups are driven by the needs of cascaded down and available to all
Content the organisation
Fig. 3.2 Approaches to leadership development (From Clarke et al. 2004)
activities in those areas, but also means that there are fewer role models in
leadership positions with longer-term implications for strategic development and
recruitment. Careers have become the ‘property’ of the individual, rather than the
organization. And this is an important distinction, as organizational control
over who they develop for positions of leadership and management diminishes, the
control over how and when this occurs, is also severely weakened. Organizations
also become less likely to invest in the leadership development of individuals who
may move on or who work part-time and thus may offer more ad hoc, short, just-in-
time courses rather than long term programs. Leadership development of course
serves other purposes (both for the organization and the individual) than the purely
developmental, and the benefits to both, of relationship-building, retention and
renewal of a sense of shared purpose, should not be underestimated.
3.5 Specific Leadership Development Interventions
The design principles discussed above appear to move us from a pre-determined

‘course’ to a personalized ‘program’ rooted in real-world experience. But what
does that look like in practice? No two leadership development programs will be the
same, but a number of potential interventions are available for consideration, and a
selection of these are briefly described.
3.5.1 Courses, Seminars and Workshops
With these principles of leadership development in mind, what can we hope to gain
from leadership courses? There are a number of immediately tangible benefits.
Courses and formal learning opportunities provide a cohort of participants with a
sense of community and unity of purpose; they also offer participants a new shared
language to think about and discuss salient issues. They provide time out for reflec-
tion and, through the support and challenge of others, encourage new ways of think-
ing about familiar situations. Although a one-off short course is unlikely to do much
other than refresh or update skills, or perhaps enthuse a group of participants new to
leadership and management concepts, programmatic approaches to short course
development can punctuate work-place activities, coaching and feedback with vital
fora for discussion and reflection. Beyond the immediate benefits, formal programs
will often result in the establishment of a sustained, working network, either infor-
mal, supported by social media, or as part of a structured alumnus program.
3.5.2 Action Learning
‘Action learning is a continuous process of learning and reflection, supported by

colleagues, with the intention of getting things done’ (McGill and Beaty 2001,
p. 11). Individuals engaged in action learning work on real life problems with a
small group of peers, where a combination of reflection, a commitment to act, and
the support and challenge of peers creates a powerful environment for change
and development. One variation on action learning is the technique of ‘step back’,
where the problem is presented by a participant who then ‘steps back’ to listen and
observe whilst the group works on the problem.
3.5.3 Coaching and Mentoring
Coaching and mentoring, and related activities (e.g. supervision, counseling, precep-
torship) are often carried out to support leadership development. (See also Chap. 8.) For
our purpose, we shall consider coaching and mentoring to lie on the same continuum
of developmental conversations, with coaching tending to focus on the short term
achievement of specific objectives and mentoring on the longer term advancement or
development of an individual within an organization or community of practice.
Many organizations provide formal mentoring schemes for faculty who are new to
the organization or have been promoted to a leadership or management position (e.g.
http://www.london.nhs.uk/leading-for-health/programmes/leadership-coaching).
Such developmental conversations can be used synergistically with 360° appraisal,
psychological tests or in aiding the transfer of classroom learning to the workplace.
3.5.4 Multi-source Feedback
Also known as 360° appraisal, the widespread adoption of multi-source feedback

in human resource development is well documented (Alimo-Metcalfe and
Alban-Metcalfe 2006). Multisource feedback is now, of course, a familiar feature

of the health professions education landscape, although care needs to be taken in
how such tools are applied in practice. In the context of leadership development,
Chappelow (2004) offers some helpful guidelines on how to use these tools to best
benefit learners, namely that:
• 360° appraisal should not be used as a stand-alone event; rather, it should be
integrated within a developmental program of challenge and support.
• Commitment from participants to engage with developmental goals arising from
the appraisal and support from line managers are critical ingredients for success.
• The process works best when it starts at the top (i.e. the use of such tools is seen
as a culturally acceptable norm).
• Poor administration of a 360° appraisal process within an organization can have
disastrous consequences.
• Timing is crucial (e.g. to avoid redundancies).
3.5.5 Simulation
Simulation is a particularly effective vehicle for the rehearsal of leadership behaviors

in the team context. Simulations may include a focus on practicing one-to-one
communication skills, such as how to give constructive feedback to a colleague or
deal with a difficult work-based situation, through to full immersion simulations
involving whole teams or organizations. The problem, as with clinical simulation, is
how the skills and approaches then ‘transfer’ to the workplace setting. Again, simu-
lation is a tool best integrated within a program of development rooted in work-
based activities. Ensuring that participants in simulation activities receive appropriate
and constructive feedback, both in the moment and through structured debriefs,
is essential as this is part of developing more insight and understanding into the
impact of one’s behaviors on others and how this can be improved.
3.5.6 Psychometric Tools That Help Facilitate Self-Insight
Zaleznik’s somewhat chilling statement that ‘leadership is a psychodrama in which

a brilliant, lonely person must gain control of himself or herself as a precondition
for controlling others’ (Zaleznik 1977, p. 75) may be questionable 40 years on, but
the emphasis on developing self-knowledge and insight in leadership development
is as strong as ever. Programs of leadership selection and development employ a
barrage of psychometric tests ranging from parlor games to high reliability psy-
chological assessments. When used thoughtfully, they can provide a quick route
to finding out information about people that may not be readily available through
observation. They can also provide a neutral language and framework for discussing
a participant’s strengths and weaknesses. But psychometrics come with a number of
health warnings; many instruments (including several in widespread use) have poor
scientific underpinnings, the results of such tests rely on a degree of self-knowledge,
and it is often the combination of resultant factors, rather than an individual
‘trait’, ‘attribute’ or ‘preference’, that is significant. As with multi-source feedback,
psychometric tests should be included in any program but are best used as a starting
point for discussion rather than being seen as offering some absolute truth.
3.5.7 Work-Based Initiatives
Shadowing, project work, consultancy, internships, and fellowships are all useful
work-based vehicles for getting into the machinery of organizations. Coupled with
coaching or action learning, the learning that results through participation can be
real and powerful. See Chap. 7 for more information about work-based learning.
3.5.8 E-learning
Despite the convenience for students, attrition rates for e-learning are often high
even in the more successful knowledge-based specialties (Martinez 2003).
Romiszowski’s review of e-learning (2004) is critical that the ‘l’ is often subjugated
by the ‘e’; that is, programmers tend to focus on the technology rather than the
learning, although the rise of social media (Facebook, Twitter) coupled with mobile
technologies have provided a new generation with a powerful vehicle for networking
and support. Global communities of practice can now come together with ease,
with near instant access to network members across the world. E- and m-learning
(mobile learning using smart phones and other mobile technologies) can be
very useful for keeping in touch and networking, as well as for gaining easy and
round-the-clock access to ‘theory’, articles and web resources; however, because
leadership development focuses on development of the individual, face-to-face
learning is essential.
3.6 A Framework for Faculty Development
Whilst the short courses, workshops and development activities described above
can be delivered on an ad hoc basis, if we take on board the idea of developing
organizational capacity and social capital, a programmatic approach to faculty
development in leadership needs to be taken. We therefore propose five principles
for designing leadership development programs which should:
• Be practical: through the incorporation of the development of key skills such as
coaching, change management and negotiation.
Mandatory pre-course multisource feedback/360°
Residential (two-day)
Project work with action learning set

• Frameworks for leadership
• Understanding yourself as a leader
• Coaching skills
Coaching/mentoring
Workshops (one-day)
Understanding organisations
Making change happen
Influencing skills
Residential (two-day)
• Working creatively with policy
• Vision, values and strategy
• Case studies in educational leadership
Personal development portfolio and/or postgraduate certificate in educational leadership
Fig. 3.3 Sample structure for a leadership development program (as outlined in Sect. 3.6)
• Be work-oriented: by including project work as a key component supported by

action learning sets.
• Be supportive of individual development: through 360° feedback, coaching and
mentoring.
• Link theory to practice: through the provision of selected leadership and
management literature relevant to the educational context.
• Build networks: through action learning, coaching and social networking.
A sample structure for a leadership development program building on these
principles is shown in Fig. 3.3. This generalized example, taken from a number of
development programs in which the authors have been involved, incorporates a
programmatic approach to leadership development, embodying the principles
outlined above, coupled with a learner-centered approach to weaving theory with
practical work-based projects, gathering feedback and processing this in a safe
environment.
As far as more detailed ‘curriculum content’ is concerned, there are a growing
number of leadership frameworks in the literature, from a wide range of different
fields. Many institutions and professional bodies will have their own and, with
minor variations, a similar list of competencies and topics tends to be covered in

each. As with any program development, it is essential to clearly define the needs
of the learners and the aims and outcomes required, and to select which of the vast
array of theories, models and concepts will best underpin the activities and intended
learning. Clearly, depending on the trainers’ philosophical approaches, background
and experience, and the needs of individuals and organizations, different approaches
and emphases will be taken. Figure 3.4 illustrates two typical frameworks for
health professionals, to which all the provisos contained in this chapter can be
adapted and used to guide leadership development for faculty members in health
professions education.
3.7 Conclusion
In a report from an ‘Independent Commission’ published in The Lancet in 2010, 20

professional and academic leaders from around the world expound their shared
vision of the future of health professions education in an interdependent world
(Frenk et al. 2010). The ten recommendations for reform are both challenging and
illustrative of the increasingly complex system in which we operate. These recom-
mendations can be seen as the ‘to do’ list for faculty members in the forthcoming
century, one in which, as the Commission highlights, ‘Professional educators are
key players since change will not be possible without their leadership and owner-
ship’ (Frenk et al. 2010, p. 1954). If we were to search for a guiding purpose to
underpin the faculty development of education leaders in the health professions,
then the list in Table 3.5 would be an excellent starting point.
It is clear that developing the leadership and management skills, approaches
and understanding of faculty members is central to effecting such transforma-
tional change and we have discussed some of the ways in which this might be
achieved. The ‘transformational’ educator described above, who is required to
work and lead health education organizations, curricula and teams in an increas-
ingly complex global environment, will not only need to have subject discipline
expertise and understanding of educational principles and practice but will also
need to develop and demonstrate a range of leadership and management compe-
tencies. The establishment of system-wide leadership development therefore
needs to be actively and proactively managed and embedded in curriculum
design and delivery, faculty and educational development programs, perfor-
mance management approaches and recruitment and retention policies. This in
turn requires leaders at all levels to believe in and communicate a coherent
vision and direction so that strategies and policies that enable educational
change that ultimately improves health services can be implemented effectively.
Developing and supporting faculty in this endeavor through ‘learning leader-
ship’ is central to achieving this task.
a
NHS Leadership Framework (UK)
b
NCHL Health Leadership Competency Model (US)
The NCHL model provides

TRANSFORMATION
breakthrough research and
a comprehensive database Achievement Orientation
for defining the competencies Analytical Thinking
required for outstanding
healthcare leadership Community Orientation
for the future. Financial Skills
Information Seeking
Innovative Thinking
Strategic Orientation
EXECUTION
Accountability HEALTH LEADERSHIP
Change Leadership
Collaboration PEOPLE
Communication Skills
Human Resources
Impact and Influence
Management
Information Technology
Interpersonal
Management
Understanding
Initiative
Professionalism
Organizarional Awareness
Relationship Building
Performance Measurement
Self Confidence
Process Management/
Self Development
Organizational Design
Talent Development
Project Management
Team Leadership
© Copyright 2004 National Center for Healthcare Leadership, All rights reserved.
Fig. 3.4 Leadership development competency frameworks. (a) Leadership Framework (UK) (NHS
Leadership Academy 2011) © 2011 NHS Leadership Academy. All rights reserved (Permission
granted to use the diagram by NHS Leadership Academy. Full details at www.leadershipacademy.
nhs.uk). (b) Health Leadership Competency Model (US) (National Center for Healthcare Leadership
2010) (Permission granted to use the diagram by NCHL, full details at http://nchl.org)
Table 3.5 Proposed reforms for health professions education

Proposed reforms
1. Adoption of responsive, competency-based curricula that include competencies for dealing
with global health issues and complex health and social systems.
2. Promotion of interprofessional and transprofessional education that enhances collaboration
and team work and includes transferable competencies such as communication skills and
analytical abilities.
3. Exploitation of the capacity and possibilities of IT in management and data handling systems
to enable transformative education that equips learners for mastering large flows of
information.
4. Harnessing global resources for local adaptation and implementation, including curricula,
materials, and faculty and student exchange.
5. Strengthening educational capacity, capability and resources and investing in faculty
development.
6. Developing and promoting a common set of professional attitudes, values and behaviors for
all health professionals to prepare them for their role as change agents, accountable resource
managers and promoters of evidence-based policies.
7. Establishing joint mechanisms to engage key stakeholders in policy and strategy development
and in planning and managing resources, including the health workforce.
8. Expanding health education out of academic centers into system wide processes that engage
primary care and communities.
9. Establishing global and regional consortia, networks and alliances to overcome the limitations
of individual organizations or countries and share resources equitably.
10. Nurturing a culture of critical inquiry which mobilizes scientific knowledge, ethical debate
and public reasoning to generate enlightened social transformation.
Adapted from Frenk et al. (2010)
3.8 Key Messages
• Leaders in the education of the health professions typically carry a dual respon-
sibility of ensuring high quality education and safe and effective healthcare.
• Effective organizations require leadership at all levels and leaders need to
learn to lead.
• Both leadership and management are vital for organizational performance.
• Leadership development requires specific solutions for different situations.
• Faculty development programs should be practical and work-focused, support
individual development, link theory to practice and build networks.
• Longitudinal programs of development are required – in addition to short courses.
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Chapter 4
Faculty Development for Research
Capacity Building
Brian Hodges
4.1 Introduction
University faculty members typically strive to balance research and teaching, and
for clinical faculty members, there is the further challenge of patient care. To sup-
port the latter clinical role, faculties have developed continuing education programs
and for development of teaching skills, faculty development programs. Yet despite
the almost universal imperative for scholarly productivity in addition to teaching
(and clinical work), programs to help faculty members develop skills in research are
not widely available. For example, in a survey of 110 physiotherapy programs in the
United States, Rothman and Rinehart (1990) found few organized plans to help
faculty members achieve scholarly goals or to foster growth in this area. The situa-
tion is similar in nursing, where the lack of programs for scholarly development has
been described (Foley et al. 2003). In medicine, there have been substantial cri-
tiques of research quality and repeated calls for more research training (Beckman
et al. 2009; Chen et al. 2004; Cook et al. 2008; Gruppen et al. 2011; Whitcomb
2002). Taken together, these papers shine light on a significant challenge in advanc-
ing scholarship and research in health professions faculties. To address this gap,
Steinert (2011) has recommended an expansion of the traditional domains of faculty
development (the development of teachers and pedagogical skill) to include specific
development for scholarship and research. This chapter takes up that challenge and
examines faculty development for research capacity. There is much wisdom to be
B. Hodges, MD, Ph.D., FRCPC (*)

Department of Psychiatry, University of Toronto, Toronto, ON, Canada
University Health Network, Toronto, ON, Canada
Wilson Centre for Research in Education, Health Professions Education Research,
University of Toronto, Toronto, ON, Canada

80 B. Hodges
gained from the descriptions and evaluations of existing programs, but an even
greater opportunity for the creation of new and innovative faculty development pro-
grams to foster research and scholarship.
4.1.1 Sources
In preparation for this chapter, information was gathered from leaders engaged in
developing research and researchers in Canada, the USA and Europe, with a focus
on health professions education research. These consultations and the more system-
atic literature review arose from a particular context: primarily colleagues and
authors who write in English and work in Euro-American countries. As such, con-
clusions about what is good “evidence” and which practices are “best practices”
require confirmation and validation when applied in other contexts and cultures.
4.1.2 Literature Review
The literature search was undertaken in English using Ovid Medline and repeated in
Ovid Healthstar using the terms health professions/medical/nursing education (and
their variations), research (and its variations) and faculty development. There is a
relatively large literature on faculty development for research, ranging from the spe-
cific (‘how to’) to the conceptual (‘faculty development and the mission of the uni-
versity’), spanning from about 1984 to 2012. There was a flurry of writing on the
topics from 2000 to 2006. The preliminary search yielded 376 abstracts, all of which
were reviewed. Relevant articles were hand searched to identify secondary sources.
A subtotal of 93 articles were read in depth and used to prepare this chapter: 36 from
the search on medical education and faculty development, 29 from the search on
nursing or other health professions and faculty development, 26 from the search of
the general faculty development literature, and 2 from the search on faculty devel-
opment and research generally; a further 36 were identified through hand searching
secondary references across all of these categories.
4.2 Creating, Nurturing and Evaluating Programs

of Faculty Development for Research
O’Sullivan and Irby (2011) have described the limitations of what they call the ‘tra-
ditional’ (p. 422) model of faculty development, which is organized around a linear
notion that education flows from faculty members to learners to patients. This linear
model is limited, they say, because it implies that patient-related outcomes (improved
care, improved health) are achieved via student outcomes. They also critique this
4 Faculty Development for Research Capacity Building 81
model because it leaves no place for context. A similar argument is made in nursing
by Drummond-Young et al. (2010) who emphasize that a comprehensive faculty
development program must involve instructional development, professional devel-
opment, leadership development and organizational development. O’Sullivan and
Irby identify four elements: context, participants, program and facilitator(s), all of
which form an integrated community of practice for faculty development that they
call a ‘teaching commons’ (2011, p. 324). This community of practice is itself
embedded in a second and larger workplace community of teaching practice. In the
literature, many agree with the notion that the context in which faculty members’
work is at least as important as (some say more important than) the formal peda-
gogical instruction they receive. For this reason, I have taken up the challenge of
O’Sullivan and Irby’s model (if not the full model itself) throughout this paper.
O’Sullivan and Irby themselves further elaborate their model in Chap. 18. In the
next section, we explore participants, context, program (curriculum) and the role of
mentors.
4.2.1 The Participants
Health professions schools spend a huge amount of time designing selection criteria
and screening tools to identify applicants who will succeed as students. Oddly, the
concept of matching faculty to development programs has received almost no atten-
tion. Yet there is literature on the characteristics associated with research productiv-
ity. For example, Levinson and Rubenstein (2000) argue that successfully undertaking
research requires ‘an intellectual commitment to discovery’ (p. 910). Bland and
Schmitz (1986) document ten critical features associated with successful research-
ers. Not surprisingly, this includes an in-depth knowledge of the research area and a
mastery of methodological skills. However, they point out that other features are
critical: having been socialized to academic values, the ability to form a relationship
with a mentor, disciplined work habits, the ability to communicate and maintain
professional contacts, being highly motivated, and the ability to work autonomously.
‘Besides prerequisite knowledge and skills in a research area, successful researchers
have academic values and attitudes derived from specific socialization experiences’
(Bland and Schmitz 1986, p. 22).
Elen et al. (2007) argue that research development requires a different focus than
the pedagogical ‘skills paradigm’ (p. 135). In the latter, academic development
focuses on ‘the development of concrete teaching competencies, often through
training of well-defined teaching strategies or the presentation of ‘tips and tricks’
(Elen et al. 2007, p. 136). Rather than learning skills, Elen et al. suggest that the
most important quality of a research educator is the development of a ‘sophisticated
epistemological belief system’ (2007, p. 134). They argue that such a belief system
is a disposition and that it is important that faculty members gain insight into the
belief system of the research communities they wish to join. Further, it should not
be assumed that just because an individual is experienced or even successful in
82 B. Hodges
previous research that they can undertake any kind of research. It has been suggested,
for example, that basic scientists may have difficulty adapting to the contexts and
approaches of education research (Brawer 2008).
There is, of course, great variation in the jobs that individual researchers have,
ranging from those for whom research is a very minor component of a multi-faceted
academic career, through to individuals for whom research is their principle aca-
demic activity. Attention to specific roles and networks in which individuals are
embedded is important to ensuring the relevance and effectiveness of a program of
development for research (Bakken et al. 2006).
4.2.2 The Context
As Arnold (2004) writes, ‘although the characteristics of individual researchers

influence productivity, the quality of research environments is even more important
for generating scientific work’ (p. 966). First and foremost then, faculty develop-
ment for research must attend to context. Bland and Ruffin’s (1992) 30-year review
of literature on research productivity emphasizes the delicate structure required to
successfully foster research and articulates 12 characteristics of a productive
research environment. In medical education, Arnold (2004) similarly provides a
helpful summary of elements of successful research groups based on eight case
studies in the USA, Canada and Europe, all of which demonstrate the centrality of
institutional support and investment of resources. Bakken et al. (2006) emphasize
the interaction of individual characteristics and context and suggest specific inter-
ventions to optimize the career development of clinician researchers. These include:
reducing role conflicts, providing continuity of research training, creating a positive
mentorship culture and creating positive outcome expectations.
The context may be even more challenging in institutions that are not research
intensive. Feldman and Acord (2002), writing about nursing, note ‘colleges and
universities without the resources of research-intensive universities face a special
challenge to support faculty research’ (p. 140). Mundt (2001) also describes the
importance of creating programs that nurture research and scholarship in environ-
ments that do not naturally foster such activities. Such programs include linking
faculty with external mentors who come from outside institutions that have a greater
research focus.
Hafler et al. (2011) highlight a ‘hidden curriculum’ (p. 440) that greatly affects
the lives and activities of faculty members. Their paper extends Hafferty’s (1998)
well-known argument about the effects of the hidden curriculum on student learning
and asks why we educators have ignored the powerful hidden curriculum that drives
faculty behavior. They note that ‘efforts to improve the instructional value, impact,
and/or relevance of formal faculty development programs will be dictated in part by
the broader array of cultural messages that faculty members encounter as they go
about learning what being a ‘good faculty member’ means’ (Hafler et al. 2011, p.
442). The key elements of the hidden curriculum for faculty members, they write,
are: promotion and tenure processes, space and time issues, salary structure and leader-
ship. Shedding light on context and the faculty-level hidden curriculum specifically
may be helpful to untangle the sobering evidence that, despite participation in activ-
ities designed to foster research (sometimes as extensive as a Masters program),
many participants do not conduct more or better research.
It is clear that faculty development programs for research that neglect these
contextual factors in the creation of programs for research development risk having
reduced long-term impact. In addition to negative factors, there are important orga-
nizational and structural elements that help researchers flourish in some settings.
Faculty development for organizational development is considered in Chap. 6.
Institutions that wish to foster research will have to attend as much to organizational
development as to faculty development.
4.2.3 The Program
In this section, we consider the key elements of a faculty development program for
research, beginning with needs assessment and then focusing on various curricular
structures, content requirements and pedagogical methodologies that can be used,
before turning to consider the qualities and roles of facilitators and mentors.
4.2.3.1 Needs Assessment
As with any educational program, curriculum content and structure should respond
to the needs of participants. And both should be based on a coherent set of objec-
tives that are meaningful and achievable. It perhaps reflects the pressure for research
productivity that faculty members face that they sometimes harbor fantasies of
being able to master all the skills of research in a half-day course. Thus, one of the
first tasks is to align participants’ expectations with realistic course goals; defining
course goals, in turn, is based on a solid needs assessment.
The literature suggests a strong desire for faculty members’ research develop-
ment. For example, a 2010 survey of 860 individuals in 76 countries (Huwendiek
et al. 2010) explored perceptions about priorities for medical faculty development.
The study, which achieved a 36 % response rate from an initial sample of 2,200
members of the Association for Medical Education in Europe mailing list, revealed
that at the very top of a long list of priority areas was research methodology.
This contrasted with areas in which participants reported having sufficient expertise
(in their own view) such as: principles of teaching, assessment, curriculum develop-
ment and other pedagogical topics. A similar, smaller study in nursing (Foley et al.
2003) surveyed 24 programs in the United States and noted that although few had
formal faculty development programs, where they did exist, the focus was on teach-
ing skills. Yet when individuals were asked about their priorities, research mentor-
ing, scholarly writing and skills to obtain grants were at the top of the list.
84 B. Hodges
In terms of the need for faculty development in specific areas, information can be
gleaned from papers that critique the quality of current research. Common themes
(that could be used to create a faculty development curriculum) include the need to:
understand and define the link between interventions and patient outcomes
(Whitcomb 2002); better align the objectives of study with appropriate methodol-
ogy (Cook et al. 2008); and employ conceptual frameworks and theory to design
better research projects (Bordage 2009).
An important issue to consider in program design is which research theories and
methodologies will be taught, given that no one course, not even a PhD, could cover
the whole breadth of research theory and methodology. Yet a solid grasp of theory
and skillful command of methodology is key to doing good research. Therefore,
difficult as it is, faculty developers working in this area have to make choices. Just
as undergraduate programs suffer from trying to cover too many different topics,
faculty developers should think long and hard about programs for research develop-
ment that cram in too many different (and often theoretically incompatible)
approaches. Is there time to deal with the fundamentally different underlying con-
ceptions of positivism and constructivism, for example? Will there be time to deal
with both the naturalistic, observational qualitative methods and controlled, experi-
mentalist approaches? Will it be possible to deal with both coding and interpretation
of language-based data as well as statistical approaches to numerical data?
These questions go to the heart of the critiques of quality in research generally
and in health professions education specifically. Bordage (2000) observed that
much research is undertaken in opportunistic settings, without a theoretical base,
with little funding, and by isolated researchers, who publish in a dispersed fash-
ion. If we take these observations as a starting point for a good curriculum, at a
minimum it should address: sampling and study design; literature searching;
using theory/conceptual frameworks; finding funding; developing a research
team; and publishing systematically.
Choices for program structure range from short workshops, through longitudinal
courses, mentorship programs and research groups, to graduate degrees. In the next
section, we have aligned each of these approaches with a set of feasible purposes
(Table 4.1) and provide references for published models and resources. Naturally,
choice of curriculum content and model should rest on the needs assessment.
4.2.3.2 Short Workshops and Modular Programs
It is evident that a one-size-fits-all short workshop will not a competent researcher

make. Yet a meaningful short workshop can be used to:
• Develop an approach to reading and using research as a consumer.
• Whet the appetite for a greater personal engagement in research.
• Develop knowledge/skills in a focal area: for example, getting grant funding,
developing a research team/collaboration, or conducting an in-depth discussion
about sampling strategies or of a particular form of data analysis.
Table 4.1 A classification of faculty development programs for research
Program type Feasible purposes Model programs Resources
Short workshops and Ability to approach research as a Medical Education Research Certificate RESME research guide
modular programs ‘consumer’ (AAMC Group on Educational Affairs, (Ringsted et al. 2011)
Wheting the appetite for greater Gruppen et al. 2011) 12 tips for getting a grant (Blanco and Lee
engagement in research RESME/AMEE (http://www.amee.org/ 2012)
Asking good research questions index.asp?pg=45) Workshop for writing in medical education
Development of knowledge or skills in a Wilson Centre Atelier (http://cre.med. (Steinert et al. 2008)
focal area utoronto.ca/About/AtelierHome.aspx) Workshop for scholarly writing in nursing
Introduction to research theories or (Shatzer et al. 2010)
methods (may be in more depth if a
focused course)
Longitudinal Executing a scholarly project with Medical Education Scholars Program Developing a scholarly project in education:
fellowships and support (not necessarily discovery (Gruppen et al. 2003) A primer for medical teachers (Beckman
scholars programs research) and Cook 2007)
Special edition of Academic Medicine
(volume 81, issue 11, 2006) focusing on
4 Faculty Development for Research Capacity Building
fellowships and scholars programs

Fulltime research Advanced skill development in research, Wilson Centre Fellowship Program Education fellowship programs: Common
fellowship with mentorship, aiming for a (Hodges 2004; Parker et al. 2010) themes and overarching issues (Gruppen
programs (often completed research project University of California at San Francisco, et al. 2006)
linked to Masters Core elements of research: design, Research Fellowship Program (Irby
programs) literature review, ethics, data et al. 2004)
collection, analysis, publication,
presentation
Masters and doctoral Comprehensive research project or thesis Index of Masters and their curricula
degrees External examination/peer review of work (Cohen et al. 2005)
Peer-reviewed publication Worldwide inventory of Masters programs
(Tekian and Harris 2012)
85
86 B. Hodges
One common targeted use of a workshop is to develop skills of academic

publication and grant writing. Paul et al. (2002), for example, found that grant writ-
ing seminars were associated with greater research productivity among occupa-
tional therapists. Blanco and Lee (2012) provide a helpful guide called ‘Twelve tips
for writing educational research grant proposals’ that can be used in a workshop.
Steinert et al. (2008) describe a workshop for academic writing in medical educa-
tion consisting of a half-day workshop supplemented by peer writing groups and a
manual for independent work. Shatzer et al. (2010) describe a program for nurses
involving a workshop and mentorship program to develop scholarly writing. Their
program focused on the fear of failure and writing anxiety, and they use a curricu-
lum designed to bolster self-efficacy in writing.
Some use workshops to help educators effectively ‘collaborate with more expe-
rienced researchers’ and become ‘better consumers of medical education scholar-
ship’ (Gruppen et al. 2011, p. 123). Given the pressure experienced by faculty
members to be productive researchers themselves, workshop objectives of this kind
must be clear to participants so as to avoid disappointing them.
However, the value and impact of a workshop may be extended with longitudinal
components. For example, Coates et al. (2010) describe how the foundational
knowledge introduced through a research certificate program (the Medical Education
Research Certificate - MERC program) was extended to support the development of
a real world research project by ‘identifying persons with similar interests and
establishing a consortium within which to conduct more robust research studies…’
(p. 835). Indeed, evidence from continuing education research demonstrating that
one-shot education sessions are of less value and produce fewer enduring results
than longitudinal approaches (Davis et al. 1999) suggests that it is advisable to try
to include a longitudinal component wherever possible.
International conferences such as the annual meetings of the Association for
Medical Education in Europe (AMEE), Association of American Medical Colleges
(AAMC) and the Canadian Conference on Medical Education (CCME), all provide
short workshops on research. Some lead to a certificate, such as the Research
Essentials in Medical Education (RESME) course that is associated with AMEE and
the longer, modular Medical Education Research Certificate (MERC) developed by
the AAMC Group on Educational Affairs (Gruppen et al. 2011). Indeed, many inter-
national meetings now include offerings in research skills development as confer-
ence organizers become aware that the huge demand for such courses is an opportunity
for revenue generation. Goldszmidt et al. (2008) have noted, however, that even in a
relatively wealthy country (Canada), nearly 50 % of their study participants report
being discouraged from participating in such courses because of the cost.
The MERC program mentioned above was created in 2004 and provides 11 main
topics, six of which are required to earn the certificate. (The curriculum is published
in Gruppen et al. 2011.) The topics are: formulating research questions and design-
ing studies; searching and evaluating the medical education literature; data manage-
ment and preparing for statistical consultation; measuring educational outcomes
with reliability and validity; research ethics; qualitative analysis methods in medi-
cal education; program evaluation and evaluation research; questionnaire design
and survey research; qualitative data collection methods; scholarly writing and
publishing; and hypothesis-driven research. Gruppen et al. (2011) underscore that
the program is explicitly not designed to develop independent researchers, again an
important message when communicating with potential participants. They also
note that while the program committee experiences constant pressure to modify the
program to do just that, they have held firm to their belief of the value and appro-
priateness of what they call the more ‘modest goal’ of ‘providing participants with
enough knowledge…to ask informed and focused questions of consultants and
experts who can help plan studies and analyze results’ (Gruppen et al. 2011, p. 125).
The program has been successful and has grown consistently in enrolment, with
over 140 individuals earning the certificate up to 2011. The authors highlight a
number of challenges including the need for constant attention to the business
model – sustainability being heavily influenced by tuition, facilitator stipends and
number of participants per course.
The Research Essentials in Medical Education (RESME) course, created by
AMEE in 2007, takes a somewhat different approach. This course is a self-contained,
4-day curriculum given during an AMEE (or other) conference. Major topics
include an orientation to the field of medical education research; asking research
questions; an introduction to quantitative design and analysis; and an introduction
to qualitative design and analysis. The formal part of the curriculum is published in
a manual that is used in the course (Ringsted et al. 2011). The balance of the course
involves hands-on activities individually and in small groups to analyze and critique
the actual research abstracts, posters and presentations given during the same con-
ference. During the course, participants are expected to create the rough outline of
a research proposal that can be refined in the year following the course through
mentorship with one of the course facilitators. This course has also proved success-
ful and has enrolled over 160 learners. In summary, modular, multi-day programs,
though expensive and time-consuming, have met with considerable popularity.
4.2.3.3 Longitudinal Fellowships and Scholars Programs
In the last two decades, a popular model for faculty development in the health pro-
fessions is the longitudinal program for education scholars, which involves a cohort
of faculty members in a one to two-year curriculum (Fidler et al. 2007). Longitudinal
programs are discussed in more detail in Chap. 10. Scholars programs and many
fellowships, unlike the full-time programs described later, do not require faculty
members to step out of their clinical or academic responsibilities on a full-time
basis. A common model is a half-day session on a regular basis (weekly, bi-monthly
or monthly depending on the program). While scholars programs and fellowships
cover a range of topics including educational theory, pedagogical methods and
assessment and leadership, most include a focus on scholarship broadly defined and
some also include a component on research. (Many such programs are described in
a special edition of Academic Medicine e.g. Hatem et al. 2006; Robins et al. 2006;
Steinert and McLeod 2006; see also Wilson and Greenberg 2004).
88 B. Hodges
To take but one of many examples, the Medical Education Scholars Program
established at the University of Michigan in 1998 includes a research methods and
design component in its curriculum as well as a required research project. Two pub-
lished program evaluations document that participants were involved in more
research publications, presentations and grants following the program (Gruppen
et al. 2003; Frohna et al. 2006). Studies of other programs suggest increases in pro-
ductivity, grant funding and promotion among participants in scholars programs
(e.g. Coates et al. 2010; Steinert and McLeod 2006), though evaluations generally
consist of uncontrolled study designs and self-reported outcomes.
Few articles report the actual objectives or curriculum for research embedded in
a scholars programs. An exception is the University of California, San Francisco
program (Muller and Irby 2006), which describes seven program objectives: develop
skills in educational research sufficient to propose, conduct, analyze, and present a
study; write a proposal with a well-defined research question; select appropriate
research designs and measures; devise an analytical plan; identify characteristics of
accepted and rejected studies; write an abstract; critique an educational research
article (p. 962). Most programs require some sort of scholarly project, though gen-
eralizing across a diverse set of programs, these projects focus most often on devel-
opment of curricula, assessment methods, and other innovations or application of
new techniques and program evaluation, reflecting an emphasis on Boyer’s (1990)
categories of scholarship of application and of teaching, more than on research
(Frohna et al. 2006; Muller and Irby 2006). This is logical given the comprehensive
focus of scholars programs. Gruppen et al. (2011) however caution that:
[E]mbedding an instruction strand on research skills into a broad faculty development cur-
riculum has some definite strengths, but it also has limitations. One limitation is the risk that
research skills receive diminished visibility when ‘competing’ with topics like teaching
skills and educational methods (p. 122).
They go on to note that many institutions lack the infrastructure, resources and
expertise to provide a robust curriculum in research skills.
A variation on the scholars program is to create a research support group.
Beckman and colleagues (Beckman et al. 2009) created a program at Mayo Clinic
that involves regular meetings of a group of scholars who are expected to participate
in, present and critique a presentation on an actual project each month. The authors
note that certain elements are necessary to make this model effective, including
accountability (attendance and tracking of participants’ scholarly activity), a spirit
of mentorship, a focus on works-in-progress, and the deployment of protected time
and money which is distributed to the group in a competitive fashion. They report a
wide range of scholarly projects, with approximately one third consisting of
research. This program uses a framework also published by Beckman and Cook
(2007) for developing a scholarly project including: key steps of refining research
questions, identifying designs and methods, and selecting outcomes. As with many
of the programs in this category, the authors report that ‘one problem is that …
scholarly productivity is achieved by a minority of its members’ (Beckman et al.
2009, p. 520).
4.2.3.4 Full-Time Research Fellowship Programs
More targeted still are fellowships specifically focused on research. There is a

long tradition of such fellowships in clinical departments created to producing
clinician-scientists with a graduate degree. This model was relatively unknown in
health professions education until the last decade. One of the first published
examples of a medical education research fellowship was by Irby et al. (2004)
who described a program at the University of California. Meant to follow on from
an education scholars program or general education Masters degree, the fellow-
ship included funding support for protected time. The program was deliberately
small, focusing on individuals thought to be good candidates for extramural fund-
ing and leadership.
On a larger scale, the Wilson Centre for Research in Education at the University
of Toronto offers a fellowship program of 2–5 years for more than 30 individuals at
a given time, placing a focus on research skills development and on one-to-one
supervision and mentorship (Hodges 2004). Fellows must take a research-oriented
graduate degree in Toronto or internationally. The emphasis of the Wilson Centre
Fellowship Program is capacity building to develop researchers who can ‘engage in
their own program of high-quality research, to collaborate with a diverse set of
research colleagues [who will be] the next generation of researchers in this field’
(Parker et al. 2010, p. 1097). A formal description and review of this program has
been published and emphasizes the importance of both formal elements (clear pro-
cedures, structured objectives, formal community activities) and informal elements
(diversity of fellows and supervisors, flexibility of expectations, fostering of healthy
independence) (Parker et al. 2010). In summary, while longitudinal programs are
useful for fostering a comprehensive set of educational and leadership skills, to
develop research skills specifically a targeted curriculum may be needed.
4.2.3.5 Masters Degrees
Researchers in many fields pursue graduate studies as a way of deepening their

research skills. While it is beyond the scope of this chapter to review the whole field
of graduate education for research, it is well within our scope to review the important
and sometimes debated question of graduate degrees for individuals who are already
members of faculty. Levinson and Rubenstein (2000) argue that formal graduate edu-
cation for researchers is essential. They argue that while helping clinicians to develop
rudimentary skills in scholarship will allow them to engage in projects that will, in
turn, help them to be promoted academically, such introductory training is not suffi-
cient to function successfully as an independent researcher. They suggest that for
junior faculty members to develop research careers, they need: ‘protected time, unin-
terrupted by clinical or teaching responsibilities, mentorship from senior research
faculty, space and a financial commitment’ (Levinson and Rubenstein 2000, p. 908)
and a graduate degree. They place emphasis on having a ‘clear road map’ (Levinson
and Rubenstein 2000, p. 908) for their career that will lead to success.
90 B. Hodges
This is a challenging undertaking for already busy faculty members who must
add the demands of a graduate program to their clinical, teaching and administrative
commitments. Yet this approach has been rising in popularity (Cohen et al. 2005).
Indeed, in the field of medical education, there has been a rapid growth of Masters
programs (Tekian and Harris 2012). Interestingly, few actually include research. As
with the scholars programs described above, many Masters programs (particularly
Masters of Education) focus on a wide array of topics and some contain no research
training at all. Goldszmidt et al. (2008) brought this important observation to the
fore. Their paper, entitled ‘It’s not just a question of “degree”’, reported that, of a
purposive sample of 108 medical faculty members at one Canadian medical school
who had an interest in medical education, 40 % had taken formal full-time fellow-
ship or Masters. While many were involved in scholarly projects, few had attained
funding or had published their work, and no significant difference was found
between those with and without formal education training. In fact, a quarter of the
participants indicated that a major weakness of the degree program they had taken
was its inability to prepare them for conducting research. Those who felt that the
degree had a positive impact on their scholarship reported completing a thesis and
having greater exposure to education literature.
Goldszmidt et al. (2008) note that more important than obtaining a degree
was research support, enhancing colleague interactions and ongoing develop-
ment activities. Major barriers included lack of protected time, lack of access to
a context and support staff that sustains research, and a lack of knowledge of
research methodology. Strongly underscoring the role of context, the authors
concluded that:
Many medical faculty perceive that they are not adequately equipped to pursue education
scholarship, especially education research. An advanced education program on its own,
such as the Master degree may not provide all of necessary training if the plan is to pursue
education scholarship. On-going institutional support and faculty development is required
(Goldszmidt et al. 2008, p. 34).
Taken together, these results suggest that formal graduate training (or a full-time
research fellowship program) may be an important part of preparation for a research
career; however, on its own, it is not sufficient. The Goldszmidt et al. (2008) study
is a clear caution about assuming that Masters or fellowship training contains ade-
quate training to undertake research; it also highlights once again that a supportive
culture and access to resources are crucial factors.
4.2.3.6 Doctoral Degrees
In most university departments and faculties, other than faculties of medicine, a

doctoral degree is required for appointment. Thus, PhDs and their graduate students
largely populate research centers in universities. An exception to this has been
physician-scientists, many of whom do not undergo PhD training.
Levinson and Rubenstein (2000) were among the first to suggest that in order to
conduct independent research, clinical researchers might benefit from PhD
training. They also recommended that clinician scientists so trained devote at least
75 % of their time to research in order to be productive. While they noted at the
time of their paper in 2000 that the number of MD-PhDs who had made major
contributions to the field (of education) was very small, they foresaw the impor-
tance of having a critical mass of such clinician researchers. Indeed, today there is
growing interest in PhD programs in many areas. Most PhD programs, by their
nature, require an intensive research-based thesis. This is true, for example, of PhD
programs in health professions education at the University of Maastricht in the
Netherlands, the University of Chicago in the United States, and at the University
of Toronto and McMaster University in Canada, to name just a few. The number of
clinicians holding a PhD is rising steadily and some are finding roles as clinician
scientists in education research centers (Hodges 2004). However, MD-PhD train-
ing is expensive and time-consuming and appropriate for a very few. While the role
of PhD researchers is likely to continue to expand, this approach is not likely to be
feasible or useful for the majority of clinical faculty members who wish to engage
in some form of scholarship. Thus, considering a track toward a doctoral program
for those who wish to go this route is important, all the while recognizing that
doctoral education will not be the most important or practical form of research
faculty development for most.
4.2.4 Facilitators and Mentors
Having reviewed needs assessment, curriculum content and structure, we turn to

the last consideration – the individuals who will play the role of facilitators and
mentors in programs of faculty development for research. As we have seen, the
research environment is crucial, as is the availability of sufficient time and finan-
cial support. In addition, the role of a research mentor also plays a crucial part.
Many papers, and the nursing literature in particular, focus on the central role of
mentorship (Morrison-Beedy et al. 2001). Chapters 5 and 8 focus on mentorship in
more depth.
In examining factors that lead to research productivity in occupational therapy,
Paul et al. (2002) noted the pivotal role of having a research mentor who helps to
develop short and long-term goals. A similar point is made in nursing by Morrison-
Beedy et al. (2001) who write that key factors for effective research mentoring include:
setting clear goals for projects; defining expectations for protégés; establishing and
maintaining good team communications; and sharing values related to research and
nursing. Mundt (2001), also writing about nursing, outlines a set of key activities for
research mentors that allowed the University of Louisville to rapidly develop a culture
of research growth and productivity. These include: development of a 5-year research
career trajectory, plans to develop or strengthen the research program, development
and critical review of proposals for extramural funding and of manuscripts, and the
provision of advice to strengthen research development. The role of mentorship, then,
appears to be particularly important in research development.
92 B. Hodges
Another key issue is the role of facilitators who provide more generic research
support to researchers versus mentors who develop individual researcher skills.
Some universities hire staff to provide statistical, design and IRB consultation while
others hire research scientists who provide mentorship across the range of research
developmental levels. Where should scarce resources be invested? It has been noted
that busy clinicians, under pressure to do research, may fall into a dependence on
some kinds of support which, though helpful, may in the long run work against
capacity building. An extreme example was recounted by a PhD scientist who,
shortly after being hired was asked to carry a pager so that physicians could call for
micro-consultations on their research between cases in the operating room.
Colleagues at larger centers for research around the world struggle with finding the
right balance between what Albert et al. (2007) call ‘service’ and ‘science’ (p. 103).
In general, for capacity building, mentorship probably has a greater long-term
impact than technical service provision.
An illustrative example from the literature, now nearly 30 years old, was the
creation of an office for support of education research at Michigan State College of
Human Medicine (Downing et al. 1983). The office was staffed to provide services
such as clarifying research questions, designing studies, statistical analysis, and
the preparation of manuscripts and oral presentations. The office was inundated
with requests and in the first year alone, 62 new projects were initiated. Tellingly,
38 % of the participants reported that they would not have undertaken the project
without the help of the research office and only 41 % reported that they would be
willing to pay for similar services. After running the office for 2 years, the authors
stated that ‘guiding them through a positive, initial research experience is educa-
tionally valuable but unlikely to generate external funding’ (Downing et al. 1983,
p. 904) This begs the question of the degree to which this kind of research support
fosters sustainability versus dependence. Said the authors, ‘providing research
opportunities for a large number of inexperienced researchers, many of whom will
not advance their research skills any further, presents many obstacles’ (Downing
et al. 1983, p. 902). While such resources are important, and indeed can propel the
research productivity of an institution, the degree to which they create sustainabil-
ity and increased capacity through development of faculty members skilled in
research is less clear. A balance between skills development and mentorship pro-
grams on one hand, and direct research support service and facilitation provision
on the other, must therefore be struck.
Lave and Wenger’s (1991) notion of legitimate peripheral participation is help-
ful in conceptualizing how a novice researcher engages with a new research com-
munity. In their concept, novices move from a peripheral to a more central role in a
community of practice. The research mentors helps individuals gradually move
from a peripheral, observer role to one of more active participants. Some (but not
all) will then move to the central role of researcher, leading his or her own research
program. Finally, O’Sullivan and Irby (2011) emphasize the importance of bringing
together faculty members from different disciplines to learn from one another and
support development. This would seem to be an essential part of achieving Boyer’s
(1990) second level of scholarship of integration. However, it is more than that.

Bringing together individuals with different disciplinary, epistemological and meth-
odological perspectives is an important part of developing a culture of broad think-
ing, and may be accelerated by co-locating research in dedicated research centers,
units or departments.
4.3 Conclusion
Faculty development for research capacity building is a complex undertaking and is,
in many ways, distinct from other forms of faculty development. However, a rela-
tively well-developed literature, including several published models accompanied
by program evaluations, is available to guide those wishing to embark on this chal-
lenge. If there is one overarching theme that emerges clearly from the literature
reviewed in this chapter, it is that faculty developers must focus not only on course
content, the participants, the mentors and the facilitators but above all else, the con-
text to which participants will return.
Our field will benefit from scholars and researchers trained to a variety of levels.
An appreciation for, and literacy in, research is good for everyone; the ability to
participate in research is useful for a smaller, but significant number of faculty
members; and the skill to conduct an independent research program is a necessity
for a few. The format of programs presented here could be seen as a progression,
perhaps even as a developmental scheme: progressing from awareness, to personal
engagement, to leadership in research. Such a model, accompanied by an appropri-
ately supportive work environment might better allow faculty members to progress
to each successive level according to their needs, interest and abilities. Such a model
also emphasizes the development in faculty development.
4.4 Key Messages
• Faculty development for research capacity building can draw from, but is not
identical to, faculty development in other domains.
• Consideration of the context in which participants work is crucial; the context to
which they return and the support they receive may be more of a determinant in
their research productivity than their educational development.
• Development should be considered sequential and progressive with focused
introductory programs giving way to longer multi-component courses and work-
shops which in turn may lead, for some, to fellowships or graduate programs.
Acknowledgements The author would like to acknowledge Elisa Hollenberg for support in the
literature search and formatting of the manuscript and references. Thanks also to Yvonne Steinert,
David Irby and Pat O’Sullivan for very helpful comments and suggestions.
94 B. Hodges
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Chapter 5
Faculty Development for Academic
and Career Development
Karen Leslie
5.1 Introduction
There is a clear need for, and benefit to, the provision of faculty development for
career development. Faculty development for individual faculty members, their
mentors, and leaders in the institutions in which they work, is required to ensure that
there is clarity about what is valued, how this informs specific goals, and how these
goals are supported, achieved, and acknowledged. This chapter will outline the role
of faculty development in the academic and career development of faculty across
the career span. The literature in this area is relatively sparse; however, there are a
number of areas for which faculty development has been described and many more
areas for which additional program and resource development is warranted. Moreover,
although the primary focus of this chapter is on academic career development,
many of the recommendations and implications are relevant to health professionals
regardless of their involvement in supporting the academic mission.
The academic environment is increasingly complex and rapidly changing in
response to many influences. There is evidence to suggest that work stress and career
dissatisfaction are frequently the result of inadequate preparation of faculty for their
roles, lack of collegial relations, inadequate feedback and recognition, unrealistic
expectations, insufficient resources, and a lack of balance between work and personal
life (Bland et al. 2009).
Faculty development for career development is the explicit provision of guidance,
learning opportunities and resources that enable individuals to reflect on their
careers and those of others, to identify goals and required resources, to implement
K. Leslie, MD, M.Ed., FRCPC (*)

Department of Paediatrics and Centre for Faculty Development, Li Ka Shing International
Health Education Centre, University of Toronto, Toronto, ON, Canada

98 K. Leslie
appropriate plans and activities, and to assess the processes and outcomes of this
work. The goal is for faculty to experience success and fulfillment within their
contexts and cultures of practice.
Faculty development for career development should consist of formal programs
including workshops and seminars, individual and group based consultation and
learning (including approaches such as coaching and mentoring), as well as the
provision of information about materials and resources that can be accessed by
individuals to guide and advance their own career development. Steinert (2011) has
proposed a model for considering the various ways in which faculty can participate
in faculty development that includes individual and group, formal and informal
faculty development, with mentoring as a core or central activity. It is clear that
there is no one best way to provide faculty development across the career span
and therefore various methods should be considered to meet the needs of faculty
members and the contexts in which they work.
This chapter will begin with a discussion about several overarching concepts for
career development that inform an approach to faculty development in this area. In
each subsequent section of the chapter, faculty development for career development
will be framed by, and incorporate where possible, the following items: (1) the
alignment of values between individuals and their organizations; (2) the processes,
structures and resources within institutions that relate to academic roles and respon-
sibilities; (3) faculty development needs of individual faculty members; (4) faculty
development needs of their institutional or organizational leaders; (5) the existing
literature; and (6) recommendations for faculty development innovation.
Case examples will be used to illustrate faculty development for career devel-
opment across the career span. Embedded in the ideas and content of this chapter
is the understanding that our work is part of our lives and that our personal and
professional identities and roles are interdependent.
5.2 Overarching Concepts of Career Development
There are several overarching concepts that inform faculty development for career
development. These include how ‘success’ is applied to career progression, the
alignment of personal values with those of the organizational context, and the con-
cept of academic vitality. Each of these will be discussed with reference to
relevant literature, followed by ideas about how faculty development could address
the identified issues and needs.
5.2.1 Definitions of Success
Prior to a discussion about faculty development for career development and success,
there is the need to consider what we mean by ‘success’ and how this is construed.
5 Faculty Development for Academic and Career Development 99
Success can be defined as ‘the accomplishment of an aim or purpose’ and to be

successful ‘as accomplishing a desired aim or result’ (Oxford English Dictionary
Online n.d.). The fundamental question, however, is ‘Who decides what is
desirable?’ with the predictable answer being, ‘It depends’. There are a number of
perspectives that may contribute to our conceptualization of success, and for a
health professional working in an academic context, this might include the per-
spectives of patients, students, colleagues, institutions, families and selves. Some
of these perspectives may be congruent and others may not. Faculty development
for career development should engage faculty in reflection on these various per-
spectives and how to reconcile them. How we think about success is informed
by what is valued in both the processes and outcomes of an academic career. Success
is a dynamic concept, one that evolves for an individual faculty member over
time and within the professional communities and cultures in which that individual
practices.
Satisfaction is the other term that tends to be used when referring to faculty
career experiences. The term ‘satisfaction’, often used in the context of faculty career
experiences, also requires some consideration. For this chapter, the term fulfillment
has been used, rather than satisfaction, as it implies a higher level faculty career
experience (Brown and Gunderman 2006).
5.2.2 Alignment of Values
Congruence between personal values and those of the culture in which we practice
has been identified as being a fundamental aspect of career fulfillment. Individuals
need to feel that they are contributing in meaningful ways to their professional
community and that, in turn, the contexts in which they practice also attribute value
to these contributions. Lieff (2009) proposes that meaningful work occurs at the
intersection of passions/interests, strengths and values, in the context of one’s prac-
tice environment. The academic health sciences organizational context is a complex
one, with multiple areas and types of practice for each individual faculty member.
When clinical faculty members describe what they value in their careers, they
speak about the rewards of providing clinical care and state that caring for patients
is energizing. Faculty also identify how meaningful it is to be part of the teaching
mission of the university and for many, this is the reason they chose to work in aca-
demia (Pololi et al. 2009b). For some faculty, a crucial career decision may involve
whether to give up clinical work in order to pursue other academic opportunities.
The other element of an academic career is involvement in scholarly activity
and the discovery of new knowledge. This takes many forms; however, being part
of a culture that embodies a spirit of inquiry, discovery and innovation is important
to faculty.
Competing tensions exist within the academic culture. Some faculty members
report that in their academic culture, research is valued above clinical and teaching
work (Buckley et al. 2000; Wright et al. 2012). Those who are on a tenure track, or
100 K. Leslie
at an institution where promotion is largely dependent on research productivity,

are often less involved in teaching and other activities to the degree that they desire.
In another study, those who had recently been promoted to associate professor
status shared that they were now able to focus on work they enjoyed and had greater
alignment with what they wanted to do versus what they felt they had to do (Field
et al. 2011).
The above mentioned areas of practice make up what is commonly referred to as
the ‘tri-partite’ mission in the academic health professions context, and at face value
it appears that faculty members and the institutions in which they practice value this
mission in similar ways.
There is evidence to suggest that this is not always the case, and faculty report
both overt and covert messaging that creates a tension between what is stated
as being of value in one’s workplace and what is actually valued (Pololi et al.
2009b). Some of this is inherent in the arrangement that is the academic health care
organization, where the healthcare system and the system of higher education
overlap yet aren’t completely congruent with each other in their priorities. Patient
care is clearly the priority mission of healthcare, with teaching, learning and the
discovery of new knowledge and understanding being the focus of the university.
Faculty development can assist health professionals to reflect on their values and
assess their strengths and interests in the midst of these complex professional envi-
ronments in order to make choices about their careers. This might be accomplished
in group-based faculty development formats; however, some faculty may prefer to
reflect and plan on an individual basis, either with printed or web-based materials to
guide this work, or through one-to-one conversations with a mentor or colleague.
Additional detail about the role of mentoring can be found in Chap. 8.
5.2.3 Faculty Vitality
There is a growing acknowledgement that institutions need to both recognize and

address the importance of providing time and resources to fostering workplace
environments that allow faculty to thrive and make strong contributions to the
organization. Numerous authors have identified that maintaining faculty vitality is
key to both the success of the faculty and to the organization as a whole (Bland et al.
2002; Bunton et al. 2012; Lowenstein et al. 2007; Pololi et al. 2009a).
Faculty vitality is a term that has sometimes been used interchangeably with
faculty development as it relates to career satisfaction and productivity. Bunton
et al. (2012) conducted a survey on faculty workplace satisfaction of full-time faculty
members in US medical schools and identified that organization, transparency and
governance within departments and the medical school were predictive of global
satisfaction of faculty. Additional factors that predicted workplace satisfaction
included clarity and focus of the mission, as well as workplace relationships and
culture, suggesting that institutions and their leaders play key roles in estab-
lishing and promoting environments that engage faculty. Examining the factors that
influence the retention of faculty members in academia is a way of understanding

academic careers and faculty engagement in the academic culture. Expressing a
negative perception of the academic medical culture and intent to leave an institution
and/or academic practice has been associated with perceptions of low institutional
support and incongruence of values (Pololi et al. 2012). Newer generations of
faculty members may have different conceptions of what an academic career means,
and these expectations may or may not align with those of previous generations,
many of whom are in leadership positions overseeing the recruitment and retention
of faculty (Bickel and Brown 2005).
The critical need for faculty development in this area of faculty wellness and
vitality is evident, and many institutions are providing this through centralized
programs and resources. To date, there is little literature on the evaluation of these
programs, and thus, the identification of best practices in this important area is a
current gap in our understanding.
These concepts of alignment of values, definitions of success, and faculty vitality
should inform our thinking about career development and be embedded in the
development, delivery, and assessment of outcomes of faculty development in this
area.
5.3 Faculty Development for Career Development

Across the Continuum
There is considerable variability in how a career evolves and this is influenced to a

large degree by the individual and by the systems in which they work. There does
not appear to be consensus on when someone is considered early, mid or late career.
Careers take different directions, and some faculty members take on roles that have
academic affiliations after having been in professional practice for some time.
Traditionally, academic careers have been viewed from a university promotions
perspective; however, this somewhat rigid application of career progression no
longer works for a large proportion of individuals. Each institution needs to be
aware of the various roles that individuals play within their own academic contexts,
and identify and address their faculty development needs relative to their career
development interests. Referring to these as career ‘points’ as opposed to career
‘stages’ may better address the fluid nature of how careers develop.
The following section will describe what has been identified in the literature
relating to the career development needs of faculty, specific to different points in a
career. Each will include a discussion of how faculty development can address the
identified needs and a summary of what has been described in the literature.
Much of what is reported in the health professions education literature is limited
to faculty development for career development targeted to faculty in the early stages
of their careers. This is largely in the form of just-in-case information provided as a
single session, orientation event or manual provided at the beginning of one’s first
days and months as a faculty member. Rather, we need to be thinking about adding
102 K. Leslie
in more just-in-time learning, delivered at the point at which it is required and often
more useful and relevant. For example, while it is important for faculty members to
be aware of criteria for promotion at their institution, it is unlikely that they need
much detail about this in their first weeks in a new position. Faculty development
should be available longitudinally, in a variety of formats, with opportunities to
reflect on, and discuss application to, practice for the individual faculty member
(Steinert et al. 2006). Included in these activities are programs that promote faculty
members’ skills in the articulation and development of career goals, identification
of learning needs, and documentation of academic achievement that align with per-
sonal and institutional values. In addition to workshops and longitudinal programs,
inclusion of faculty development strategies such as guided self-assessment and
reflection, mentoring, coaching, and leadership development (for which there are
separate chapters in this book) are needed. There should be materials and offerings
readily available to faculty for when they need the information and/or skills to help
them address a particular career goal or decision. In addition, those in roles that sup-
port faculty members’ careers (e.g. directors, chiefs, chairs, and mentors) need to be
aware of these programs and resources and be able to refer faculty to what might be
most appropriate and relevant for them. This assumes that these leaders and mentors
are aware of, and value, these faculty development resources.
5.3.1 Early Career Faculty
Health professionals, early in their careers, are often simultaneously developing

their identities as experts in their professional field and developing an area of
academic expertise or focus. For those who may have completed graduate work or
some type of specialty training prior to becoming a faculty member, there may be
an existing academic identity. This identity can be further developed in relation to
the networks of colleagues they may seek out or be welcomed into, although not
everyone manages to acquire these networks. This alignment of identity and
purpose is important for faculty to be able to identify career goals and plans.
The availability of faculty development for career development can be variable
between different academic roles. For example, in the research culture, there are
distinct career development programs usually linked to early career grants and
funding programs. These programs can include seminars and workshops, formal
research mentorship and guidance, and activities that promote networking (Brown
et al. 2008; Bruce et al. 2011; Byars-Winston et al. 2011). Many begin during graduate
training in order to facilitate the development of established networks of colleagues
and a platform for future success. Faculty members who are part of these types of
programs are more successful with respect to outcomes such as publication and sub-
sequent funding success; however, as participation in these programs often
involves a competitive application process, selection bias may influence these
reported outcomes (Pion and Cordray 2008). Parker et al. (2011) describe a program
that included on-line learning modules in addition to the above-mentioned
components. They also utilized a novel evaluation that took a developmental approach
and explored identity development in addition to more traditional end point research
productivity. Their research was framed by Ibarra’s work that postulates that indi-
viduals try on different professional identities in early career stages (Ibarra 1999).
Some institutions have clear homes for teacher and educators, with teaching
academies (Irby et al. 2004) and centers for medical education and faculty
development. These entities promote both formal and informal opportunities for
faculty to access additional support for career development and to identify relevant
faculty development opportunities that will prepare them for their academic roles
as teachers, scholars and leaders in the education realm. While these centers are
resources for faculty at all points in their career, access to formal faculty devel-
opment opportunities, becoming a member of a community of like-minded indi-
viduals, and having an opportunity to link with potential mentors can be an enormous
advantage for those early in their career, seeking to establish their identity as teachers
and educators.
In summary, faculty early in their careers can benefit from faculty development
that enables them to identify their own values and career objectives, connect with a
community of colleagues with similar career foci, and develop an understanding
of their ongoing career development needs. This can be achieved through a variety of
faculty development formats and can be supported by having one or more mentors.
Senior leaders and mentors to these early career faculty may require their own
faculty development in order to understand their roles in assisting faculty with the
identification of career goals that align with the institution and broker connections
with faculty development resources and programs that align with these career goals.
5.3.2 Mid-Career Faculty
As mentioned earlier in this section, it is somewhat challenging to identify what can

be considered to be mid-career as this necessitates clarity about whether your career
will have a definitive end! Golper and Feldman (2008) suggest that mid-career
faculty may experience ‘loss of direction’ as they may become more in demand by
others to be mentors and may have taken on more administrative roles on institu-
tional committees. To identify the career development needs of associate professors
that had been recently promoted, Field et al. (2011) interviewed 39 faculty members
from six departments. Faculty expressed that they felt a greater alignment between
institutional expectations and their own intrinsic motivation (not entirely surprising
as the promotion process is centered on what is valued by the institution). These
faculty members identified the need for assistance with skill development relating
to leadership responsibilities they were assuming, an area which has also been iden-
tified from surveys of faculty career development needs (Miedzinski et al. 2001;
Sanfey et al. 2012). Chapter 3 provides further detail about this area of faculty
development.
104 K. Leslie
In summary, while faculty who are mid-career may have many of the same career
development needs as those earlier in their academic career, they have additional
faculty development needs with respect to the knowledge and skills required to
enact formal leadership positions and to fulfill their roles as mentors.
5.3.3 Late-Career Faculty
Health professionals in the latter parts of their careers may be completing leadership
positions or contemplating taking on new leadership roles within their local or
national practice communities. Tannen (2008) writes about the afterlife for retiring
deans and other senior administrators, and suggests that continuing in clinical,
teaching and administrative roles as well as considering retirement should all be
considered as career choices. Individuals at this stage in their careers have much to
offer as mentors to those in earlier career stages; however, as a group, late career
faculty have their own mentoring needs that are often not met, as mentoring initia-
tives and resources tend to be focused on more junior faculty.
There is a dearth of recent literature on late career planning and retirement issues
for health professionals, in particular for those working in an academic context.
Wasylenki (1978) discusses the concept of coping with change in the context of
academic physician retirement and reviews the literature in this area. He suggests
that knowledge of crisis theory, and how it examines loss, might be a useful lens
to bring to academic physician retirement. For example, loss of identity, income,
occupation and opportunities for socializing all need to be considered when thinking
about faculty needs and what areas faculty development might address.
Merline et al. (2010) surveyed members of the American Academy of Pediatrics
(AAP) and identified that part-time work and reduced work hours in anticipation of
retirement are options that are used and desired by older pediatricians. The study
authors suggest that supporting options for gradual reduction in work hours or other
forms of phasing out of the workforce could be beneficial in extending career
length. It has been suggested that department chairs can play an important role in
the careers of their faculty members by raising these issues with department members
when they are in their 50’s (Hall 2005).
The literature on faculty development for late career and retirement planning for
academic health professionals is non-existent; in fact, this is an area with much
opportunity for scholarship. There are many ways that faculty development might
be offered to address some of the identified needs. Workshops on retirement planning
should be offered on a regular basis, addressing areas such as practice options,
financial planning and resources, and health and wellness. In parallel with these
sessions for faculty, faculty leaders may require faculty development in order to
develop strategies to address academic human resource planning in the areas for
which they are responsible and to consider ways in which the experience and expertise
of the more senior members of their organizations can be valued and utilized.
Peer mentoring, either 1:1 or group based (and outlined in Chap. 8), might be a
particularly valuable faculty development strategy for later career faculty, and could
facilitate exchange of knowledge and shared learning about career development
strategies to address common challenges relating to negotiation of late career and
retirement plans.
To summarize, late career faculty members have unique needs relating to how
their interests and needs can be addressed within the academic context. Faculty
development for those earlier in their careers should include proactive planning
for the future, including retirement. For those at later career points, faculty
development is needed to assist with transition planning, whether this transition
involves realignment of their academic roles and responsibilities, or retirement from
academic practice.
5.4 Processes and Structures That Support

Career Development
There are many opportunities within existing institutions and organizations for
faculty members to receive faculty development for their career development. Many
of these opportunities link with existing processes, which map onto an academic
career trajectory, as outlined in Fig. 5.1.
The following section will review some of these processes, including recruitment,
orientation, systems of assessment (e.g. performance reviews, promotion and
tenure), ongoing professional learning, and retirement planning. Faculty develop-
ment initiatives that have been developed will be cited, and opportunities will be
identified where existing practices could incorporate faculty development.
5.4.1 Recruitment
JF is a 33-year-old who has recently completed her specialty training and is now consider-
ing faculty positions at several institutions across the country. She has completed several
interviews and is now deciding between two offers of employment; one being in an aca-
demic department, and the other in a community-based practice. She is primarily interested
in clinical work; however, she wishes to be involved in teaching, and thinks she may aspire
to an educational administrative role in the future. She is also hoping to have one or two
children in the next five years and is worried about how this might affect her ability to prog-
ress academically.
The above example illustrates a number of issues that relate to the recruitment
process for new faculty, the need for faculty development for career development
for the individual, and recognition of the role that institutions and their leaders play
in ensuring that expectations are aligned for these new potential recruits. What
information does JF have about the two institutions from which she has received job
106 K. Leslie
Fig. 5.1 The above model depicts the career development cycle, situated within a framework for
faculty development that promotes career success and fulfillment. Specific workshops (or on-line
materials and programs) can provide faculty development when it is needed, with longitudinal
programs and mentorship providing opportunities for reflection and ongoing assessment of needs
and learning. At the institutional or organizational level, faculty developers can contribute to the
development and implementation of policies and procedures that align with, and promote, career
development
Workshops: ‘just-in-time’ delivery (e.g. CV preparation, interviewing skills)
Longitudinal programs and formats such as certificate programs and mentoring
Faculty development at the institutional level through advocacy and contribution to development
of policies and procedures (e.g. recruitment, promotion, advancement)
offers? How closely do their values align with hers? Is there a good fit with her skill
set and interests? What supports are available to her as a new faculty member?
While the institutions and their leaders must acknowledge the role they play in
ensuring alignment of expectations, there is clearly the need for career development
support for JF herself.
How might these aspects of the recruitment process be addressed by faculty
development? Applicants submit a curriculum vitae that will be reviewed by
prospective employers during the recruitment process. This is an opportunity
for faculty development around crafting a well-organized and comprehensive
curriculum vitae. For example, knowing what to delete, keep and add to a
curriculum vitae that may have served you at a much earlier stage in your career,
but may or may not be suitable for application for an academic position, may be
invaluable. At the same time, most new positions include some description about
the position and the expectations of the new faculty member. Postgraduate and
graduate programs can provide faculty development to individuals to promote
reflection about the alignment of their skills and interests with those of the insti-
tution through formal seminars and through mentoring. Some professional orga-
nizations also provide workshops at annual meetings to assist senior trainees
with this process.
Interviews provide an opportunity for the individual and the recruiters to further
explore aspects of the role, including expectations of both parties. Negotiation of
what a faculty position entails is varied, and new faculty members, especially those
transitioning from training, are often not in a position to have much power in this
process, or perceive that they don’t. Utilizing existing mentors or identifying some-
one to be a ‘coach’, and using strategies such as role playing interviews or nego-
tiations, can be a useful faculty development strategy as these skills lend themselves
to active learning approaches. These techniques could also be embedded into a
workshop or seminar on interviewing and negotiation.
Leaders and administrators need to configure their recruitment strategies and
approaches in such a way as to engage those recruits that they wish to bring into
faculty positions. There needs to be a search for a good fit between the individual’s
and the institution’s values, goals, and needs (Staveley-O’Carroll et al. 2005;
Viggiano and Strobel 2009). There is a dearth of literature assessing the delivery
and impact of programs or strategies that address this particular time in a faculty
member’s career. Similar to the scholarly work being done about admissions
processes to health professions training programs, there needs to be greater study
about the most effective approaches to recruitment into academic practice. This
information could then be provided as faculty development to those individuals
involved in supporting new recruits and responsible for developing and engaging in
recruitment processes.
5.4.2 Orientation to Roles and Culture
Socialization into a profession and a culture has been identified as a fundamental

aspect of career development as these informal ways of being are often not com-
municated through formal methods of instruction (Bland et al. 1990). There are a
number of ways this can occur and more often than not, this occurs serendipitously,
rather than intentionally. A number of factors may influence the extent to which this
socialization occurs, including access to others with similar roles and identities, in
addition to more formal orientation programs for new faculty that may be offered by
schools, departments or programs. The provision of faculty development that
explicitly offers orientation and guidance for faculty new to the academic context
108 K. Leslie
can augment existing formal orientation programs and the implicit socialization that
already exists in a given institution.
Bland et al. (1990) proposed that there are key competencies that all faculty
should acquire through socialization in order to be successful in their academic
careers. She called these Professional Academic Skills (PAS), and proposed that
these be formally included in faculty development curricula for new faculty, based
on an extensive review of studies that examined correlates of success in academic
achievement (largely in research-associated settings). These PAS include three sub-
areas: Academic Values, Academic Relationships and Managing an Academic
Career. Acquiring academic values includes understanding academic values, norms
and traditions, and resolving or managing value conflicts. Academic relationships
refer to the application of knowledge and skills at multiple professional levels, and
building and maintaining relationships. Managing an academic career includes:
setting goals and priorities, understanding reward and promotion systems,
understanding the operations of the workplace, identifying one’s roles and daily
activities, and understanding goals and operations of relevant external organiza-
tions. Delivery of a faculty development curriculum that addresses these PAS needs
to be multifaceted and longitudinal. To date, there have been no published reports of
institutions that have implemented such a curriculum; however, Morzinski and
Fisher (2002) used them as a basis for evaluation of their faculty development
program and faculty members reported enhanced academic socialization skills
and formation of relationships with career-supportive colleagues as a result of their
participation in the program.
Clarity around roles, responsibilities and expectations can assist faculty with
decision-making around activities in which they should engage. In an attempt to
mitigate some of the challenges related to the expectation that faculty meet the
‘triple threat’ of having to demonstrate excellence in all areas of work, a number of
institutions have developed career development frameworks. These frameworks
describe the proportion of time allocated for the different academic roles, depending
on the primary designation (e.g. clinician, researcher). It appears that these can
make an important contribution to clarity of roles and expectations, particularly if
linked to a system of assessment (Harris et al. 2007; O’Brodovich et al. 2007;
Simpson et al. 2007). The program described by O’Brodovich et al. (2007) was also
aligned with faculty compensation. The ‘tight alignment of faculty needs, institu-
tional priorities and academic reward structures’ (Simpson et al. 2007, p. 945) are
highlighted in these examples. Faculty development can assist individuals and their
supervisors and mentors in becoming familiar with the utility and application of
these frameworks so that they can be used to guide what faculty members choose to
do within their current roles, and also what they might aspire to do in the future.
In the absence of specific job descriptions and frameworks, institutional promo-
tions tracks can be used to provide direction to faculty as to the focus of their activi-
ties. There has been an evolution from mostly research and tenure tracks, to a
diversity of tracks that include non-tenured as well as clinical and teaching faculty
tracks (Coleman and Richard 2011). There continues to be wide variation between
institutions, with many institutions continuing to expect that all faculty members
demonstrate research achievement in the traditional paradigm of the tenure

track system. Faculty development can have a role at the organizational level in
promoting understanding about how different scholarly activities and achievements
can be included, acknowledged and valued in promotions processes. This can be
accomplished in a variety of ways, including having faculty developers sit on
departmental and institutional promotions committees and contribute to the
development of promotions guidelines and workshops for faculty about the promo-
tions process.
There are a number of other tools that can assist with career development
planning including CVs, dossiers and portfolios. Often these are seen as make work
activities for faculty; however, there are creative approaches that allow them to be
used to promote reflection on activities and accomplishments, and identify areas for
future directions and associated goal setting. Use of these tools in the context of a
supportive mentoring relationship strengthens their ability to be of use in this regard.
Faculty development curricula can also address how these tools can be used to
facilitate career development planning.
5.4.3 Assessment of Achievement
There are a number of benchmarks in academic systems that can provide faculty
with the opportunity to reflect on their career progression. While these processes
and structures are often seen as summative in nature, all have the potential to be
used in a formative manner to support career development.
Performance reviews that may take place annually, or in some institutions at the
3 year mark following one’s initial faculty appointment and variably thereafter, can
provide information to faculty and their supervisors about achievement of academic
goals within identified career roles. These reviews provide an opportunity for
faculty to reflect on their existing roles and related expectations, and compare these
to their own personal needs and goals, and to those of their department, hospital or
university. The value of these performance reviews can be enhanced by faculty
engaging in reflection and discussion prior to submitting their review materials,
and in further discussion after receiving feedback about performance. Faculty
development activities can be coordinated with the timing of these reviews, and can
provide faculty with learning about goal setting, identification of continuing
education activities that might prepare them to address these goals, and the develop-
ment of ways in which they can assess the outcomes of this learning and achievement
of career goals.
Pololi (2006) describes a nine-step strategy for an academic career development
plan that incorporates the consideration of a desired pathway, goal setting, and the
involvement of a supervisor or mentor to assist with ensuring alignment with the
organizational environment. The steps begin with the identification and prioritiza-
tion of values, and include identification of strengths, then short and longer term
110 K. Leslie
career goals, along with required skills and associated learning goals. She identifies
the importance of mentoring to facilitate this process.
The promotion and tenure process can scaffold career development, and as
mentioned previously in this chapter, each institution has its own set of criteria for
promotion through the ranks. These criteria can be utilized proactively to guide
decision-making about an individual’s goals and activities. In the past, promotion
criteria have not considered aspects of scholarship other than the scholarship of
discovery (Boyer 1997). There has been a shift to more inclusive concepts of
scholarship that have been applied to teaching, education and scholarly clinical
and administrative activity (Levinson and Rubenstein 2000; Simpson et al. 2007).
In addition to the traditional curriculum vitae, portfolios and dossiers are being
used to document and describe these activities and achievements. Portfolios can
also be utilized to monitor progress and promote reflection about ongoing faculty
development needs. Zobairi et al. (2008) explored the knowledge and use of
academic portfolios in primary care departments and discovered that just over half
of the leaders who responded utilized portfolios for their faculty. The majority of
these leaders viewed portfolios as extensions of the CV and found them useful for
annual reviews and promotions purposes. Enhanced learning is also required for
faculty members to construct and develop an academic portfolio so that it not only
describes information that is valuable for institutional purposes, but can also be used
to inform career development decisions and plans.
Faculty development can play a role in assisting health professionals to capitalize
on the process of developing and reflecting on portfolios. Faculty and their mentors
can learn about the ways in which information about activities and accomplish-
ments can be identified and documented to facilitate self-assessment, the provision
of feedback, and identification of ongoing learning needs. Ross and Dzurec (2010)
describe an innovative approach to this process, using concept mapping as a way of
capturing the processes and outcomes of various scholarly activities. The appeal of
this approach is that it provides a visual collective representation of one’s activities
and achievements.
There have been specific faculty development initiatives described that address
career development for educators, academic clinicians and researchers. Each group
has distinct activities and achievements that may be valued in the promotions
process, depending on the institution. There is a clear need for institutional leaders
and their promotions committees to become more familiar with, and accepting
of, these activities and achievements, so as to value all scholarly activity. Faculty
development aimed at this level can assist with this required institutional learning.
Morahan and Fleetwood (2008) describe a model created to address the needs of
faculty in developing nations that combines activity (clinical, service or educa-
tional) with scholarship. They suggest that this may be a way to begin to develop
different ways of thinking about scholarly activity.
Faculty development programs that incorporate learning about educational
scholarship include fellowship programs (Gruppen et al. 2006) and a variety of
other formats including workshops, group mentoring (Thorndyke et al. 2006), and
graduate programs that provide specific skill development in the area of educational
research (Cohen et al. 2005). These programs can assist faculty in acquiring the
skills required to engage in scholarly educational work, and also in being able to
describe and report this activity in ways that are recognized and valued with institutions.
This is particularly important, as activity and achievement in teaching and education
does not always align with the metrics used in the promotions process.
In comparison, the metrics by which achievement is assessed for applied and
basic science research are much more widely recognized and understood. However,
there are other career development challenges for those faculty members engaging
in this type of career activity. Competition for increasingly scarce funding, the
requirement for prolonged periods of training, and lifestyle concerns have resulted
in lower numbers of junior faculty pursuing careers as researchers and scientists
(Shea et al. 2011). Faculty development interventions include specific workshops
providing guidance around grant preparation or manuscript writing. Specific
mentorship for clinician-scientists has been identified as of paramount importance;
however, it is unclear as to how this can be best provided. The majority of papers
that describe mentoring programs in this regard do not include information about
how mentors are chosen and prepared (a huge faculty development opportunity!) or
what actual processes constituted the mentoring itself (Shea et al. 2011). Faculty
development that aims to provide all faculty members with learning and practice
with feedback on the development of the skills associated with effective mentoring
should be an essential component of all academic programs.
5.4.3.1 Ongoing Professional Learning
ML, 44 years old, is an associate professor of nursing at his institution. He has been heavily
involved and successful in his program of research, and has recently been offered (and
strongly encouraged by his Department chair and others) an opportunity to take on a major
leadership role at his university. ML feels he would require additional training for such
a role, and also wonders what this would mean for his research program and his future
promotion to full professor.
What are the career development issues in the above case scenario? Does taking
on a local leadership role impact ML’s ability to pursue his research career and
demonstrate international impact of his work? What kind of skill development
might he require if he were to consider the leadership position? Where and how
might he acquire this learning? What kind of local pressure is ML under to take on
this new role? Does he have adequate mentorship in order to make an informed and
well thought out decision about this significant career development situation?
Career development for faculty is informed by the identification of goals and
associated learning needs, and by the acquisition and application of this learning
(Pololi 2006). In the academic context, faculty development is the means by which
this learning can be provided, and as mentioned throughout this chapter, there are
many ways in which this faculty development can be provided, including workshops,
online learning, formal and informal workplace based learning, and longitudinal
certificate and graduate programs.
112 K. Leslie
Sabbatical leaves have also been identified and described as a strategy by which
faculty can be provided with the time to pursue further learning opportunities (and/
or to regenerate themselves) (Bernstein et al. 1999; Brazeau and Van Tyle 2006).
Career opportunities such as the one described in the above case provide a
cue for faculty members to revisit their values, skills and career goals, and to refer
to these when considering new career opportunities. During this process, the
need for further faculty development and professional learning is often identified.
5.4.4 Retirement
Retirement is most often considered as an event. In fact, retirement is a career

development process, about which faculty and their supervisors and leaders need to
be adequately informed.
Consider the following scenario:
FR is 63 years of age and has recently completed a very successful 10-year term as a
Department Chair of a large academic department. Over this time, his clinical and research
activities have been reduced in order to allow him the time for his leadership role, although
he has continued to be involved in teaching and as a co-investigator in several research
projects. He is wondering what comes next. He is passionate about his professional work
but isn’t sure whether he wants to go back to the long hours on the inpatient unit or writing
grant applications. He isn’t confident that he is as up-to-date with his clinical field as he
would like. He would also like to be able to spend more time with his three grandchildren
and work in his garden more.
What are the opportunities for FR? What kinds of career goals does he have?
What might the new chair of his department have in mind? Does FR have interests
outside of his professional role? How is his health? Does he have a strong financial
plan in place if he were to contemplate retirement? Does his institution support
part-time work if this is something FR might desire?
Within the academic health professional literature, there is a paucity of information
to help address some of these retirement related issues and questions. As outlined
earlier in this chapter, a number of authors have identified the need for both an
appreciation of, and creativity in thinking about, the roles that more senior faculty
members can have in a department. Genovese (2006) proposed that: ‘The key to a
successful slowdown/call reduction plan resides in an understanding of the needs
of the practice and the benefits that senior physicians can provide’ (p. 46). There is
a need for health professions faculties and departments to develop innovative
models for allocation of responsibilities, in order that the experience and expertise
of more senior faculty members can be leveraged as a valued resource to the orga-
nization. In their book, The Vitality of Senior Faculty Members-Snow on the
Roof-Fire in the Furnace, Bland and Bergquist (1997) discuss that while there does
not appear to be a decline in competence or productivity as faculty age, there is
often a shift in their priorities and values. The importance attributed to the align-
ment of values has been discussed earlier in this chapter, and it is evident that it
plays a role in decision making for senior faculty, as it does at all career stages.
So too does one’s conceptualization of one’s identity, and Viggiano and Strobel (2009)
allude to the fact that one’s professional identity contributes to one’s personal
identity; faculty development could assist faculty with preparation for the shift in
identity that comes with retirement. Late career faculty contemplating retirement
often have difficulty identifying suitable mentors from within their own departments;
therefore, specific faculty development resources such as peer mentoring groups
might address some of these career development needs.
5.5 Role of the Institution in Faculty Development

for Career Development
As discussed in the preceding section, there are a variety of institutional processes

that can promote faculty development for career development. This includes the
provision of mentoring, as well as other programs that are supported administra-
tively within programs, departments, hospitals and universities. It is important that
there is institutional support for these entities (financial and mission based support)
as this provides a strong message to faculty members that they are a valued resource
to the organization.
5.5.1 Provision of Mentoring
Mentoring has been identified as an essential component of faculty success.

In today’s fast paced, next deadline work environment, carving out the time and
permission to think about and proactively consider career opportunities does not
always happen (Leslie et al. 2005). The identification and cultivation of informal
mentoring relationships may be less feasible for faculty in smaller departments, or
in geographically isolated workplaces. Faculty development in the form of formal
mentoring programs can complement existing informal mentoring, and innovative
models of mentoring, including the concept of developmental networks, are gaining
prominence in the literature as ways to enhance opportunities for mentoring and
supporting career development (Dobrow et al. 2012). Fostering faculty skills in the
identification and use of these mentoring supports is important, as is further study
about both processes and outcomes. This will provide greater understanding of how
best to implement these supports for career success and organizational vitality.
5.5.2 Faculty Development Resources
There are numerous institutional resources that can provide leadership and co-
ordination or oversight of faculty development for career development for faculty
114 K. Leslie
members. They may be called something different at each institution; however, their
function is to oversee faculty appointments, career planning, promotion, shifting roles
and responsibilities, retention, satisfaction/engagement, performance and wellness.
They include such entities known as an Office of Faculty Affairs, Office/Centre for
Faculty Development, Office/Department of Continuing Education/Continuing
Education and Professional Development, or Office/Program for Faculty Wellness.
Many institutions also have a Centre or Office of Medical Education, which
can play an important role in the provision of services and supports for career devel-
opment. The scope of these programs may be different between institutions, and
their collective functions may be provided in distinct ways; however, they represent
an explicit source of faculty development resources and programs for faculty
members. Information about the establishment of faculty development programs
can be found in Chap. 16.
Career development needs and the faculty development required in order to
promote successful career progression and fulfillment requires attention at multi-
ple levels in the institution, from the Dean, to Department Chairs and Chiefs, to
peer mentors and colleagues. Currently, most faculty development is directed at
individual faculty members. In order to address the issues identified throughout
this chapter, it is evident that faculty development should include leaders, and
groups within an organization who have the ability to influence changes in struc-
tures and processes. See Chap. 6 for more information about faculty development
and organizational change.
5.6 Conclusion
In conclusion, there are many ways in which faculty development programs and
resources can augment how faculty experience, reflect on, and plan their careers in
academia. This faculty development needs to be integrated into existing programs
and processes within departments, programs and institutions. There needs to be
ongoing dialogue between individuals who are in leadership positions, those who
have roles as mentors, and faculty across the career spectrum, as to what faculty
development is needed, and how best to provide this in the local context. In reviewing
the literature on career development and considering the faculty development needs
related to career success and fulfillment, it is apparent that faculty development
for individual faculty, their mentors, leaders and institutions is required to ensure
that there is clarity about what is valued, how this informs specific goals, and
how these goals are supported, achieved and acknowledged. Some combination of
longitudinal programs, workshops, and on-line learning and resources, supported
by ongoing individual and group based mentoring, will be required to meet the
diverse needs of faculty and their work settings.
A number of areas merit additional exploration and study. The first of these is the
concept of academic identity; how this is developed within the health professional
practice context, how it evolves over a career, and how it informs professional learning
and practice. Clarity about our professional identity, and in particular identity within
the academic culture, is key to the alignment of values that is so crucial to success
and fulfillment within an academic career. Academic identity should be considered
in the development, delivery and evaluation of faculty development.
A second area for further study is how the nature of the academic affiliation
frames career progression. For example, how do faculty members who wish to have
part-time positions (at any career stage) align with the present system of academic
recruitment, assessment and promotion? Punnett (2008) writes that women and
women’s issues committees originally brought forth this concept into academic
medicine; however, increasingly there are other instances where part-time work is
either desired or required. As more schools move to distributed campuses with
associated community-based experiences for trainees, there will be increased
numbers of community-based health professionals taking on part-time academic
roles and faculty appointments. It is not yet clear as to how these career trajectories
align with more traditional conceptions and what faculty development should look
like for these health professionals.
The final point that requires a significant amount of attention is the area of assessment
and evaluation of faculty development for career development. There are many
papers that describe the identification of need, and the development of programs,
activities and frameworks to address these needs. However, few to no rigorous and
longitudinal evaluations of comprehensive career development strategies have been
published in the academic health professions literature. This is clearly a complex
undertaking; however, there is a need to demonstrate the impact of this work so that
it can be recognized and resourced to the degree that is needed to support the most
valuable resource that institutions have, that is the faculty.
An institution is not so much a producer of great faculty as it is the product of a great faculty
(Kanter 2011, p. 919).
5.7 Key Messages
• Faculty members are most effective in their roles when their values, knowledge
and skills are aligned with those of the organizations in which they work.
• Faculty development that supports academic and career development is particu-
larly important at career transitions; however, it should be provided explicitly
across the career continuum.
• Faculty development for career development should consist of formal programs
including workshops and seminars as well as individual and group based consul-
tation and learning (including approaches such as coaching and mentoring).
• Faculty development for career development should be embedded as an overall
organizational strategy and aimed at individuals, leaders and their institutions.
116 K. Leslie
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Chapter 6
Faculty Development
for Organizational Change
Brian Jolly
6.1 Introduction
There seems to be a widely held assumption that the long-term outcomes of most
faculty development initiatives will include some degree of organizational change.
In many cases they do; most people engaged in faculty development have observed
change at the institutional level after faculty development interventions. However,
not all faculty development initiatives lead to changes and, clearly, some organiza-
tional changes take place without much faculty development.
Faculty development targeted at the individual can only achieve limited change.
The degree of limitation depends on where that individual sits within the organiza-
tion and how they engage with the development process. Faculty development for
organizational change needs to be considered from the perspectives of all stakehold-
ers. Each stakeholder group requires different approaches, but synergies can be
obtained with a well-considered approach. Faculty development for organizational
change requires attention to the educational and institutional milieu, the workforce
and the organization itself. Most of the time, change will be slow and also affected
by external factors. In addition, not all change will be attributable to the effect of
faculty development alone. Using strategies designed to counteract, or at least
acknowledge, the inhibitors of change can lead to more effective outcomes for fac-
ulty development.
This chapter will explore the mechanisms and strategies that can be used by fac-
ulty developers to promote or assist in positive organizational change. It will discuss
B. Jolly, MA (Ed), Ph.D. (*)

Medical Education, School of Medicine and Public Health, Faculty of Health,
The University of Newcastle, Callaghan, NSW, Australia
Australian Society for Simulation in Healthcare and Health Division
of Simulation Australia, Adelaide, SA, Australia

120 B. Jolly
some barriers to this process and make suggestions, in the form of ‘strategies for
success’, for faculty developers, organizational leaders and those participating in
development. This will include what to focus on and how to construct faculty devel-
opment, so that organizational change is more likely and aligned with organiza-
tional needs and priorities.
6.2 What Would Faculty Development

for Organizational Change Look Like?
The term ‘faculty development’ is an indistinct one for two reasons. First, because it is
so varied in its manifestations (Brew and The Society for Research into Higher
Education 1995). Second, because faculty development does not have a theoretical
underpinning all of its own (Steinert 2010), although to have one that is clearly identifi-
able would be useful (Steinert et al. 2012). Indeed, such a theory might help to con-
struct faculty development that is ubiquitously seen as fit for purpose. In this section,
we will look at how both providers and users commonly perceive faculty development,
and how these perceptions might impact on its value as an organizational change agent.
There are about 12–15 commonly used definitions of faculty development (or its
equivalent UK term ‘staff development’). Most faculty development is currently
targeted towards individuals or small groups of individuals who have common
learning or development goals (e.g. the need to update teaching or management
skills). However, some definitions of faculty development are couched in language
that strongly implies that there are organizational imperatives (Jolly 2002). This
contrast between individual and institutional needs, and the role of the institution in
the provision of faculty development activities, is a key factor and is reflected in the
following four definitions of faculty development:
• ‘A continuous process in which opportunities are provided for professional
growth of the individual within the academic environment’ (Allen 1990, p. 266).
• ‘A tool for improving the educational vitality of our institutions through attention
to competencies needed by individual teachers and to the institutional policies
required to promote academic excellence’ (Wilkerson and Irby 1998, p. 388).
• ‘The broad range of activities that institutions use to renew or assist faculty members
in their multiple roles. Faculty development activities include programs to enhance
teaching and education, research and scholarly activity, academic leadership and
management, and faculty affairs, including faculty recruitment, advancement, reten-
tion, and vitality. The intent of these activities is to assist faculty members in their
roles as teachers, educators, leaders, administrators and researchers’ (1st International
Conference on Faculty Development in the Health Professions 2011).
• ‘A broad concept which covers the systematic identification of the present and
anticipated needs of an organization and its members, and the development of
programmes and activities to satisfy these needs. It [faculty development] is
concerned with all aspects of a person’s work’ (Elton 1987, p. 55).
6 Faculty Development for Organizational Change 121
The last of these seems to be the one most applicable to organizational change,
(even though the third is the most recent). The utility of Elton’s 1987 definition is
that it focuses on a systematic process that is aimed at both the individual’s and the
organization’s benefit and addresses ‘all aspects’ of professional life. The broad
compass of this definition may be tenable in our current academic and healthcare
organizations, but only if the way that we promote, deliver and evaluate faculty
development undergoes some radical change. Elton’s conceptualization of faculty
development clearly implies that personal development activities are being under-
taken by academic and clinical staff in educational corporations and that, as a
result, some progress or growth will occur. The benefits of this growth are defined
and achieved by both the faculty member and by the organization. Typically, in
commercial business communities, while personal growth is undeniably important,
it is normally the case that this growth is encouraged primarily because the organi-
zation requires it, and will profit or become more competitive in some way from it
(an idea which is further discussed in Sect. 6.9). However, by comparison, in uni-
versities, the notions of competition and profit generation as legitimate goals of the
institution, although increasing in strength (Wildavsky 2010), are highly depen-
dent on the local cultural context, including the extent of government funding for
institutions and the intensity of the struggle to attract research income and stu-
dents, a context which is markedly variable across different countries. The contrast
between individual learning and organizational change will be discussed further in
Sects. 6.4 and 6.8.
6.3 What Does Faculty Development Currently Include?
The types of activity that comprise faculty development are diverse and have been
modeled on numerous approaches including lectures (Davis et al. 1999), mixed
methods (Khan et al. 2013), action groups, survival or physical exertion courses
(Marinac and Gerkovich 2012), psychotherapy, and academic ‘speed dating’
(Laprise and Thivierge 2012; Muurlink and Matas 2011). This testifies to the
almost limitless and indistinct boundaries, both in content and in methods, of what
has become known as ‘faculty development’. The context in which faculty devel-
opment operates is also varied and has included, in general terms, personal devel-
opment, as in the sabbatical or elective; professional development, such as study
for a higher degree or specialist qualification; and workforce ‘tuning’, where a
slight change or redeployment can deliver a lot more by making work more effec-
tive and/or more efficient. Sometimes faculty development seems almost indistin-
guishable from similar activities that could be called ‘continuing professional
development’. Certainly both faculty development and continuing professional
development share common ground in the educational strategies and methods
used. They also both currently embody and perpetuate a perspective that puts the
individual at the focus of both types of activities. So where does faculty develop-
ment sit in the organizational framework?
122 B. Jolly
6.4 In What Context Does Faculty Development

Operate and How Does It Work?
In academia, the idea of institutional benefit is pitched against the cherished value
of academic freedom. This tension often becomes intense when universities are
threatened by economic downturns, resulting in reductions in student enrolments in
previously expanded areas, and the only way to reap institutional benefit is to reduce
academic staff numbers or cut departments (e.g. see Meyers 2012, who cites over-
expansion of student numbers and, somewhat forcefully, excessive interest in the
pedagogy of higher education as contributors). However, it also comes to a head in
the simmering tensions between research and teaching, the two major foci of aca-
demic life that are supposed to be complementary, though frequently in opposition
(Rust 2011). Hence, although faculty development frequently means developing
personnel more fit for the (twofold) purpose of the institution, this has been a
challenging concept in institutions of professional learning or medical research.
This is largely because traditionally, individual personal and professional qualities
(e.g. intellect and empowerment), especially in research capacity, have often been
valued above institutional ones and, more importantly, above humanistic and educa-
tional ones (Handy 1999). For example, Handy (1999) describes the cultures operat-
ing in medical and academic institutions as ‘person culture’, where charisma and
expertise dominate the power hierarchy. This conflict between institutional or soci-
etal needs and personal autonomy has been epitomized in several Australian univer-
sities, and discussed generically in the UK, over the last decade, when attempts to
introduce compulsory faculty development on teaching skills for incoming staff
were resisted by some senior academics because the time devoted to this was per-
ceived to harbor potential detrimental effects on research capacity (Onsman 2009;
UK Department for Education and Employment 1999).
How the institution and the individuals within it perceive faculty development
will determine how it is used. In the definitions above, Wilkerson and Irby (1998)
are saying that faculty development should concentrate on the things that teachers
do that can promote quality teaching and academic excellence. But Elton (1987), a
prolific and major researcher in higher education, suggests that the goal and content
of faculty development should be much broader than this. Indeed, it is becoming
increasingly common in most large universities for faculty development to address
a wide range of issues: financial and management skills, including the management
of change, conflict resolution, leadership, innovation, creativity, and cultural com-
petence. However, the precise nature of the institutional, as opposed to the personal,
goal (i.e. what type of benefit should ensue?) is often not made explicit. If faculty
development is seen in an institution to be only for the benefit of an individual,
maybe as a right, or at least as an essential concomitant of academic life, it is
unlikely to be regarded as a force for change in that organization.
This means that if faculty development is to be an instrument of change in an
organization, it should encompass promotion of its role within the institution as a
mechanism both to enhance the skills of individuals and as a means to develop the
academic capital of the institution. Consequently, to be contemporary, relevant and
organizationally acceptable, faculty development will need reframing so that it has

a broader perspective than a focus on the individual. For example, faculty develop-
ers should find out before they start a project how their colleagues currently view
the faculty development programs in their organization. Are these being run primar-
ily to generate external income or goodwill from outside the organization? Are they
responsive to faculty members’ needs? Do they work, as far as the typical recipient
is concerned? Is there a faculty development ‘centre’ and is it lofty and insular, or
responsive, collaborative and outgoing?
Thus, a first strategy in using faculty development to achieve organizational
change might be as follows: Faculty development must be defined for, and
promoted to, an institution’s members in a manner that clearly connects with
its capacity to contribute to organizational change. This means that an explana-
tion of why a program is being developed should be identified in the program’s
rationale, promotional material and development activities. For example, promo-
tional material for a faculty development activity in a university might say, ‘This
University is not seen by its students as offering sufficient, or timely, feedback to
enable students to improve their work and this is having a deleterious impact on
national ratings and government funding streams. So that we can do better, a sys-
tematic literature review has isolated the main features of a useful feedback strategy,
a needs assessment conducted to determine training requirements, and a program
devised for faculty that will promote a more sensitive, systematic and effectively
delivered approach to feedback….’. Although this example, which will also serve
later when we come to strategy number two, uses the university as the primary
focus, there is no reason why other organizations could not exhibit similar traits.
However, there are dangers in the use of such a strategy. How will the movement
towards this rationalization portray units or academics engaged in faculty develop-
ment? Will they be seen as sufficiently freethinking or mainly as agents of control
for the organization, as could be typified for example by courses on conflict resolu-
tion, financial management, and how to deal with unruly students?
6.5 What Is the Organizational Potential of Faculty

Development Initiatives?
Healthcare organizations and universities are run by people, for people. Even so, the
impact of people in organizations varies. For example, service industries such as
healthcare and education, by and large, depend heavily on the technical and social
skills that their members possess. Traditionally, other industries such as mining,
agriculture, car production and engineering, while valuing personal skills, may in
fact employ fewer people, more machines, and be more reliant on the technical
capabilities of staff and technology-directed systems at all levels of the organiza-
tions. However, this traditional clear demarcation is rapidly changing (Hilton 2008),
so that even traditionally scientific- and technology-based occupations in future
will require more ‘soft skills’. Additionally, in the next 20 years, healthcare will
124 B. Jolly
expand enormously. By 2025 it is predicted that healthcare providers will be caring

for an older, wiser and more complex clientele and that healthcare will also have the
largest workforce of any organization in the western world (e.g. Buerhaus et al.
2008). Thus, for healthcare at least, developing the people in these organizations
would seem not only to have some merit as a rational strategy to promote change,
but also to be absolutely vital to the general mission of healthcare. The study of
nurses learning new communication skills, described in the next section (Heaven
et al. 2006), demonstrates quite clearly that approaching the development of faculty
in a more inclusive manner has advantages. But it also makes it more taxing because
it needs to take into account a wider range of factors.
Another feature of faculty development is that the choice of the faculty develop-
ment program is usually determined by the individual, typically from a smorgas-
bord of offerings prepared by the institution. That menu can be modern and
adventurous, or classic and refined. In either case, this has utility for the individual;
they develop skills, have time for reflection, and can pursue their personal goals. But
in doing so, they may develop skills that are well matched to the organization’s
goals and profile, and/or outgrow the organization’s role and mandate, and be reluc-
tant, or unable, to function within it. From the organization’s point of view, they will
be ‘lost’ to the system and organizational change will be less likely as a result.
Hence the second strategy for success, which takes the first strategy a step forward,
is that: Faculty development needs to be forward looking and directly linked to,
or at least cognizant of and responsive to, organizational goals if it is to assist
in promoting organizational change. In the example we gave earlier of delivering
better feedback to students, the development activity was presaged by information
that linked it directly to institutional as well as individual goals.
Where faculty development is placed in an organization, how it is funded and
governed, its structures and its staffing are therefore vitally important. If ‘the
University’ needs change, it is unlikely that a faculty development unit that is primar-
ily focused on a faculty or department (e.g. the Medical Education Unit) will be able
to deliver it. This is not because it could not achieve the required programs, but
because it would not be guided and driven by the appropriate power-brokers and sup-
ported in its mission at an appropriate level. From the counter perspective, if a faculty
or divisional unit took on such a role, it would probably be seen as not being suffi-
ciently focused on the needs of its faculty members. In practical terms, for organiza-
tional change, the Vice Chancellor or President (or whoever is the most powerful
stakeholder in the organization) needs to show visible enthusiasm for the develop-
ment program, and offer encouragement and support to those who undertake it.
6.6 What Happens to Faculty Members Who Have Been

‘Developed’?
Paradoxically, organizations that have invested in faculty development for their

staff can be unreceptive to, or even inhibit, change that might otherwise result from
the faculty development activities. For example, in a well-designed randomized
controlled trial, 61 clinical nurse specialists received workshops with either new
patient-centered communication skills training, followed by clinical supervision, or
communication skills training alone (Heaven et al. 2006). The authors first mea-
sured the impact of the workshops with simulated patient encounters, and there
were clear immediate impacts on skills, which were, in fact, developed equally well
by both groups. The researchers then followed the nurses in their real-patient
encounters, at baseline before, and then twice after the intervention. The results
showed that only those who experienced the additional supervision showed any
evidence of continued transfer of the workshop-learned skills to the workplace. The
study was groundbreaking in that it not only showed that clinical supervision had an
effect; it also demonstrated that ‘without such support in the workplace, clinical
nurse specialists find it virtually impossible to provide optimal support for their
patients and find integration of new learning extremely difficult’ (p. 323). An almost
identical process was charted in psychiatry nursing by White and Winstanley
(2010). These studies underline the fact that just training someone to take on a more
complex role will not guarantee that this role will be developed in the workplace,
unless it is accepted by co-workers, and championed, directed and supported by a
supervision process.
In a prescient paper, Shanley (2004), writing from the nurse education perspec-
tive, critiques the deficiencies of many faculty development programs in relation to
organizational change. She identifies that a ‘sophisticated and learner-centered staff
development program will have little effect if the learner has to return to a work-
place where managers, supervisors, and peers do not support implementation of the
new learning…’ (p. 84). She also raises a number of other issues that confirm the
frequent tensions between existing systems, procedures and protocols, and new
learning. She presages the Van Roermund et al. (2011) study’s findings (see below)
about new work practices that are not encouraged because things have always been
done in ‘a different way’. Shanley also highlights the negative impact that underly-
ing conflict or lack of direction and cohesion within the organization can have on
the outcomes of faculty development programs. The ‘characteristics’ of organiza-
tionally responsive faculty development that Shanley goes on to identify in the arti-
cle have much in common with the ‘strategies for success’ that are described here.
A related phenomenon was also detected by a recent study of how general practi-
tioners (GPs) in the Netherlands see themselves as teachers. These GPs had been
engaged in some faculty development on a new competency framework for educators
in general practice (Van Roermund et al. 2011). The authors described how two major
factors appeared to have had the greatest influence on implementation of this new
educational framework. The first was ‘identification’. This process took place post-
faculty development and involved the faculty development recipients identifying or
characterizing themselves in relation to the new framework; they effectively asked
‘what type of professional/teacher/person am I?’ The authors used the metaphor of a
mirror to describe this process. When teachers looked into the new mirror provided by
the faculty development experience, they truly believed they could do better and
engaged with enhancing their competencies. However, they nevertheless held on to
the beliefs and methods they had learned through experience. In this situation, the
faculty development activity did not automatically lead to acceptance of the new
126 B. Jolly
model of teaching or to expression of the desired outcomes. The second factor was the
organizational culture. As soon as a new staff member was appointed, existing expe-
rienced mentors engaged in a socialization process that shaped their new colleague’s
professional development as a teacher. In this type of environment, the new teacher
not only learnt ‘how to teach’ (irrespective of what the faculty development process
might have been), but they were also ‘initiated into the do’s and don’ts of teaching in
the local departmental culture’ (Van Roermund et al. 2011, p. 6). This phenomenon
has been recognized by researchers such as Billet (1995), as the inherent ‘power’ of
work-based learning and culture to trump other more traditional, propositional and
procedural forms of learning: craft holding sway over concepts.
These analyses tell us a great deal about the need to pay attention to an organiza-
tion’s characteristics when developing individuals to work more effectively in that
organization. Faculty development needs to address the workforce needs, but also the
leadership and middle management perspectives in an organization. In universities
and faculties of health, which are often required to respond rapidly to change, there is
huge inertia compared to organizations that exist in the competitive or volatile market
place and have to change on a regular basis to survive (Ernst and Young 2012).
This brings us to the third strategy for success: When designing development
activities for organizational change, it is necessary to address the elements in
the organization, or in the participants’ institutions, that can foster or impede
the work of those that have undertaken the development process.
One way of doing this, of course, is to engage the participants, and those who
may represent potent barriers to change in the development process, by asking them
who or what will help them to change their practice or might hinder it; in other
words, how will their new skills fit into their existing organization and what support
will they need or receive? In one of my early forays into faculty development in the
early 1980s, colleagues and I designed a 2–3 day program on teaching skills for
medical registrars to use in the clinical context. We reasoned that it would be impor-
tant to engage the registrars’ seniors, the consultants, in this process. We therefore
offered a 1-day orientation course to the consultants to show them what their regis-
trars would be doing. This turned out to be so effective that a year later we had to
start a course for the consultants as well.
Another way of managing the process is to enable the participants to deal with their
own organizations in a more effective way. This highlights the importance of faculty
developers or participants in programs spending some time getting to know their orga-
nization, the participants in the program and how they work in their own environment.
6.7 What Does Research Tell Us About Faculty

Development as an Organizational Change Agent?
Faculty development is also challenged because most research and evaluations of its
impact (see Chap. 17 for examples) have used self-reports from faculty or individ-
ual behavioral change as outcome measures, and not indices of the extent of ensuing
organizational development (Towle 1998). In a recent systematic review of the

impact of ‘resident-as-teacher’ programs, only 2 of the 29 studies that met the inclu-
sion criteria addressed organizational change as an outcome (Hill et al. 2009), and
notably both of these were undertaken in the early 1990s. Of course, faculty devel-
opment frequently results in some organizational change, and most faculty develop-
ers have observed, and long exploited, this feature (Elton 1998; Hatton and
Bullimore 1993; Mennin and Kaufman 1989).
Nevertheless, it is likely that many organizational outcomes have remained unre-
ported in the literature, even in education journals, let alone in those reporting orga-
nizational change. This limits our understanding of how effective faculty
development can be at this level. Moreover, the organizational benefits of faculty
development can be almost completely overshadowed by concurrent political, social
and economic changes. For example, in the 1980s, a new faculty development ini-
tiative at St Bartholomew’s (‘Bart’s’) Hospital Medical School, comprising a week-
long course on teaching and assessment, resulted in a small, well-motivated, cadre
of highly trained faculty who, with some support from educational professionals,
went on to radically change the undergraduate medical curriculum from a highly
traditional subject-based model to a community-oriented, integrated and student-
directed one. However, the major changes that took place were often attributed to
the contiguous reorganization of hospitals and medical schools in the London area
that dominated the front page of the daily London papers for months (Waddington
2003). Teasing out the relative impacts of all these influences would have taken an
extensive and probably unachievable research program. Critical co-dependencies
between the various drivers for change would have been huge confounders in the
investigation.
Generally, the research effort required to monitor all the impacts of faculty devel-
opment is substantial. Historically, such research has not been within the remit of
units set up to manage faculty development (O’Sullivan and Irby 2011, Chap. 18).
Consequently, as a whole, faculty development programs have been evaluated only
over the short term and, commonly, at an individual level. Many have also not been
in a position to scope their longer term impacts, either because of a dearth of
research skills or a lack of appropriate funding; it is difficult to persuade institutions
to fund follow-up outcome studies 5–10 years after the program has run its course.
This leads to a consideration of how faculty development can best lead to change.
The first three strategies in our quest for organizational change are really focused on
where faculty development needs to start, not where it needs to go.
6.8 How Does Faculty Development Challenge

the Organization?
A good deal of faculty development that occurs appropriately in health professions

education is frequently also responsible for confronting university staff and admin-
istrations with uncomfortable educational and social justice issues. For example,
128 B. Jolly
faculty development programs that target cultural competence often invoke

challenges to the way in which indigenous or immigrant students are customarily
dealt with. Achieving increased access by low socio-economic status groups to
higher education through programs that allow less academically successful students
entry (see Langlands 2005) sometimes involves changing the mindset of academic
institutions wedded to high academic achievement and elitist models of academic
progress. In the same vein, equality of access programs for students in medical and
other healthcare disciplines (see GMC 2010), for which there has been associated
faculty development, have challenged the accepted university standards for singular
merit-based entry criteria (e.g. a certain grade point average in the USA, or 3 A
grades in the national ‘A level’ school examinations in the UK). This has led to some
faculties being identified as mavericks within the larger institutional context. Thus,
‘faculty requirements’ and ‘university needs’ may not be aligned, let alone those
between individuals and the parent organization. This can cause tension and leads to
the fourth strategy for success in exploiting faculty development to accomplish
organizational change: Faculty development programs must possess attributes
and enshrine values that are shared, or at least tolerated, by the organizations
and the faculty members that use them. However they must also be prepared to
manage and successfully reconcile, or at least balance, the tensions that arise when
these values are not shared, or indeed clash.
Currently, faculty development in most organizations is not linked to strategic
organizational issues, but to concepts of best practice in teaching, research, and
management. So it is legitimate to discuss what, if any, organizational changes have
come about as the result of faculty development initiatives.
6.9 How Does Faculty Development Promote

Organizational Change?
There are few published studies of faculty development that seem to aim for, or
report, organizational change. Faculty development is the method of choice to
attempt to change staff practice by most health professions educational organiza-
tions: professional groups and associations, universities, and postgraduate colleges.
As the article by Heaven et al. (2006) suggested, faculty development is often used
to generate new clinical practice. It is also virtually the only framework used to
change educational practice, even though the engagement with faculty development
by the vast majority of teachers in higher and professional education is relatively
infrequent. Many academics and practicing health professionals also attend confer-
ences to develop their knowledge and skills, but this can frequently be less related
to institutional priorities and more to discipline or methodological issues.
Nonetheless, uptake rates of faculty development opportunities provided by institu-
tions are universally low. Consequently, perhaps we should not be surprised to find
that faculty development does not currently have a huge demonstrable impact at an
organizational level.
There has also been an extensive and continued debate about the extent to which
organizations can learn. Antonacopoulou (2006), in a review of several studies from
this literature, makes some salient points. First, she suggests that the concept of the
‘learning organization’ (Argyris and Schön 1978) is flawed by the fact that organi-
zations do not have brains. However recent conceptions, such as the notion of a
community of practice (Lave and Wenger 1991), position the responsibility for
organizational change within a group, locally and culturally determined, exercising
organizational control functions. This immediately reinforces the same issues we
have previously discussed: isolated individuals having been successful in develop-
ing themselves (or being developed) into change agents cannot necessarily effect
substantial organizational development, even in a relatively small part of the organi-
zation. Antonacopoulou (2006) further discusses how, in the banking sector, an
organization’s approach to self-development and/or learning can have significant
effects on the middle managers’ capacity to change organizational practice. She
identifies that in organizations in which respect for learning and encouragement
to learn is genuine, managers are more likely to be self-reliant, more likely to pur-
sue goals that will widen their employability, and more likely to seek the respective
development more often. By contrast, managers who learn in order to satisfy the
organization’s requirements effectively do not learn at all, they ‘merely play by
the rules of the political game’ (p. 465). In this respect, universities paradoxically
seem to have taken an almost opposite path. The academic culture values self-
development above most other things, as long as it reflects the academic values of
freedom of thought, quality research and impactful publications. So, courses on
statistical methods to improve research quality outnumber, by the tens or hundreds,
courses on teaching and learning. Courses on managing a department and changing
a culture to be more research-productive occur with some frequency; however, they
are usually taught in a theory-free context. That is, our understanding about how
some strategies work is very limited, and although there are often practical hints and
rules of thumb, no real theoretical guidelines may exist. Also, in this process, indi-
viduals make choices from a menu of courses that is provided by other individuals
with specific interests rather than as a collective (community of practice) decision to
self-develop skills in certain areas. The chances of this approach having an impact
on the organization are small. Let’s take work on leadership as an example.
Steinert et al. (2012) reviewed the literature on faculty development programs
aimed at leadership. They aimed to synthesize existing evidence addressing the
effects of faculty development interventions designed to improve leadership abili-
ties on the knowledge, attitudes, and skills of faculty members in medicine and on
their institutions. Scrutiny of 48 articles, describing 41 studies of 35 interventions,
showed limited changes in organizational practice. The authors also identified that
although there was evidence of some organizational impact through implementation
of specific educational innovations, changes in organizational practice were infre-
quently examined. In the small number of studies that did include this dimension,
there were reported organizational benefits such as a shift to mission-based
budgeting, an improved profile for education and scholarship in promotion and
tenure decisions, implementation of specific educational innovations, increased
130 B. Jolly
collaboration, and creation of new leadership development programs. Thus, either

because of lack of research power, or because of little attention to institutional out-
comes, we know very little about how faculty development can generate a leader-
ship culture. Currently, in Australia, a government agency, Health Workforce
Australia, is promoting a framework called ‘LEADS’ to address leadership issues in
healthcare reform (Health Workforce Australia 2012) and is offering leadership fel-
lowships to individuals to use in the workplace and act as change stimulators.
In universities, the major effects of successful faculty development at the organi-
zational level seem to be when a faculty development course is so well received by
an organization and evaluated highly by participants that it becomes part of the
institution’s activities. This has happened several times, as reported in the literature
(e.g. Litzelman et al. 1994; Roberts et al. 1994). However, it is likely that many
more such ‘adoptions’ have been accomplished without making it into print.
Yet, we might ask, does adoption into the activities rank highly as an organiza-
tional change? Other hallmarks of organizational change might be expected in
‘true’ or transformational change, such as reference to continued development of
faculty members or recognition of objectives contained in faculty development
programs that become part of the mission and goals of the institution. Or perhaps
transfer to another context would rank as even higher organizational impact. For
example, Johansson et al. (2009) successfully disseminated, into a Swedish setting,
a Californian-based faculty development model for residents that the originating
institution had adopted.
But some programs seem to be energizing change quite effectively. The
Foundation for Advancement of International Medical Education and Research
(FAIMER) asked whether its International Fellowship Program was having an
impact on leadership and institutional change respectively (Burdick et al. 2010,
2012; Friedman et al. Chap. 15). FAIMER uses a project-based approach to its pro-
grams; fellows who come from a wide variety of countries and healthcare contexts
must devise a local project, describe why the project is important, what will be
achieved, the methods, timeline, and budget, as well as how they will evaluate the
success of the project. Notably, projects are required to have written support from
their institutional leadership.
Findings from the first study (Burdick et al. 2010) suggested that the high engage-
ment experience of the FAIMER model offering integration of education and leader-
ship/management tools gave participants skills and capabilities that could be utilized
across national contexts and result in a global network of interdependent leaders. A
similar process is being used also in the Australasian College for Emergency
Medicine’s Mentoring Champions Program – designed to strengthen an individual’s
capacity to mentor others and lead the implementation of a mentoring program
across the workplace (Australasian College for Emergency Medicine 2012).
The second study of FAIMER fellows investigated the degree and mode of
impact of the fellowship projects. Across the 435 projects analyzed, the vast major-
ity addressed one or more of the following areas: educational methods, curriculum
change, program evaluation, student assessment, and alignment of educational content
with local healthcare needs. Overall 62 % of these projects achieved (self-reported)
high institutional impact. Burdick et al. (2012) suggest that one explanation for the
relatively high incidence of organizational impact may be effective project mentor-
ing and their demanding fellow selection process. This process includes the essen-
tial requirement of support for the project by the leadership of the fellow’s home
institution before the project commences. Such a requirement is a key feature of
many change management theories (Grant and Gale 1989), and faculty develop-
ment may be no exception to this.
The insistence by FAIMER on getting engagement between fellows and their
institutions before the faculty development is delivered may turn out to be a key
factor in a project’s capacity to engender institutional change on a wide front. So,
reflecting this in the steps for success would suggest that the fifth strategy should be
as follows: Faculty development facilitators and faculty development partici-
pants should engage with their respective institutional leadership before the
faculty development takes place to negotiate the scope of potential desired out-
comes and to gain institutional support and/or commitment. This might be easi-
est when both facilitators and participants work in the same organization. But the
international and cross-cultural success of the FAIMER fellowship program sug-
gests that it is also worth the effort even if they work independently, and it may be
beneficial to have an external, and potentially more objective, perspective.
In addition to this legitimization stage, achieving a wide impact may depend on
other skills that are not traditionally the focus of faculty development programs.
Some illuminating research throws light on what skills might be needed in this com-
plex setting. Lieff and Albert (2012) studied 16 medical education leaders’ approaches
to what they do and how they learn and influence change. They found that these lead-
ers operated in four major ‘domains’ of activity; intrapersonal, interpersonal, organi-
zational (e.g. creating a shared vision), and systemic. In relation to the organizational
context it was salient to discover that, among many other activities:
Much of their (leaders’) attention was given to understanding the role of individuals and the
culture in the facilitation of change. This resulted in developing a diversity of efforts at dif-
fusing organizational resistance as well as shifting attitudes and culture (Lieff and Albert
2012, p. 315).
Examples like this emphasize that if organizational change is desired from a

faculty development program, it should perhaps give champions the skills and the
institutional support to study how the essential pieces, the structures and the people,
fit together, and where the pockets of resistance might come from.
These authors also found that the leaders in their study took an external systemic
perspective and that:
Political navigation of individuals, processes and structures of their academic contexts was
essential for their success. They oriented themselves by deliberately engaging with certain
groups in order to learn about the politics, power, culture and issues (Lieff and Albert 2012,
p. 315).
Although such skills may come naturally to some people, or be developed as the
result of their career paths, there is no reason to believe that occupying an academic
or professional career would necessarily provide such skills, anymore than it would
132 B. Jolly
be to assume the same about teaching and assessment skills. So faculty development
focused on organizational change should contain an element of politics, social the-
ory and strategic planning.
One of the most wide ranging and intensive faculty development programs to
have been launched in the last decade involves the attempts to eradicate error and
improve patient safety. It is difficult to know whether this could be characterized as
totally ‘faculty development’ as opposed to continuing professional development
but, in the main, in Australia at least, there has been collaboration between the uni-
versity and health care sectors that has produced many faculty development initia-
tives. Greenfield et al. (2011) documented the progress of one area of this
development – interprofessional learning (IPL) towards better patient safety.
Specifically, the researchers looked at which factors shaped the development and
organizational impact of interprofessional improvement initiatives, created through
collaborative action research, in one politically autonomous health organization.
This organization provided healthcare to a population of nearly 500,000 people,
encompassing three domains: a health service, incorporating 5,000 managers, clini-
cians and policymakers; an academic nexus involving 400 health academics in uni-
versity settings; and 71 professional associations with an estimated 300 staff. Over
a 2-year period, participants devised more than 111 interprofessional improvement
projects including the development of an IPL focused approach to health profes-
sions preceptorship, to achieve a shared approach to learning and practice for stu-
dent clinical placements. Three researchers analyzed ethnographic data relating to
the 111 initiatives to identify factors that promoted or inhibited their development
and impact on the organization. The analysis showed that of the 111 initiatives, 76
progressed beyond the initial proposal and/or discussion. The degree of success was
variable between the three domains. Very few of the projects that were aimed at the
interface between one domain and another made an impact, and little impact was
made within the professional association domain, even though participants in all
domains had identified that such activity was highly important.
This is of great concern because a very great many faculty development projects
operate at these margins. For example, universities train registered health profes-
sionals to teach and assess students using faculty development approaches. Medical
schools and postgraduate colleges accredit work sites for training suitability often
achieved through a briefly visiting accreditation panel or paper based exercises,
without real social engagement. In Greenfield’s (2011) study, success within health
and academic domains was relatively high; more than 50 % of projects made an
organizational impact. Out of the 111 projects, 27 were formally sanctioned within
the organization. Six determinants of maximal impact were identified:
• Site receptivity, which echoes the features identified earlier in the Heaven et al.
(2006) study on communications skills.
• Team cohesion, which related to the strength and determination of the team
involved in each initiative.
• Leadership, which concerned the presence of a champion at the head of, or
supervising, the team who could articulate concrete aims for initiatives in
ways that resonated with the professional and organizational concerns of their
colleagues.
• Impact on healthcare relations, which was about team processes.
• Impact on quality and safety issues, which highlighted the visibility of the initia-
tive’s agenda toward the aim of patient safety.
• The degree of integration into or legitimization by the institution.
There has traditionally been tension in health care organizations between provid-
ers (doctors, nurses) and managers (administrators) (e.g. Davies et al. 2003). A
major faculty development initiative in many countries, but particularly in the UK,
has been the attempt to get more doctors involved in health care management. This
has not been altogether a successful program. Ham et al. (2011) researched the
activities of doctors who became chief executives of National Health Service orga-
nizations. Most had left a clinical role to bring organizational and service improve-
ment to patients. Although these doctors were positive about their roles, they
nevertheless described themselves as ‘keen amateurs’ who identified that they
needed structured support to become skilled management professionals. In a way,
the connection between these executives and the nurses in Heaven et al.’s (2006)
study is easy to see; putting people with certain new skill sets into roles is one thing;
making them effective in that role is another. This allows us to identify two further
‘strategies for success’ in faculty development for organizational change. The first
of these is that: Faculty development must include a focus on those complex
skills necessary for the participants in the program to impartially and sensi-
tively observe, engage, and persuade their colleagues back in the workplace.
In a sense, this resonates with the reality television series that immerse under-
cover bosses in their own organizations, or those that train up apprentices for chief
executive status. These shows, while trite, clearly show how important those skills,
not normally regarded as academic ones, really are; selling as opposed to explain-
ing, promoting as opposed to evaluating, and engaging in menial as opposed to
intellectual tasks. Hence, the final strategy would be as follows: Faculty develop-
ment must recognize the range of the additional contextual factors in the field,
and identify and enhance the capacity of the developed professionals to deal
with these factors.
This strategy is also crucial if the faculty development program is being run on
behalf of another organization. It also implies that, as far as organizational change
is concerned, generic courses are likely to be less successful than those tailored to
an organization’s needs, structure and culture.
6.10 Conclusion
We have identified seven strategies for success at the organizational level if institu-
tions are going to achieve positive organizational change themselves as a result of
faculty development. Of course there are probably many more to be tried, but the
134 B. Jolly
literature base for this area is widespread, multi-disciplinary, not always reported in
the kind of journals health professionals tend to read, and has a wide conceptual
scope. In this chapter, we have just scratched the surface of this literature in attempt-
ing to bring together a contemporary and relevant set of strategies.
The main criticism to be leveled at faculty development programs in this context
is that they often are not, or at least are not seen to be, aimed at long term institu-
tional transformation of the kind that might be required to engage with major
challenges: the need, for example, to provide a learning culture in health care orga-
nizations or value work-readiness in academic ones (Newton et al. 2009, 2011). To
be useful as organizational change agents, faculty development programs also need
to be designed, supported and promoted in ways that, at a minimum, reflect organi-
zational values and goals. The explanation of why a program is being developed
should be identified in the program’s rationale and reflect the institution’s main
values, whether it is teaching, research, or a balanced combination of the two.
Such constraints will impact how activities are funded. Academic and health
organizations should present these programs as delivering what they need, and
make explicit why they need it. Then perhaps we would see units that run these
activities flourish. In addition, perhaps if programs explicitly embraced academic
values in their preparation and design (be they evidence-based, visibly anchored in
real world problems, and diligently monitored, as FAIMER does), they would be
better received and more successful.
6.11 Key Messages
Faculty development for organizational change:

• Must be defined for, and promoted to, an institution’s members in a manner that
clearly connects with its capacity to contribute to organizational change.
• Needs to be forward looking and directly linked to, or at least cognizant of and
responsive to, organizational goals if it is to assist in promoting organizational
change.
• Should address the elements in the organization, or in the participants’ institu-
tions, that can foster or impede the work of those that have undertaken the devel-
opment process.
• Must possess attributes and enshrine values that are shared, or at least tolerated,
by the organizations and faculty members that use them.
• Should enable facilitators and participants to engage with their respective insti-
tutional leadership before the faculty development takes place to negotiate the
scope of potential desired outcomes.
• Must include a focus on those complex skills necessary for the participants in the
program to impartially and sensitively observe, engage, and persuade their col-
leagues back in the workplace.
• Must recognize the range of the additional contextual factors in the field, and identify
and enhance the capacity of the developed professionals to deal with these factors.
Acknowledgements The author wishes to acknowledge the gracious help and stimulating ideas
of Clare and Jane Conway and Mary Lawson in the preparation and proofing of this chapter.
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Part III
Approaches to Faculty Development
Chapter 7
Learning from Experience: From Workplace
Learning to Communities of Practice
Yvonne Steinert
7.1 Introduction
Although the majority of faculty development activities consist of workshops and

seminars, fellowships, and other longitudinal programs (Steinert et al. 2006), much
of faculty development occurs in the workplace; in fact, many faculty members
learn about teaching, leadership, and scholarship ‘on the job’. For example, when
teachers work together to develop new curricula or assess student progress, they are
learning from experience; when chairs of departments meet together to discuss the
joys and challenges of mentoring junior faculty, they are engaged in ‘on the job’
professional development that builds capacity and helps to meet organizational
priorities; when researchers develop a new grant or prepare a novel experiment for
presentation, they are engaged in workplace learning. In a recent study (Steinert
2012), 12 faculty members described the process by which they became medical
educators and highlighted the following variables as critical to their development:
the interest and desire to teach; the value of ‘doing’ medical education and learning
as a result of specific job responsibilities; the value of mentors and role models; the
benefits of belonging to a community of like-minded individuals; participating in
formal (structured) faculty development opportunities; and pursuing an advanced
degree. Faculty members in this study also highlighted the value of authentic
experiences in the workplace. Although this study specifically examined the role of
faculty members as educators, we could postulate that the value of learning on the
job and belonging to a community of practice is also relevant in developing faculty
members’ other roles.
The goal of this chapter is to highlight the role that learning from experience
can play in the development of health professionals. Although workplace learning


142 Y. Steinert
(or work-based learning as it is sometimes called) has been described as a strategy

to promote professional development in higher education and other contexts
(e.g. Billett 1996; Eraut 2004a; Raelin 1997), it has largely been ignored in the
faculty development literature in the health professions (Cook 2009; Steinert 2010a, c).
As DuFour (2004) has noted, ‘the traditional notion that regarded staff development
as an occasional event that occurred off the school site has gradually given way to
the idea that the best staff development happens in the workplace rather than in a
workshop’ (p. 63).
This observation is consistent with the view expressed in Chap. 1 that ‘professionals
learn in a way that shapes their practice, from a diverse range of professional
development activities’ (Webster-Wright 2009, p. 705) and that we should move
away from the notion of developing faculty to ongoing professional learning. This
perspective also reminds us that we may have inadvertently created a false dichotomy
between working and learning. In this chapter, we will discuss the role that learning
from experience can play in the development of faculty members and suggest that it
is time to refocus our attention on the workplace. More specifically, we will discuss
the tenets of workplace learning and some of its key components, including role
modeling, reflection, and learning from peers. Other aspects of learning from experience,
such as repetition, rehearsal, practice, and feedback, will not be the focus of
this chapter. However, we will explore the link between workplace learning
and communities of practice, the role of such communities in promoting faculty
development, and the need for organizational/institutional support to enable learning
in the workplace.
7.2 Workplace Learning
Health professionals learn in the workplace. In fact, ‘it is in the everyday workplace –
where faculty members conduct their clinical, research and teaching activities, and
interact with faculty, colleagues and students – that learning most often takes place’
(Steinert 2010b, p. 407). Although this form of learning has not received significant
attention in the faculty development literature in the health professions, its importance
has been described in higher education, management and human resource develop-
ment (Boud and Garrick 2001), undergraduate medical education (Dornan et al. 2007),
and postgraduate medical education (Swanwick 2005, 2008). Swanwick and McKimm
(Chap. 3) also highlighted its importance for leadership development.
7.2.1 What Is Workplace Learning?
There is no one definition or theory of learning in the workplace. Rather, the litera-
ture provides a range of conceptual approaches and empirical findings (Cheetham
and Chivers 2001). For the purpose of this discussion, workplace learning will be
7 Learning from Experience: From Workplace Learning to Communities of Practice 143
defined as ‘learning for work, learning at work, and learning from work’ (Swanwick
2008, p. 341), with an emphasis on observation, participation, and expert guidance
in an authentic environment (Billett 1994). According to Boud and Garrick (2001),
the goals of workplace learning vary considerably and can include the improvement
of performance for the benefit of the organization (i.e. the team or the enterprise),
the improvement of learning for the benefit of the learner, and the improvement of
learning as a social investment (i.e. for citizenship or social responsibility). However,
fundamental to the notion of workplace learning is a view of learning as a socially
mediated constructive process (Billett 1996), the value of ‘participation in work’ as
a catalyst for learning (Billett 2004), and the complexity of this process in an
ever-changing environment. Retallick (1999) has described a number of features of
workplace learning that distinguish it from other forms of professional learning: ‘it
is task-focused, collaborative, and often grows out of an experience or problem for
which there is no known knowledge base’ (p. 34). Workplace learning also occurs
in a political and economic context (Retallick 1999) in which the notion of learning
and work may not always be compatible.
How then does learning in the workplace occur? Eraut (2004a) describes four
types of work activity that give rise to the acquisition of knowledge and skill:
participation in group activities (including team work); working alongside others
(and gaining a new perspective from colleagues); tackling challenging tasks (which
can increase confidence and problem solving abilities); and working with clients
(or patients). Awareness of these different opportunities, which do not rely on the
transmission of facts or expertise, can help faculty members and faculty developers
begin to think about facilitating learning in the workplace. Eraut (2005) also
identifies three main factors which influence learning in this setting: those deriving
from the organization of work; those deriving from relationships at work; and those
deriving from the agency of the individual and those who help him or her. This
classification can provide health professionals with an additional road map for
analysis and change.
In another context, Billett (1996) proposes a learning curriculum for workplace
learning which accounts for the ‘constructive nature of learning through problem-
solving’ (p. 53) and consists of two key components: activities and guidance. From
this perspective, we need to sequence workplace activities that are of increasing
complexity and, in so doing, permit the learner to experience more responsible
goals and tasks, and create a pathway that affords learners the opportunity to access
the outcomes of their work activities so that they will understand what they have
achieved. For example, a faculty member might first learn about clinical teaching
with one student at the bedside, and then with guidance from a colleague, work with
a more heterogeneous group of students and residents. Feedback from the learners
will also help to inform future actions. Alternatively, another faculty member might
first design a practicum for nursing students before taking on the leadership of a
clinical placement. Clearly, the sequencing of activities and the delineation of
learning pathways to achieve specific goals are critical factors in the development
of faculty members. The process of engagement is another essential component in
this learning pathway, and as Swanwick (2005) has suggested, without individual
144 Y. Steinert
engagement, learning may be superficial or, at worst, non-existent. Engagement is

also dependent upon the congruence between the individual’s interests and values
with those of the workplace (Billett 2002).
Learning in the workplace offers a number of advantages: the value of authentic
activities (which enable goal-directed learning and problem-solving), close (or
proximal) guidance by colleagues in achieving relevant goals and moving from
peripheral tasks to complex activities, interaction with ‘expert others’ (who also
serve as role models for problem-solving), and engagement in tasks (which
promotes reinforcement of knowledge and skill) (Billett 1995). Taking advantage
of these opportunities, and overcoming some of the common limitations (e.g.
the possible construction of inappropriate knowledge, reluctance of experts to
provide guidance or sharing of knowledge, and limited access to appropriate expertise),
remains a challenge.
7.2.2 What Is Learned in the Workplace?
In examining what is learned in the workplace, Eraut (2004b) identifies the following
possibilities: task performance (e.g. collaborative work); awareness and under-
standing (e.g. of priorities and strategic issues); personal development; team
work; role performance (e.g. leadership; accountability); academic knowledge and
skills; decision-making and problem-solving; and judgment. This typology, based
on Eraut’s research in a number of settings, could be used as a way of helping faculty
members to identify their own learning goals and outcomes in the workplace. In an
interesting study of novice teachers in the health professions, Cook (2009) used
these descriptors and observed that workplace learning primarily involved personal
development, task and role performance, and awareness and understanding (of
clinical teaching), in addition to experience, observation, reflection, and feedback.
As Cook (2009) noted, the novice teachers in this study learned both the ‘means’
and ‘ends’ of teaching through their everyday practice (p. e612).
7.2.3 How Can Learning in the Workplace Be Enhanced?
Billett (2002) has suggested that participatory practices in the workplace are central
to learning and include: engaging in work activities that are novel; securing appro-
priate guidance from experienced colleagues; and being able to practice critical
tasks. He also highlights the interaction between the ‘affordances and constraints’
of the work setting (Billett 2004, p. 312) and the ‘agency and biography’ of the
individual participant. That is, the work environment imposes certain norms and
expectations (often in the interest of its own continuity and survival) regarding who
can benefit from specific opportunities; at the same time, the individual can choose
when he or she wants to engage – and in what way. Awareness of both organizational
factors (e.g. in the hospital, the community or the university) and individual factors
(e.g. learning goals and preferences) is key to enhancing workplace learning. So is
the notion of expert guidance. For example, Billett (2002) stresses the value of
intentional, guided learning strategies in the workplace and identifies different
levels of guidance which may be required for optimal learning, dividing them into
‘proximal (close) and distal (distant) forms of guidance’. Proximal guidance refers
to guidance from a colleague or expert that enables joint problem solving and
mirrors many facets of cognitive apprenticeship (Collins et al. 1989), including
modeling, coaching, scaffolding, and fading. In this case, the ‘learner’ (i.e. a faculty
member) remains in the ‘driver’s seat’ and can determine the choice and sequencing
of activities. On the other hand, distal guidance is less direct, providing ‘clues and
cues’ based on social influences, cultural norms, the physical environment, and
institutional practices. Distal guidance can suggest ways of problem solving in a
much less direct fashion; however, it can be equally powerful in the learning process.
Although proximal guidance is preferred by most professionals, both forms of guidance
influence faculty members’ behaviors.
7.2.3.1 Making Learning Visible
Based on research in higher education, it would be worthwhile to help health profes-

sionals see their everyday experiences as ‘learning experiences’ and be encouraged
to reflect with colleagues and students on learning that has occurred in the clinical
or the classroom setting (Steinert 2010a). Interestingly, Eraut (2004a) uses the term
‘informal learning’ to describe learning in the workplace. As he postulates, the use
of ‘informal’ recognizes the ‘social significance of learning from other people, but
implies greater scope for individual agency than socialization’ (p. 247). It also
draws attention to the learning that takes place during or between professional
tasks, sometimes even without the individual being aware of what is being learned.
Ironically, this can be viewed as both a strength and weakness of workplace learning.
Informal learning is largely invisible, either because much of it is taken for granted
or not recognized as learning (Eraut 2004a), and it is our responsibility to make the
invisible visible, through ongoing reflection and dialogue. We must also remember
that this type of learning need not be serendipitous (Swanwick 2005); rather, informal
learning can be ‘planned’ or ‘emergent’ (Megginson 1996), and we must take advan-
tage of what occurs in our everyday environment.
7.2.3.2 Adopting a Workplace Pedagogy
The notion of a ‘workplace pedagogy’ (Billett 2002) has great appeal. It brings
together notions of teaching and learning for faculty members and helps to explain
how cultural, social, and situational factors interact with the individual’s interests,
preferences, and capacities (Billett 2002). A pedagogy for the workplace consists of
more than intentional, guided learning at work, and as faculty members, we need to
146 Y. Steinert
examine participatory practices (e.g. engaging in workplace activities; seeking

guidance; accessing valued practices) and be cognizant of the fact that ‘access’ is
not always equitable. As Billett (2002) has stated, ‘workplace pedagogy needs to
account for how workplaces invite access to activities and guidance and how
individuals elect to participate in what the workplace affords’ (p. 27). This
framework suggests that we need to carefully examine how intentional and indirect
guidance can be accessed in the workplace, how workplaces facilitate participation
and guidance, and how individuals choose to engage in learning in the workplace.
The strength of workplace learning lies in the notion of guided participation
while performing authentic activities; as a result, we should try to maximize these
learning opportunities for all health professionals.
7.3 Role Modeling as a Key Feature of Workplace Learning
Learning through role modeling, by observing colleagues and other team members,
is a key feature of workplace learning (MacDougall and Drummond 2005). Although
this complex method of learning has been frequently described in the training of
health professionals (e.g. Cruess et al. 2008; Jochemsen-van der Leeuw et al. 2013;
Kenny et al. 2003), it is rarely discussed as a method of faculty development. And
yet, we can all remember moments when we observed colleagues in action and
were impressed by either what they said or how they behaved in a particular situation.
In multiple ways, role modeling is a powerful process by which faculty members
can learn about the various aspects of their many roles.
Learning from role models occurs through observation and reflection and, as
Epstein et al. (1998) noted, is a mix of both conscious and unconscious activities.
While most health professionals are aware of the conscious observation of behaviors
in others, much of what we learn through this process is incorporated into our daily
lives without conscious awareness. As a result, becoming aware of this unconscious
process can be a first step in making the most of role modeling’s learning potential. As
noted by Mann (Chap. 12), the process of role modeling is rooted in Bandura’s (1986)
theory of social learning and consists of four inter-related processes: attention, reten-
tion, reproduction, and motivation. Awareness of these processes, which are influ-
enced by environmental, behavioral, and personal factors (Jochemsen-van der Leeuw
et al. 2013), can help faculty members benefit from what occurs naturally. It is also
important to note that role modeling, and observational learning which underlies this
process, can be quite informal (and spontaneous) or more structured (and deliberate)
(Steinert 2010a). Making this process more intentional, and valuing its contribution to
ongoing professional development, would be a worthwhile first step.
In addition, learning from role models is a complex process, especially as we
cannot assume what the role model is intending to demonstrate, even if we share
similar backgrounds and interests. As a result, dialogue about what is being observed
is important, and both the observer and the one being observed should be encouraged
to talk and reflect on what is occurring – either in the moment or at a later time.
Mann (Chap. 12) outlines how faculty members can be more mindful and explicit in
their role modeling with students across the continuum. In looking at role modeling
as a strategy for faculty development, we must also become aware of its power as a
method for personal learning and professional growth. In addition, we need to
become more aware of what we are observing, reflect on our observations (either
alone or with colleagues), and be willing to discuss what we have seen in a safe
environment. Role modeling has previously been described as central to ‘character
formation’ (Kenny et al. 2003), professional identity (Reuler and Nardone 1994),
and the acquisition of professional behaviors (Cruess et al. 2008; Jochemsen-van
der Leeuw et al. 2013) for students across the health professions. Its role in the
formation of faculty members’ identity and behaviors is yet to be determined. The
impact of negative role modeling must also be explored and, as faculty members,
we should be mindful of what we emulate. Lastly, we should be aware of the critical
role of the institution (and the environment) in facilitating role modeling as a component
of professional learning, especially as the influence of the ‘hidden curriculum’
(Hafferty 1998) on role modeling can be profound (Cruess et al. 2008). Moving
forward, faculty developers should not only help faculty members take advantage of
this powerful method of learning, they should also strive to change the workplace
environment in which role modeling takes place. By working together with
colleagues in making this implicit strategy more explicit, we can help to promote
role modeling as a valued instrument in the process of change.
7.4 The Role of Reflection
Learning through reflection on experience is ‘a key process in understanding

how learning actually occurs in the workplace’ (Retallick 1999, p. 34). Health
professionals’ ability to think critically and engage in reflection has long been con-
sidered an important factor in the improvement of clinical performance (Epstein
1999; Mamede and Schmidt 2004). Would it then not stand to reason that reflection
could improve health professionals’ skills and behaviors as faculty members?
Although many interpretations of reflection exist, the following definition will
help to guide this discussion:
Reflection is the process of stepping back from an experience to ponder, carefully and per-
sistently, its meaning to the self through the development of inferences; learning is the
creation of meaning from past or current events that serve as a guide for the future (Daudelin
1996, p. 39).
The notion of reflection has its roots in the work of Dewey (1933), who concep-
tualized reflective thought as a five-stage process (in Mamede and Schmidt 2004,
p. 1302–1303):
1. A state of doubt, perplexity or uncertainty due to an emerging difficulty in
understanding an event or solving a problem.
2. Definition of the difficulty by thoroughly understanding the nature of the problem.
148 Y. Steinert
3. Occurrence of a suggested explanation or possible solution for the problem,

through inductive reasoning.
4. Rational elaboration of ideas produced through abstract, deductive thought
focusing on their implications.
5. Testing resulting hypotheses by overt or imaginative action.
In looking at these stages through the lens of a teacher/educator, leader/manager
or researcher/scholar, we can easily see how this could apply. A ‘state of doubt or
perplexity’ is not uncommon in the life of a faculty member.
Building on the work of Dewey, Schön (1983) suggested the notion of reflective
practice, which he viewed as consisting of two kinds of reflective activity: ‘reflection
in action’, which refers to a spontaneous reaction (i.e. ‘thinking on your feet’) and
‘reflection on action’, which refers to thinking of a situation after it has happened.
The former, which is frequently described as a subliminal process of which the
participant is only partially aware, is usually triggered by recognition that ‘something
does not seem right’ (Hewson 1991). This type of reflection also allows a faculty
member to mentally reconstruct the experience, paying particular attention to
context. Reflection on action forms a bridge between the re-lived situation and
knowledge retrieved from internal memory or other external sources. While the
development of the capacity to reflect ‘in’ and ‘on’ action has become an important
feature of clinical practice, ‘reflection for action’ (Lachman and Pawlina 2006), which
involves planning for the next step, forms an additional avenue for improvement.
Moreover, although the concept of reflective practice fits in well with attempts to
understand the development of professional expertise (Mamede and Schmidt 2004),
it has remained relatively unexplored – and undervalued – in faculty development.
Mann (Chap. 12) reviews a number of underlying concepts and principles related
to reflection and reflective practice. Essential to the context of workplace learning is
the importance of being aware of different stages of reflection, learning to reflect,
and acknowledging the role of reflection in professional development (or learning)
in the workplace. According to Retallick (1999), reflection may progress through
four stages: articulation of a problem or concern; analysis of the problem by probing
for information or asking questions; generation of hypotheses that address the prob-
lem and development of tentative theories and solutions; and learning by testing
hypotheses and theories in the workplace. Knowledge of these stages may help a
researcher think about challenges in his lab or the supervision of graduate students,
just as it may be of value to a course coordinator or unit head. Boud et al. (1985)
provide another framework, consisting of three elements that are critical to the
reflective process and can enhance workplace learning. They include:
• Returning to experience – which refers to the recollection of salient events, the
replaying of the initial experience in the mind of the learner, or the recounting to
others of the key features of the experience.
• Attending to feelings – which includes utilizing positive feelings and removing
negative feelings, both of which are needed for learning to occur.
• Re-evaluating experience – which is clearly the most important and is often
not completed if the other two phases are ignored. Re-evaluation involves a
re-examination of the original experience in light of the learner’s goals, associating

new knowledge with that which is already processed, and integrating new
knowledge into the learner’s conceptual framework.
This conceptualization may also be helpful to individual faculty members or
faculty developers who would like to help improve the reflective abilities of their
colleagues. As Raelin (1997) observed, ‘since higher level reflection may not occur
naturally, educational opportunities need to be provided within the workplace to
provoke critical reflection’ (p. 567). In addition to creating a work environment that
supports reflection, such opportunities can include the use of reflective exercises,
narrative writing and storytelling, appreciative inquiry, and the analysis of critical
incidents (Branch et al. 2009; Higgins et al. 2011; Mann Chap. 12; Sandars 2009).
Faculty members and faculty developers would be wise to consider these triggers
for reflection, especially if we decide to not leave learning to chance.
In multiple ways, reflection can contribute as much to learning as experience
itself (Raelin 1997), for reflective learning can help to make the implicit explicit and
promote professional growth by changing perspectives, uncovering attitudes, and
linking knowledge and skills to faculty members’ professional values (Higgins et al.
2011). As Lachman and Pawlina (2006) observed, ‘the process of reflection and its
basis of critical thinking allows for the integration of theoretical concepts into practice,
increased learning through experience, enhanced critical thinking and judgment in
complex situations’ (p. 460).
7.5 Learning from Peers
As stated at the outset, learning from peers in the workplace is formally recognized
as a strategy for personal growth and development in the education and business
literature. It is also a common strategy in the clinical arena, as health professionals
learn from each other in both formal (e.g. rounds) and informal (e.g. in the hallway)
settings. Surprisingly, however, learning from peers has not traditionally been
viewed as an approach to faculty development in the health professions, and it is
only recently beginning to emerge in this literature (McLeod and Steinert 2009).
However, learning from peers is closely related to the notions of role modeling (as
peers are often the role models) and reflection (as discussion with peers can prompt
critical thinking) and can take on different forms.
Earlier in this chapter, we discussed Billett’s (1996) notion of guidance from
peers (and experts), much of which occurs spontaneously in an unstructured fashion.
Boillat and Elizov (Chap. 8) also describe the value of peer coaching and mentoring –
both in the workplace and in more formal contexts. As these authors describe, peer
coaching is a form of workplace learning and commonly involves observation and
feedback; it can also include consultation around specific issues or challenges and
can help to enhance faculty members’ performance in their diverse roles. In multiple
ways, peer coaching is well-suited to the health professions as it is problem-based
150 Y. Steinert
and built upon trust and collegiality. It is also ‘learner-centered,’ relying on collaborative
expertise and joint decision-making. In an interesting monograph, Claridge and
Lewis (2005) state that ‘coaching is about enabling a learner to develop in the best
way for them at the time’ (p. 1) and describe a number of principles of coaching for
effective learning that is relevant to workplace learning. These include the central
role of the ‘learner’ in moving the process forward, the fundamental importance
of the relationship between peers (built on trust and respect), the value of curiosity-
driven questions with a focus on appreciative inquiry (rather than a deficit-based
approach), and an emphasis on outcome and action. This approach has numerous
advantages and can easily be adopted by faculty members and faculty developers to
enhance the process of learning from peers.
Most of the literature on peer coaching and feedback in the workplace relates to
the improvement of teaching effectiveness (Bennett et al. 2012; Brown and Ward-
Griffin 1994). In a variation on this theme, McLeod et al. (2013) examined the value
of peer assessment of lecturing skills. To accomplish the task, the authors invited
faculty members to videotape their lectures and then critique their performance with
a small group of peers. Feedback on this activity highlighted the benefits of peer
review, including increased reflection, a renewed sense of collegiality, exposure to
new ideas, and an opportunity for skill acquisition. The value of reflection was also
highlighted in one of the participants’ remarks: ‘it is helpful to see yourself through
the eyes of others’ (McLeod et al. 2013, p. e1048). In fact, the notion of seeing
yourself through the eyes of a peer is probably the single most powerful aspect of
learning in this context.
Peer mentoring has also been highlighted as an important component of workplace
learning, especially in the promotion of research capacity in the health professions
(McCloughen et al. 2006; Paul et al. 2002; Records and Emerson 2003; Santucci
et al. 2008). In this context, a sense of trust, collegial support, common goals, critical
inquiry, and shared experiences can lead to successful relationships. Chapter 8
outlines a number of mentoring models that exist in the literature. Suffice it to say
that we should recognize mentoring as an important learning strategy in workplace
learning (Carter and Francis 2001), for it offers many advantages, including the
mitigation of professional isolation while promoting an understanding of organizational
norms and values. Moreover, as with peer coaching, it can help to contextualize
learning, promote reflection, and foster collaborative inquiry and practice.
7.6 From Workplace Learning to Communities of Practice
Learning in the workplace often leads to the development of a community of practice.

However, although these two concepts are distinct, they are both grounded in
social constructivism and the belief that social participation is the basis of learning.
Critical reflection and dialogue are also considered essential to both (Herbers
et al. 2011). Communities of practice, which have been described in many fields,
vary in nature. Some are quite formal in their organization, while others are more
fluid and dynamic. Irrespective of the structure, however, it has been suggested
that members are brought together by engaging in common activities and by what
they learn through this mutual engagement (Wenger 1998).
Barab et al. (2002) define a community of practice as a ‘persistent, sustaining,
social network of individuals who share and develop an overlapping knowledge
base, set of beliefs, values, history and experiences focused on a common practice
and/or mutual enterprise’ (p. 495). To elaborate on this definition, a community of
practice involves three defining components: a domain, a community, and a practice
(Wenger 1998). That is, a community of practice refers to a group of individuals
with a shared domain of interests and concerns. These individuals have a clear
commitment to the domain, value their collective experience, and learn from each other.
Members of a community of practice also engage in joint activities and discussions
and share information. They develop relationships among themselves and view
interaction (and a sense of community) as critical to their success. Members of
the community are also practitioners, and they work to develop a shared repertoire
of resources, experiences, and tools to solve problems and promote scholarship and
change (Herbers et al. 2011). Based on this perspective, practice refers to what
community members do to advance a set of shared goals, and in this context, this
can refer to health professionals’ work in education, leadership or research.
Lave and Wenger (1991) suggest that the success of a community of practice
depends on five factors: the existence and sharing by the community of a common
goal; the existence and use of knowledge to achieve that goal; the nature and
importance of relationships formed among community members; the relationships
between the community and those outside it; and the relationship between the work
of the community and the value of the activity. In his later work, Wenger (1998)
adds the notion that achieving the shared goals of the community requires a shared
repertoire of common resources, including language, stories, and practices.
Interestingly, this list of ‘indicators’ can be helpful to individual faculty mem-
bers who are wondering if their workplace might be a community of practice and
to faculty developers who would like to help nurture their potential.
To facilitate this process, Wenger et al. (2002) describe a number of principles
that can help to build a community of practice. These principles, outlined in Chap.
14 as well, include the following: design for evolution; open a dialogue between
inside and outside perspectives; invite different levels of participation; develop
both public and private community space; focus on value; combine familiarity and
excitement; and create a rhythm for the community. Clearly, these design princi-
ples are not recipes for success; they do, however, provide a framework for devel-
oping a community of practice.
This discussion would be incomplete if we did not address the concept of legitimate
peripheral participation, which is closely tied to learning and development in a
community of practice. This social practice, which combines ‘learning by doing’
and apprenticeship into a single theoretical perspective, is the process by which a
novice becomes an expert. According to Lave and Wenger (1991), learners begin by
practicing legitimately on the periphery of a community and slowly move towards
full participation (as they negotiate their own place within that community); in so
152 Y. Steinert
doing, they develop expertise and ‘know how’. That is, they move from ‘newcomer
to old-timer’ (Swanwick 2008), and in the process, learn to ‘talk-the-talk’ and
‘walk-the-walk’. Learning in the clinical environment has recently been recognized
as a process of legitimate peripheral participation (Egan and Jaye 2009) that is
fundamental to the development of professional identity for students at all levels of
the continuum. Would this process not also be a critical factor in the development
of faculty members’ identity and the acquisition of expertise in the many facets of
being a faculty member?
Few articles have specifically examined the role of communities of practice in
faculty development. In one study, Herbers et al. (2011) report on the experience of
four faculty members who tried to improve their teaching practices and enhance
their graduate programs in education by belonging to a community of practice. Not
surprisingly, critical reflection and dialogue were fundamental to the learning
process, viewed as a transformative process by the authors and the participants.
In another report, Sherer et al. (2003) describe the development of an online com-
munity of practice of college teachers through a faculty development portal and cite
several benefits to participation, including the opportunity to access educational
materials and enhance knowledge of teaching through collaboration with colleagues.
The emerging potential of online communities is also discussed by Cook (Chap. 11).
In the context of the health professions, Sherbino et al. (2010) relay the benefits of
a national clinician educator program (e.g. improved educational problem solving;
development of new projects) through the lens of a community of practice, and
Jippes et al. (2013) demonstrate how social networks (in a community) can enhance
the adoption of an educational innovation.
Although communities of practice can develop in the workplace, they can also
emerge as a result of structured (or formal) faculty development programs, usually
longitudinal in nature. For example, a number of longitudinal programs (e.g. Teaching
Scholars Programs) have led to the development of a community of practice (e.g.
Gruppen et al. 2006, Chap. 10; Moses et al. 2009; Steinert and McLeod 2006). In a
similar vein, Lown et al. (2009) reported that fellowship participants commented on
the value of support from a community of peers and mentors and perceived this
sense of collegiality as a ‘ticket of admission’ to an academic career. Moreover,
although the creation of a community was not an intended outcome in this program,
belonging to a network of peers who shared similar goals and values was viewed as
an unexpected benefit. This finding was also observed in a faculty development
program for physicians in a longitudinal mentoring program for undergraduate
students (Steinert et al. 2010) as well as in the rehabilitation sciences and nursing
(Li et al. 2009). Despite these findings, it is surprising that faculty developers have
not made this goal more explicit in the design and delivery of their educational
activities. It would also be worthwhile to examine the role that Academies of
Medical Educators (Bligh and Brice 2007; Cooke et al. 2003; Irby et al. 2004;
Searle et al. 2010) and Centres (or Departments) of Medical Education (Davis et al.
2005), communities of practice in varying degrees, can play in the development
of faculty members.
According to Wenger (1998), social participation within the community is the

key to informal learning. It is ‘embedded in the practices and relationships of the
workplace and helps to create identity and meaning’ (Boud and Middleton 2003,
p. 194). As faculty members and faculty developers, we face an array of possibilities
to make this learning count.
7.7 The Role of the Organization
The workplace (or organizational setting) clearly plays a role in facilitating both
intended and unexpected learning experiences. Workplace ‘affordances’ (labeled as
such by Billett 1994) vary from setting to setting and from group to group, and
health professional leaders need to examine the workplace itself to assess whether
it promotes – or hinders – a spirit of inquiry and learning. For example, Evans et al.
(2006) used the concept of ‘expansive’ and ‘restrictive’ environments to describe
the extent to which they facilitate learning. Expansive environments include close
collaboration and opportunities for networking outside the immediate environment
and, in the process, facilitate professional development. Building on this notion,
Fuller and Unwin (2003) found that ‘successful’ workplaces demonstrated a number
of common characteristics, of which some were related to the configuration of
formal and informal learning; other attributes related to allowing participation in
multiple communities of practice, the development of what they called a ‘participative
memory’, and the provision of access to learning opportunities. Recognition of the
‘learner’ (or in this case, the faculty member) – and the value of learning within
the organization – was also described as a key ingredient to successful apprentice-
ships in the workplace. Other factors that can affect learning in the workplace
include: the allocation and structuring of work; expectations of individual roles,
performance, and progress; the facilitation of encounters and relationships with
people in the workplace; and continuity and support, over an extended period of
time (Eraut 2005). As faculty members and faculty developers, we must be aware of
the factors that can promote learning in the workplace, strive to overcome perceived
barriers, and acknowledge success.
7.8 Challenges Moving Forward
Boud and Middleton (2003) suggest that informal learning (in the workplace) is
often not acknowledged as learning within organizations as it is viewed as ‘part of
the job’. Others have described workplace learning as ad hoc or incidental (Billett
1994), and not part of professional development. However, from our perspective,
there is value in rendering informal learning (in the workplace) as visible as possible.
How do we do this? What barriers must we overcome to achieve this goal?
154 Y. Steinert
In discussing the question of how teachers’ workplace learning can receive

recognition as a legitimate form of professional development, or be accredited by
universities and other professional bodies, Retallick (1999) suggests that professional
learning portfolios can play an important role. In fact, he argues that a portfolio can
contribute to enhanced educational effectiveness, a renewed professional culture of
teaching and learning, and ongoing development. He also states that the ‘systematic
documentation of workplace learning could become a normal part of teachers’
work… [and] play an important part in developing the scholarship of teaching’ (p. 49).
Although Retallick (1999) and other authors focus on the educational role of faculty
members, this suggestion can apply to all faculty roles, as a portfolio can easily be
used to document personal and professional growth as a leader and scholar. It is
clear that professional learning does occur in the workplace, that faculty members
can provide evidence of, and make sound judgments about, the quality of their learning,
and that workplace learning does not only mean experience, but also refers to the
learning which results from that experience (Retallick 1999). We must now find
ways to credential this learning. At the same time, the challenge for faculty develop-
ers is to understand how faculty members learn in the workplace, discover ways of
enhancing – and optimizing – this learning, and find the means to more effectively
utilize this learning within the organizational context.
In summary, it is important to not leave workplace learning to chance. Enhancing
role modeling and reflection, as stated earlier, is one option. There is also merit in
ensuring that learning on the job is not haphazard and that we work with departments,
divisions or other designated units to ascertain whether ongoing professional
development in the workplace can achieve its desired outcomes and increase faculty
members’ individual abilities and collective capacity (DuFour 2004). In addition, it
would be worthwhile to explore whether workplace learning can enable faculty
members to apply their new knowledge to a change in behavior, focus on results
rather than activities, and demonstrate a sustained commitment to achieving mutually
beneficial goals.
7.9 Conclusion
The goal of this chapter has been to highlight the role of workplace learning and its
key elements of role modeling, reflection, and learning from peers in an attempt to
help us begin to recognize, acknowledge, and validate naturally occurring events as
a form of learning and faculty development. Moreover, although the primary goal of
this chapter has been the professional growth and development of the individual
faculty member in the workplace, we should remember that the development of
individuals can lead to more productive workplaces (Bierema 1996).
Health professionals encounter numerous competing demands and priorities in
the workplace and often experience a tension between their multiple responsibilities
(e.g. clinical demands versus educational needs). As faculty members and faculty
developers, we need to distinguish between learning episodes (in which learning is
the main objective) and those in which work is primary (and learning may be an
unrecognized by-product). We may also wish to re-consider the value of apprentice-
ships in faculty development, for as Wenger (1998) has said, ‘learning cannot be
designed. Ultimately, it belongs to the realm of experience and practice… Learning
happens, design or no design’ (p. 225).
7.10 Key Messages
• Health professionals learn about their multiple roles in the workplace.

• Workplace learning requires authentic experiences, individual engagement,
intentional guidance, and organizational support.
• Role modeling, reflection, and learning from peers are essential components of
workplace learning.
• Workplace learning can lead to a community of practice, which in turn can pro-
mote ongoing professional learning.
• Faculty members and faculty developers should try to intentionally recognize
and validate workplace learning and communities of practice as venues for fac-
ulty development.
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Chapter 8
Peer Coaching and Mentorship
Miriam Boillat and Michelle Elizov
8.1 Introduction
As our understanding of the processes of learning and change has evolved, the paradigm
of faculty development has also changed in both its focus and scope of activities.
Faculty development is now accepted to be more than the improvement of teaching
skills and can include personal growth, work-life balance and career development.
It encompasses the broad development of many academic roles, some of which may be
better developed by activities that incorporate notions of self-directed learning, collab-
orative peer relationships, reflection and work-based learning (Steinert 2011). Support
for new approaches to faculty development is found in two reviews of faculty develop-
ment initiatives in medical education (McLean et al. 2008; Steinert et al. 2006). Key
features of effective faculty development highlighted in these reviews include the role
of experiential and authentic learning, the value of feedback, the importance of peers as
role models and as providers of collegial support, and the value of extended programs.
The conceptual framework developed by Steinert (2010), where peer coaching is
described as a more formal, individualized form of faculty development, and mentor-
ship as a means of enhancing any faculty development strategy, lends further support.
Faculty development should encompass both formal and informal approaches, and
should provide opportunities for individual and group reflection. Common goals, col-
legiality and shared reflection are important components of faculty development that is
work-based and integrated within communities of practice (Steinert 2010).
M. Boillat, MD, CCFP, FCFP (*)

M. Elizov, MD, FRCPC, MHPE
Centre for Medical Education and Department of Medicine,

160 M. Boillat and M. Elizov
Peer coaching and mentorship share at their core unique strengths that align with
these concepts of effective faculty development. They are highly personalized
approaches that are learner-centered, thus meeting individual faculty needs. Their
relational nature requires a level of collegiality, trust and commitment to both the
process and to the individuals involved that is beyond what one might expect in tradi-
tional faculty development activities. Additionally, the need for honest reflection
when using these approaches has the potential to increase self-awareness and facilitate
lasting change. Because both these approaches encourage the admission of uncer-
tainty and fallibility, they require a safe environment that optimally develops in a
longitudinal fashion. Peer coaching and mentorship both emphasize experiential and
authentic learning. The educational principles and theories that inform them include
situated learning (Lave and Wenger 1991), experiential learning (Kolb 1984), princi-
ples of adult learning (Knowles 1973), and transformative learning (Mezirow 1991).
As peer coaching and mentorship share many features, they are sometimes used
interchangeably; however, key differences should be highlighted. Peer coaching
often focuses on tasks or skills to be developed. It is immediately practical and
exploits daily learning opportunities. It is a form of work-based learning and com-
monly involves observation of teaching and feedback. It is also useful for other
teaching activities such as developing course objectives or preparing tests and
assignments. Peer coaching is not limited, however, to improving teaching skills,
and can be used in leadership development or to support other faculty roles. Peer
coaching often involves reciprocal learning between faculty members with similar
levels of experience and expertise. On the other hand, mentorship has more of an
‘abstract’ quality in that it is often removed in either place or time from daily events.
Mentoring relationships may involve a greater sense of depth, caring and emotional
bonding because they address issues such as personal work-life balance and career
development. Mentors also provide guidance instrumental to effective functioning
within an organization and advocate on behalf of their mentees for resources and
support necessary for the fulfillment of the mentees’ goals (Allen et al. 2009).
This chapter will provide definitions of peer coaching and mentorship which will
frame the subsequent description of these faculty development strategies. A number
of different models of peer coaching and mentorship will be reviewed and the benefits
and challenges of each will be discussed. General principles for the implementation of
these strategies in faculty development will be outlined. In closing, we will suggest
future directions for research and summarize key messages regarding the utilization of
these promising faculty development strategies for the health professions.
8.2 Definition of Terms
8.2.1 Peer Coaching
There is lack of consensus in the literature about the precise definition of peer
coaching (D’Abate et al. 2003). Peer coaching was initially developed to improve
teaching skills in classroom settings. However, it is also useful to support and
8 Peer Coaching and Mentorship 161
develop other faculty roles and skills such as leader, manager or researcher (McLeod
and Steinert 2009). In business and management, peer coaching to improve
performance in the workplace, and coaching for leadership (often referred to as
executive coaching), have been used for a number of years (Joo 2005). Peer coach-
ing may involve coaching by a more experienced individual or by a peer with a simi-
lar level of experience. It may be reciprocal, with two partners serving as coach to
each other, or it may be one-way, with one partner serving as coach and the other
receiving the coaching. Peer coaching may also occur in small groups. In the educa-
tional context, Huston and Weaver (2008) define peer coaching as ‘a collegial pro-
cess whereby two faculty members voluntarily work together to improve or expand
their approaches to teaching’ (p. 7). Peer coaching can be considered a peer learn-
ing partnership, described by Eisen (2000) as a ‘voluntary, reciprocal helping rela-
tionship between individuals of comparable status who share a common or closely
related learning/development objective’ (p. 5).
Peer coaching as a faculty development approach is well suited for the health
professions. It depends on a trusting collegial relationship and promotes shared
reflection. It generally involves learning with a colleague in one’s own context. At
its core, peer coaching involves peer feedback, which itself has been identified as a
key component of effective faculty development programs (Steinert et al. 2006).
Three phases have been described in peer coaching for teaching skill development:
(1) pre-observation discussion to clarify personal learning objectives, context, expec-
tations and process; (2) direct observation by the peer coach; and (3) post-observation
debriefing session when observations are shared, constructive feedback is provided,
and shared reflection and discussion occur (Flynn et al. 1994).
Peer coaching should be distinguished from consultation with an expert. The lat-
ter can be of great value as well, though it does not tap into the unique opportunity
for growth when individuals learn together through discussion, observation of spe-
cific skills, feedback and reflection. It is also important to differentiate peer coach-
ing as a faculty development initiative, from summative peer review, which has been
described as a component of performance review for the purpose of evaluation and
promotion (Bernstein et al. 2000). Although both approaches share some common
elements (observation of teaching, intent to improve teaching practices), in its
essence, peer coaching is voluntary, confidential, formative and based on the self-
identified needs of the recipient of the coaching.
The length of peer coaching programs described in the literature is variable, and
it may take place once or be longitudinal over time (Eisen 2001; Fry and Morris
2004; O’Keefe et al. 2009). When longitudinal, peer coaching relationships often
change according to evolving needs (Huston and Weaver 2008).
8.2.2 Mentorship
The literature abounds with definitions of mentor or mentorship. Some of these

describe characteristics of good mentors or mentoring relationships, while
others describe the strategies or roles employed within the mentoring relationship
(Blixen et al. 2007; Rose et al. 2005; Smith and Zsohar 2007; Tobin 2004). A landmark
study from business defined mentorship as ‘…a relationship with a person who took
a personal interest in your career and who guided or sponsored you…’ (Roche 1979,
p. 15). Despite varying definitions of mentorship, the essence is a relationship, and
those that attempt to define the relationship itself often describe some or all of the
following important elements (Bland et al. 2009; Eby et al. 2010; Jackson et al.
2003; Johnson 2007; Kram 1983):
• An interpersonal connection, sometimes described as a ‘click’ or a ‘fit’ that is
felt to be most effective and satisfying.
• The development and evolution of the relationship over time passing through
specific phases: initiation, cultivation, separation and redefinition (Kram 1983).
• The need for a defined purpose, noting that this purpose may change over time
as it is frequently determined by both the life phase and career phase of the
mentee.
• The broad purpose being to help the mentee develop or acquire the skills, the
competencies and the relationships needed to be successful and satisfied in their
personal and professional lives.
• A collaborative learning relationship with each person benefitting from the
experience to varying degrees.
An additional component, developing a reflective practice, cannot be underesti-
mated. Reflection in medicine, as described by Schön (1983), is commonly under-
stood to mean self-reflection on one’s own experience and this is extremely
important for mentees to do. However, reflecting on the experience of others, in this
case the mentor, can also be extremely valuable, particularly in certain higher stakes
situations such as making career decisions or finding work-life balance, potentially
avoiding erroneous or ill-timed decisions that can have far-reaching and long-lasting
consequences.
While these elements are not exclusive to mentoring relationships, it is their
combination that leads to the working definition of mentorship that will be used in
this chapter.
This section would be incomplete if the attributes of both the mentor and the
mentee that contribute to the relationship’s success are not considered. The charac-
teristics of ideal mentors do not change and these have been well described in the
literature (Sambunjak et al. 2010). These can be divided into personal, relational
and professional characteristics. The personal ones include being altruistic, patient,
trustworthy, reliable and motivating. The relational ones include being compatible,
sincerely dedicated to developing an important relationship with the mentee, able to
assist the mentee in identifying their strengths, and developing and reaching specific
goals. The professional characteristics include being experienced, knowledgeable
and well-respected.
Sambunjak et al. (2010) also described the findings of several studies that exam-
ined the characteristics of good mentees and found that good mentees are those that
take initiative in the relationship and are committed to its success. They are passion-
ate about achieving their own success and are proactive and willing to learn. They
come prepared for meetings with their mentor, complete assigned tasks, and honestly
respond to feedback. Importantly, they are also self-reflective and have the courage
to make effective changes.
8.3 Peer Coaching as a Strategy for Faculty Development
First described in the education literature as a process for professional development

primarily in the classroom setting, Flynn et al. (1994) adapted peer coaching to the
clinical setting and reported on its use as a method for personalized faculty develop-
ment in that context. Hekelman et al. (1994) described the following goals for peer
coaching: to help clinician teachers recognize and improve teaching behaviors and
practices; to develop the ability to adapt teaching strategies to meet the needs of
individual students; and to evolve into a community of peer coaches who work
together to enhance teaching.
Effective faculty development should result in positive changes in practice. Peel
(2005) argues that peer coaching is transformative in nature because it relies on
active engagement by the professional and on critical reflection. A comprehensive
approach to faculty development should include activities that enhance the reflec-
tive capacity of faculty members and that emphasize learning from experience and
from peers (Wilkerson and Irby 1998). Peer coaching does just that.
We will describe four models of peer coaching and the contexts in which they
have been used. We will consider their strengths and limitations, as well as their
similarities and differences. Finally, we will highlight some recommendations for
the successful implementation of a peer coaching program.
8.3.1 Peer Coaching Models
The first two models of peer coaching are situated in a general educational context
but can be readily adapted to the health professions. The third model uses peer
coaching for teaching improvement in the clinical setting, and the fourth empha-
sizes a multi-disciplinary application of peer coaching across the health professions
and focuses on broad teaching responsibilities.
8.3.1.1 Teaching Partners Program (TPP)
The Teaching Partners Program is a faculty development program for teaching

enhancement that involved 12 community colleges in Connecticut (Eisen 2001).
The program was 1 year in length and participation was voluntary. Participants
came from different disciplines and selected their teaching partners with assistance
only as needed. Thus, some partners knew each other well, while others started the
program as strangers. There were a total of 120 participants over 5 years. Mandatory
attendance at three workshops providing group training on the TPP was required
before starting the program. The partnerships were reciprocal: each partner spent a
semester as the observer and then switched in the next semester to be the one
observed. Most observations and feedback sessions occurred on a weekly basis.
Each participant was asked to set personal learning goals for the observations and
feedback sessions. The program included three components: (1) in-class observa-
tions and surveys of each other’s students; (2) feedback sessions to discuss and
explore alternate teaching approaches; and (3) reflective written reports of their
experiences each semester. The program was evaluated using a qualitative case
study design. During in-depth interviews, when participants were asked to define
their learning, most described some kind of change: change in practices, change in
self and change in perspective. They felt the changes resulted from what they
learned through peer feedback, modeling, student feedback gathered by the partner,
peer-supported experimentation, joint reflection and self-reflection. They felt the
key facilitator of learning and change was the peer relationship, in particular its
authenticity and trustworthiness, the non-evaluative nature of the feedback, the non-
hierarchical status of the partners, and the duration and intensity of the partnership.
Eisen (2001) concludes by stating that ‘peer learning partnerships may be particu-
larly well-suited for established professionals who have expertise to share in return
for support with their own professional growth goals’ (p. 41) and by noting that it is
consistent with the principles of collaboration and teamwork.
Health professionals can benefit from this novel form of professional develop-
ment that draws upon shared expertise, authentic work-based learning, peer rela-
tionships and non-evaluative feedback.
8.3.1.2 Peer Coaching: Professional Development

for Experienced Faculty
This peer coaching program was created at Seattle University in 2005 (Huston and
Weaver 2008). It resulted from a number of requests by faculty members for class-
room observations that exceeded the capacity of the faculty development office. Ten
senior faculty members from five colleges and ten different departments known for
their exemplary teaching were selected as peer coaches. Preparatory workshops
were conducted to introduce the coaches to the practice of peer coaching. The
coaches were first partnered with each other and asked to engage in reciprocal peer
coaching, taking turns coaching and being coached over a period of 4 months. At
the end of this period, they were offered the possibility to serve as coaches for other
faculty members who were requesting in-class observations of their teaching. Eight
of the ten agreed to continue coaching. The success of this program included the
ability to recruit, train, and retain senior teachers as peer coaches. These senior
teachers received 4-months of intensive ‘faculty development’ through an experi-
ence of reciprocal coaching, which prepared them to become peer coaches for oth-
ers. The coaches in this program were senior faculty members. The authors describe
the effectiveness of this program in meeting the professional development needs of

this unique group by allowing them to: (1) converse with colleagues; (2) admit limi-
tations or lack of knowledge in a safe and confidential environment; (3) analyze
real-life problems in a sophisticated manner; (4) share teaching practices and make
teaching visible to others; (5) see how others teach; (6) decrease isolation and
increase collegial relations; (7) give back to the community by helping less experi-
enced faculty improve teaching; and (8) link scholarship and teaching. The chal-
lenges of this program were primarily logistic in nature: finding dates and times for
the senior faculty members to get together, and developing an efficient system to
subsequently connect coaches with teachers in a timely fashion. The authors con-
clude by saying:
Finally, if campuses are dedicated to providing faculty development throughout the career-
span of the faculty they support, providing additional opportunities for experienced faculty
members is a must. We believe peer coaching is an appropriate and meaningful investment
in the ongoing development of this important group (Huston and Weaver 2008, p. 18).
Experienced health professionals may be particularly well-suited for, and willing

to engage in, a faculty development program like this that prepares them to take on
the role of a senior coach for a less experienced faculty member. In fact, the role of
senior coach may provide serendipitous professional development opportunities for
experienced health professionals as it allows them to share best practices, reflect on
common challenges, find solutions to problems, and see how others teach.
8.3.1.3 Physician Peer Coaching Program (PPCP)
This model focuses on peer coaching in the clinical context (Sekerka and Chao 2003).
The Physician Peer Coaching Program was started in the Department of Family
Medicine at the Case Western Reserve University in 1991. PPCP trains preceptors as
coaches so they can help other preceptors with ambulatory teaching practices. It is
based on the following principles: voluntary participation by both the coaches and the
preceptors being coached; intentional training of the coaches; collaboration and parity
of colleagues (coaches and preceptors); shared identification of goals; focused obser-
vation of teaching; non-evaluative feedback and ongoing coach support. The PPCP is
a one-way model of peer coaching, with one partner doing the coaching and the other
being coached. Using an inductive qualitative method, the coaches’ experiences
(n = 26) were analyzed and both coaches and preceptors were asked to evaluate the
coaching session. The authors found that peer coaching contributes to professional
development by encouraging time for reflection and for learning; it also positively
influences the coach as well as the preceptor who receives the coaching.
Reflection plays an important role in health professions education. Sandars
(2009) says that ‘guided reflection, with supportive challenge from a mentor or
facilitator, is important so that underlying assumptions can be challenged and new
perspectives considered’ (p. 685). Peer coaching structures a conversation with the
aim of promoting self-awareness and joint reflection. Thus, it is not surprising that
peer coaching shows benefit to the coach as well as to the person being coached.
8.3.1.4 The Colleague Development Program
In 2006, the Faculty of Health Sciences at the University of Adelaide in Australia

developed and implemented a faculty-wide multi-disciplinary program of peer
observation of teaching (O’Keefe et al. 2009). The program was designed to provide
opportunities to develop teaching skills, to explore innovative teaching and/or
assessment techniques and to receive constructive feedback and suggestions for
improvement within the context of a collegial partnership. Participation was volun-
tary. Due to the varied disciplinary backgrounds of the participants, it was hoped
that the program would promote collegiality across the six schools of the Faculty of
Health Sciences. The program was conducted over 8 weeks and participants were
asked to complete the following components: (1) identification of personal learning
objectives; (2) identification of a colleague to serve as peer coach; (3) discussion of
objectives, challenges and context with the peer coach; (4) observation of teaching;
(5) discussion and feedback; (6) review of the written report provided by the peer
coach that included mutually agreed outcomes, documentation of good practice and
suggestions for improvement; and (7) attendance at the program debriefing and
evaluation meeting. Two interactive seminars were offered in the first week of the
program that provided instruction on how to identify personal learning objectives
and how to give effective feedback. Teaching activities around which peer observa-
tion partnerships could occur included direct observation of teaching, review of
video-recorded teaching or review of course documentation such as curriculum
design or assessment documentation. Reciprocal partnerships were encouraged but
were not obligatory. The program was evaluated through an anonymous written
survey of participants’ expectations at the introductory seminar and an anonymous
questionnaire and focus group discussion upon completion of the program. Twenty-
three of the forty-two enrolled faculty members completed the study. For many
participants, the partner was from the same school. Approximately half had a recip-
rocal relationship. Direct observation of teaching was the most popular form of
teaching activity, and although the majority of observations involved the minimum
requirement of one teaching session, some colleagues did multiple observations.
The average time commitment over the 8-week program was 10 h. Four themes
emerged from the focus groups: an appreciation for the opportunity to discuss
teaching challenges and experiences, the value of meeting teachers’ individual
needs, a greater sense of connectedness, and suggestions for improving the program
in the future. Strengths of the program included: flexibility, non-evaluative forma-
tive feedback based on the teacher’s learning objectives, its multidisciplinary nature,
and selection of the peer coach by the teacher. Unfortunately, only a small number
of teachers participated in the program in the first year and approximately half com-
pleted the program. Although the program was faculty-wide, most partnerships
were from within the same school. Overall, the authors felt the program was a suc-
cess and concluded that participants in the Colleague Development Program
reported ‘increased confidence in teaching, confirmation of good practice, exposure
to new ideas, a feeling of institutional support and a greater sense of collegiality’
(O’Keefe et al. 2009, p. 1064).
Most clinical settings involve teams of health professionals working together.

Interprofessional peer coaching provides an ideal opportunity to promote collegial-
ity and to model interprofessional collaboration and communication.
All four models of peer coaching for faculty development that we have
described allow for personalized coaching based on the teacher’s individual needs
in a specific setting. They engage feedback from colleagues in a constructive and
formative manner. This feedback provides insights and perspectives that go
beyond the feedback and evaluation normally received from students. The above
models also rest on the power of shared reflection and self-reflection. Through
reflection, teachers are encouraged to question what they do, how they do it, and
how they might do it differently. Cole et al. (2004) state that ‘reflective activities,
when combined with skills practice, may result in more durable change than
would skill acquisition alone, because they can produce new insights and motiva-
tion for change’ (p. 470). Another similarity in the models described is the self-
identification of the learning objectives by the teachers which serves to engage the
teachers in the process. All programs include an introductory workshop or semi-
nar which provides training on personal goal-setting and the principles of feed-
back. They all depend on a collaborative, supportive and safe environment which
is a key feature of peer coaching.
There are some differences in the four models that deserve to be highlighted:
(1) the reciprocity of the partnership is not always present or even encouraged. A
disadvantage of a one-way partnership is the potential loss of the sense of shared
learning; (2) in one of the models, experienced faculty with exemplary teaching are
chosen to serve as coaches. It is difficult in this situation to avoid the power relation-
ship that may emerge; (3) the teacher being coached does not always choose the
observing peer coach which can lead to diminished buy-in by the teacher, poor
chemistry between the partners, and less trust and honesty in giving feedback; and
(4) the length and intensity of the peer coaching relationship vary among models.
While each model has advantages and disadvantages, we believe that there are
unique strengths to peer coaching when it is a non-hierarchical and reciprocal part-
nership between two colleagues of similar experience and expertise, and is longitu-
dinal over several months.
8.3.2 General Principles
8.3.2.1 Peer Coaching as a Faculty Development Strategy
Peer coaching is a dynamic and flexible faculty development approach that depends
on a collaborative and supportive relationship between peers. It is based on identifi-
cation by the faculty member of personal learning needs based on real-life experi-
ences and challenges, and provides the opportunity to work with a colleague to find
strategies and solutions. This often results in a deep and trusting longitudinal
partnership with a colleague. The faculty member being coached may feel less
intimidated when working with a peer coach with a similar level of experience and
expertise. On the other hand, some faculty members may prefer to be observed and
to receive feedback by an ‘expert’ rather than by an ‘equal’ peer. Both the faculty
member being coached and the peer coach benefit from shared reflection and
enhanced self-assessment (Bell 2001; Sekerka and Chao 2003). Peer coaching is an
approach that can also adapt and respond to the evolution and growth of faculty
members as they work together to improve their skills.
Peer coaching is not for everyone and may feel threatening to some. In a recent
study by Peyre et al. (2011), the majority of faculty members indicated interest in a
program of peer observation, but a few cited not wanting to be watched as a reason
for not participating.
The following guidelines should be considered when implementing a peer coach-
ing program (Huston and Weaver 2008; Siddiqui et al. 2007):
• The program should ensure a safe, collegial environment where confidentiality is
respected.
• The aim of the peer coaching program should be for development and improve-
ment, and thus formative in nature.
• The goals should be set by the colleague being coached and shared with the
coach.
• The context of the person being coached should be reviewed before the observa-
tion occurs and mutual expectations should be clarified and discussed.
• Whenever possible, the experience should be one of shared learning both for the
coach and for the person being coached.
• Sufficient allocation of time is also needed for participants, and their participa-
tion should be encouraged, recognized and rewarded in some way.
Peer coaching is an individualized faculty development approach that is well
suited to enhance the development of health professionals. Although commonly
used to improve teaching skills, it can be adapted for other faculty roles such as
leadership and management skills. For example, Henochowicz and Hetherington
(2006) conducted a literature review that described different models of leader-
ship coaching for health care leaders. They found that coaching was an effective
but underutilized tool for leadership development in the health professions. Peer
coaching reduces isolation, increases collegiality, promotes shared practices,
enhances reflection, and encourages new strategies and approaches in a safe and
supportive environment. It can be applied in a cross-disciplinary or similar-
discipline fashion. Huston and Weaver (2008) comment that cross-disciplinary
coaching broadens the conversations and encourages exchange around common
issues. Similar-discipline coaching deepens the conversations by allowing col-
leagues with a good understanding of the other’s contexts to help each other
to improve. Finally, peer coaching focuses on change and on application of
new learning in the workplace. It creates a sense of accountability for change
between peer coaches. And although peer coaching requires time, is resource
intensive, and may be more difficult to implement than a one-time activity,
the long term impact of such a program is promising.
8.3.2.2 Faculty Development for Peer Coaching
Introductory training in the form of preparatory workshops or seminars on peer

coaching is essential to its success (Claridge and Lewis 2005). Tee et al. (2009), in
a study looking at the academic coaching role to enhance student learning, describe
how coaches were prepared for their role by attending a faculty development pro-
gram that focused on skill development and a shared understanding of the role.
Because much of the success of peer coaching relies on peer to peer feedback, con-
sideration should also be given to training coaches in the principles and practice of
giving feedback effectively. The underlying principles that enhance the quality of
feedback include establishing a respectful learning environment, communicating
clear objectives for the feedback session, beginning with self-assessment, basing
feedback on observation and promoting reflection (Ramani and Krackov 2012).
8.4 Mentorship as a Strategy for Faculty Development
In this section we will describe the various mentoring models that exist, and the
faculty development contexts in which they have been, and can be, used. Drawing
from the relevant literature, general indications for the effective use of mentoring as
a faculty development strategy will be developed. This literature is still relatively
sparse and will therefore be complemented by literature from outside the health
professions.
As has been described earlier in this chapter, faculty development in its broad-
est sense is the development of all the skills, competencies and relationships that
a person needs in order to be a satisfied and successful member of the faculty.
Explicitly, this requires the development of more than just teaching and research
skills, though these are clearly important. It requires, for example, that the faculty
member identify and pursue goals meaningful to them, while appreciating the
very real functional and organizational limitations that impact on those very goals.
It requires that the faculty member find personal and professional balance allow-
ing them to weather disappointments, overcome obstacles, and find satisfaction in
their successes. It also requires the faculty member to build and maintain the
relationships they need to not only actively pursue their goals but also to feel sup-
ported as they immerse themselves in the culture of their professional environ-
ment. (See Chap. 5 for a more detailed discussion of faculty development for
career development.)
These are not new concepts, and they have been explored, along with evidence
of their effectiveness, in business and academia (Merriam 1983). Within the health
professions, the nursing literature is more robust in its examination of mentoring
and its benefits, but mentorship specifically as a faculty development strategy in this
broad sense has not been systematically examined. The development of these kinds
of skills, competencies and relationships are not easily, or necessarily appropriately,
achieved in the lectures, courses or workshops classically associated with the term
‘faculty development’. However, mentorship can be an ideal faculty development

strategy for these more personal and interpersonal skills and competencies because
of the equally personal and interpersonal nature of the mentoring relationship, its
mentee-centered focus and the reflective practice it encourages. Mentorship can
provide the instrumental and psychosocial support needed for faculty development
that goes beyond the traditional instructional needs (Sambunjak et al. 2006).
8.4.1 Mentoring Models
As described by Bland et al. (2009), there are three main models of mentorship: the
traditional dyadic mentoring relationship, peer mentoring and group mentoring,
and while the basic structure of these models may differ, the key elements of the
relationships within them, as outlined in the definition section, are retained. These
elements include the interpersonal connection, the evolution of the relationship over
time, the need for a defined purpose, the collaborative learning environment within
the relationship, and the importance of a reflective practice.
In this chapter, we will collapse the three models described by Bland et al.
(2009) into two main models: dyadic and group mentoring. Peer mentoring and
the more traditional hierarchical mentoring structure can be viewed as character-
izing the nature of the interpersonal relationship, and as such can be subsets of
both the dyadic and group mentoring models.
8.4.1.1 Dyadic Mentoring Models
The traditional, hierarchical dyadic relationship is the one most classically associ-
ated with mentoring. It is a relationship between two people, in which the mentor is
usually more senior than the mentee and has the advantage of experience that can be
incorporated into the guidance provided. Because of their more senior position, the
mentor can often effectively advocate for their mentee, protect their mentee from
excessive time demands, and provide networking opportunities that are so invalu-
able (Johnson 2002). A faculty member could, and probably should, have multiple
mentors of this traditional kind as each mentor can provide either a different per-
spective, or can focus on different areas of the mentee’s needs depending on the
mentor’s individual strengths and achievements (de Janasz and Sullivan 2004).
Descriptions and some elements of evaluation of formal traditional dyadic
mentoring programs exist the literature (Mark et al. 2001; Tracy et al. 2004); how-
ever, only a few describe these as intentionally part of a wider faculty development
program, and fewer still have evaluated outcomes. In an article by Morzinski et al.
(1996), a formal mentoring program as part of a 2-year faculty development
program was described. The mentoring aspect was incorporated to help address
three core areas of professional academic skills identified as being critical to the
success of faculty members. These skills, as described by Bland (1990), were: (1)
knowing how to manage one’s career; (2) understanding the values, norms and
expectations of academic medicine; and (3) developing and maintaining a produc-
tive network of colleagues. The program included a formal matching and orienta-
tion process, planned mentor-mentee pair activities, and larger group activities. The
authors found that the program had overall moderate to high effect on the partici-
pants’ development of their professional academic skills, and felt that these findings
supported previous reports of the effectiveness of mentoring as a broader profes-
sional development strategy.
Another study by Balmer et al. (2011) described a traditional dyadic mentor-
ship within a 3-year faculty development program specifically designed to help
pediatricians develop their educational scholarship skills. The assigned mentor
was focused on helping the participant develop their educational project, and had
a very functional role, almost akin to a research supervisor. The study found that
though the participants began with just the traditional dyadic relationship with
their project mentor, over time they typically developed a network of senior men-
tors as their project needs evolved. Additionally, while the project mentors were
meant to assist the participants in completing their scholarly projects, many
became mentors in a broader sense, providing support, advocating for their
mentees, and providing networking opportunities and career advice. This study
again shows that while mentorship may initially be formed around a specific need,
when the relationship works well, it can also become a strategy for developing
many non-instructional skills required by faculty in order to become successful
and satisfied in their careers.
Significant challenges exist with the traditional dyadic mentoring relationship,
often related to potentially negative interpersonal interactions and power differen-
tial issues (Connor et al. 2000; Johnson 2007; Pololi et al. 2002). As a result, men-
torship between peers has emerged as an interesting alternative. Peer mentorship
has been described as a process whereby two or more people at a similar profes-
sional stage enter a more equal relationship in that all parties provide and receive
support and guidance from each other drawing on relevant experiences and knowl-
edge. Each person can then be both mentee and mentor at different times depend-
ing on the expressed needs. This differs from the traditional dyadic model wherein
the mentor draws on their greater experience and expertise to guide and advise the
mentee. In the study by Balmer et al. (2011), participants in the program also
developed peer mentoring relationships as important informal support systems
which complemented the more formally established traditional mentoring relation-
ships. The authors concluded that ‘the complex reality of these relationships chal-
lenges the application of traditional mentoring models and suggests unique
considerations in developing mentoring programs…’ (p. 85), lending support to
the notion of peer mentoring as valid and useful. The non-hierarchical nature of
this type of mentorship can allow for an exchange that is not constrained by the
sense of vulnerability inherent in relationships wherein a significant power differ-
ential (actual or perceived) exists.
8.4.1.2 Group Mentoring Models
In this model, a group of people are mentored at the same time with a single mentor
acting as both mentor and group facilitator. In the more hierarchical approach, the
mentor/facilitator is separate from the group and is a more experienced or senior
colleague who can draw upon their experience to guide discussions. In the peer
group mentoring approach, either discussions are led by consensus, or each member
of the group acts as a facilitator at different times (Bland et al. 2009). The line
between traditional hierarchical and peer group mentoring approaches is blurred
when peer mentorship evolves within a group initially led by a single senior mentor
and members of the group recognize that they can learn and be guided by each other
and not just by the senior mentor.
Several authors describe programs that have used these methods as faculty
development strategies. Connor et al. (2000) describe the development of a
network of senior doctors who used peer mentorship to assist each other in
their personal and professional development. While the initial program was
designed to specifically teach senior doctors practical mentoring skills, what
evolved was the development of a network of senior physicians who would call
upon each other as peers and co-mentors for personal and professional issues.
A second program, described by Pololi et al. (2002), illustrated the benefits of
a facilitated group mentorship program wherein intra-group peer mentorship
also evolved. The Collaborative Mentoring Program was a program that aimed
to ‘provide a framework for professional development, emotional support,
career planning, and the enhancement of personal awareness and skills impor-
tant for a successful career in academic medicine.’ (p. 378). While the partici-
pants clearly benefitted from the structured activities and mentorship provided
by the mentors/facilitators, they also described their peers as having attributes
consistent with those of a mentor, and very much valued the peer mentorship in
their development process.
While group mentoring models were developed to address some of the chal-
lenges with the dyadic mentoring model such as recruiting and training of sufficient
numbers of effective and implicated mentors, and the significant time demands
required of the mentors in the dyadic model (Johnson 2007; Pololi et al. 2002), they
are not without their own challenges. The issues of recruitment, training and time
requirements remain when mentors for groups are needed, though fewer are needed
overall as a single mentor can be responsible for several mentees. In group mentor-
ing using a more senior mentor/facilitator, issues related to a hierarchical structure
and power differentials again exist, but the value of learning from a senior mentor’s
experience is lost when using a peer group mentoring structure. Additional potential
challenges can exist when group members have differing needs and when group
dynamics are suboptimal. Not all groups will ‘click’ and evolve to develop the trust
and respect for this process to be most effective and beneficial, similar to dyadic
relationships.
8.4.1.3 Dyadic vs. Group Mentoring Models
No single model seems to be ‘the best’ when it comes to mentorship in faculty

development. The selection of a model would depend on the identified needs as
well as the resources available, and models can be blended or modified. Ideally,
a faculty member would have both a traditional dyadic mentoring relationship
to benefit from a very personalized focus with an experienced mentor, as well as
some form of peer mentorship, either as a dyad or within a group, for the support
and collegial networking that are so vital. While Balmer et al. (2011) described
how peer group mentorship evolved as an unintended, but positive, outcome of
a program initially designed using only a traditional hierarchical dyadic mentor-
ing model, one could envision the development of a program where both models
would be part of the structure from the outset. This blended model could then
capitalize on all the best that mentorship as a faculty development strategy has
to offer.
8.4.1.4 Formal and Informal Mentoring Formats
A traditional view of the mentoring relationship is that it is an informal process

where two people with common interests simply find each other and develop a
relationship (Kram 1983). The importance of the personality fit and match of inter-
ests and goals cannot be underestimated in the success of a mentoring relationship,
and forms the basis of informal processes. The reality, however, is that many peo-
ple who would benefit from having a mentor, including women and minorities
(Johnson 2007; Ragins 1989; Sambunjak et al. 2006), do not find a suitable match.
It may also be that individuals who are less able to network or self-promote, and
who would derive great benefit from having a mentor, will have difficulty finding
a mentor through informal processes. Additionally, finding even one mentor can
often be challenging given the time commitment required and the need for a good
fit of goals and personalities, and certainly finding several on an informal basis
becomes even harder.
As a result, some academic centers have developed formal mentoring pro-
grams that ensure that each new faculty member has a mentor. Some programs
achieve this by creating a database of potential mentors or by facilitating intro-
ductions to potential mentors while still letting new faculty initiate and develop
their own mentoring relationships. Others, such as those described in the section
above (Balmer et al. 2011; Morzinski et al. 1996; Pololi et al. 2002), assign
matches through structured mentoring programs. While these programs may
improve participation rates and the studies described have shown good outcomes,
they demand far more resources (human and financial) than informal processes,
and they may ultimately still be unsuccessful if the match between mentor and
mentee is suboptimal.
Just as a blending of mentoring models may be appropriate depending on

circumstances, a blending of formal and informal mentoring formats may also
be ideal. A program wherein all faculty are provided a mentor in some way
(formal), but where matches can be re-assigned without stigma or fear of reprisal
if the ‘fit’ is missing or needs change (informal), would be optimal, although
this would require significant belief in the validity and utility of the process by
all parties.
8.4.2 General Principles
8.4.2.1 Mentorship as a Faculty Development Strategy
Mentorship cannot, and should not, be the sole faculty development strategy
employed. However, from the studies described above, it can be seen that mentor-
ship can complement the more traditional faculty development teaching necessary
for the acquisition of practical or technical skills related to a faculty member’s roles
in areas such as instruction and research. Mentorship can be very effective in the
development of personal and professional skills and competencies that require
significant introspection and personal reflection to achieve, or are highly relational
and interpersonal in nature. It implies the development of the faculty member in a
broader sense, taking the faculty member as a whole person whose personal and
professional lives are intertwined and inseparable, and for whom the development
of skills in either sphere can impact positively, both in terms of increased success
and satisfaction and less stress and burnout.
8.4.2.2 Faculty Development for Mentorship
Regardless of the mentoring format or model used, mentoring as an effective fac-

ulty development strategy requires both effective mentors and effective mentees.
Scant literature exists describing programs designed to train people to become
betters mentors and fewer still have assessed outcomes. Johnson et al. (2010)
describe the Mentor Development Program designed to train health science
researchers to be effective research mentors and discuss evaluation methods.
Connor et al. (2000) evaluated a program designed to train senior physicians in
mentoring skills, and found that not only did those physicians feel they developed
mentoring skills, they also benefitted from becoming part of a network of senior
doctors and engaging in their own personal and professional development. This
suggests that, at least for the mentors, faculty development to improve mentoring
skills can be both useful and appreciated. To our knowledge, no studies exist
describing or evaluating faculty development activities designed to help people
become better mentees, though as described earlier, there is literature that
describes the characteristics of good mentees.
8.5 Implications for Research
Peer coaching and mentoring have only been described as faculty development
activities in the health professions in the relatively recent past. Therefore, there are
many avenues for further exploration and we will highlight four of these:
1. The interplay between peer coaching and mentorship as formative faculty devel-
opment strategies and their use in the process of academic promotion could be
explored. As faculties put more emphasis on mentoring as a required academic
activity, and on the use of peer coaching for summative peer review for promo-
tion, the safe and honest atmosphere so essential to the success of these strategies
and to buy-in by faculty may be compromised. On the other hand, making these
approaches part of the promotion process may lend more legitimacy to these
approaches and enhance their use.
2. There is a need to evaluate faculty development outcomes at the higher levels of
Kirkpatrick’s (1994) model of evaluation (Steinert et al. 2006). This is particu-
larly important as both peer coaching and mentorship are resource intensive
activities and support for them would depend on evidence of tangible outcomes
beyond satisfaction.
3. The growing emphasis on the interprofessional nature of the clinical environ-
ment and the importance of learning together can be further explored within the
context of peer coaching and mentorship as novel faculty development strate-
gies. Research looking at the impact of these approaches on teamwork is needed.
We suspect that faculty participation in interprofessional peer coaching and/or
mentorship may well enhance the communication, collaboration and collegiality
so essential to effective clinical teams.
4. Exploring more explicitly blended models of mentoring is needed to capitalize
on the benefits of having a more experienced senior mentor, as well as the ben-
efits of the support and collegial networking that comes from peer mentorship.
8.6 Conclusion
As we better understand how faculty learn and change, the value of peer coaching
and mentorship as effective faculty development strategies in the appropriate con-
texts becomes evident. Health professions organizations need to recognize a broader
definition of faculty development that includes all the personal and professional
skills needed for success in the various roles that faculty members play. The power
in these strategies lies in their highly relational quality and in the self and shared
reflective practices that they encourage and develop. They are truly learner-centered
in their essence, as faculty members self-identify their learning needs and determine
their level of engagement. The dynamic nature of these processes can adapt and
respond to the changing needs of faculty members. They are highly personal
forms of faculty development and we feel that the resultant sense of accountability
in addition to enhanced reflective capacity will lead to greater long term change.
Although they are both time and human-resource intensive, when they work well,
we believe they can create self-sustaining communities of practice where faculty
members feel committed to each other and to learning, improving and growing
together.
8.7 Key Messages
• Peer coaching and mentorship show promise as novel faculty development strat-
egies in the health professions.
• Their effective use rests on an acceptance of a broad definition of faculty devel-
opment, one that supports multiple faculty roles (including roles beyond teach-
ing) and both personal and professional skills.
• Peer coaching and mentorship are relational and reflective in their essence, and
evolve with changing faculty needs.
• Although peer coaching and mentorship are resource-intensive, they involve a
greater sense of commitment and accountability, which may result in more sus-
tained change over time.
• Intentional and structured faculty development to train effective peer coaches
and mentors is essential.
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Chapter 9
Workshops and Seminars: Enhancing
Effectiveness
Willem de Grave, Anneke Zanting, Désirée D. Mansvelder-Longayroux,

and Willemina M. Molenaar
9.1 Introduction
Workshops and seminars are among the mainstays of faculty development programs
in the health professions. They can vary in duration, modality and content, and
can include topics such as education and research as well as career and leadership
development (Steinert 2011). In the educational sphere, workshops and seminars
may include instructional development and other teaching responsibilities, such as
curriculum planning and evaluation, stimulating and managing curricular change,
and promoting educational improvement at the organizational level (Wilkerson and
Irby 1998). Depending on specific goals, workshops and seminars can target
individuals, groups or entire organizations. This modality holds strong appeal for
most participants because face-to-face delivery of professional development, and
collegial exchanges among participants and facilitators, can encourage deep learning
W. de Grave, Ph.D.
Department of Educational Development and Research, Faculty of Health,
Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
A. Zanting, Ph.D.
Centre for Education and Training, Ikazia Hospital Rotterdam, Rotterdam, The Netherlands
D.D. Mansvelder-Longayroux, Ph.D.
Faculty Development Programmes, Centre for Innovation in Medical Education,
Leiden University Medical Centre, Leiden, The Netherlands
W.M. Molenaar, MD, Ph.D. (*)
Institute for Medical Education, University of Groningen and University Medical Center
Groningen, Groningen, The Netherlands

182 W. de Grave et al.
and change (Byham 2008). Additional appeal stems from their relatively short duration,
which allows teachers to fit them into their busy schedules, as well as their formal
nature, which ensures their visibility and credibility within the organization.
Traditionally, faculty members’ learning was largely informal, including ‘learning
on the job’ and learning through ‘trial and error’, with or without support by senior
colleagues. More recent faculty development programs have shifted towards more
formal learning, which according to Eraut (2000) is characterized by a higher intention
to learn (as compared to informal learning). Formal learning is characterized by a
prescribed learning framework, an organized learning event or package, the presence
of a designated teacher or trainer, the award of a qualification or credit, and the exter-
nal specification of outcomes. Clearly, neither formal nor informal learning can fulfill
all the needs of faculty members, and a mix is likely to be most effective (Steinert
2011; Wilkerson and Irby 1998). In fact, for optimal effectiveness, the selection of
formats should be based on reliable evidence (Blumberg 2011; O’Sullivan and Irby
2011). As a result, the notion of Best Evidence Medical Education (BEME) as ‘the
implementation, by teachers in their practice, of methods and approaches to educa-
tion based on the best evidence available’ (Harden et al. 1999, p. 553) can be trans-
ferred to faculty development as well. However, many faculty developers are
‘experts by experience’. Their professional and educational backgrounds vary
widely and many have had little or no training for their role as faculty developers.
As a consequence, they are often guided by professional and personal insights and
experiences rather than by empirical evidence of available methods and formats.
Therefore, our goal in this chapter is to encourage faculty developers to adopt a
more critical stance when selecting and developing activities and formats by asking
questions such as the following (Clark 2010; Yardley and Dornan 2012): What are the
features of this particular method? What is the evidence to support its use? How valid
is this evidence? For what purpose, for whom, and when is this method appropriate?
How does this method or format fit with our understanding of teacher learning?
This chapter focuses on workshops and seminars, formal learning activities of
short duration. We view these as valuable contributions to the gamut of faculty
development activities in addition to those which are described in other chapters of
this book. After defining these two formats, we will briefly review the literature on
the evidence of effectiveness of faculty development, in general, and of workshops
and seminars, in particular. We will also formulate recommendations to enhance
their effectiveness. Subsequently, we will propose a framework for a new approach
to the design of workshops and seminars, based on theories about learning for
teachers which combine learning outcomes, learning activities and instructional
methods. To illustrate these principles, we will provide an example of a workshop and
a seminar, using this framework. Although both examples focus on the enhancement
of instructional effectiveness, workshops and seminars can be used to address other
faculty roles (e.g. leadership and research) as well. We will then discuss transfer
of acquired knowledge, skills and attitudes to daily practice; the final section will
focus on challenges and opportunities for the future.
9 Workshops and Seminars: Enhancing Effectiveness 183
9.2 Defining Workshops and Seminars
The terms workshop, seminar and short course are often used interchangeably.
As the terminology used for such faculty development activities is not always
well defined, the intended meaning varies widely, depending on the developer’s
intentions and the facilitator’s knowledge, skills and familiarity with the format
(Clark 2010). In addition, evaluation studies often fail to provide a detailed
description of the activity they are evaluating (Amundsen and Wilson 2012;
Steinert et al. 2006; Stes et al. 2010). Compounding the confusion is the wide
variation in outcomes and context. In this chapter, we will focus on workshops
and seminars (or short series of seminars), representing well-known and
frequently used formats for faculty development. However, much of what is
discussed here also applies to other modular formats, such as short courses and
training sessions.
Workshops generally have two different emphases: the acquisition of knowl-
edge and skills, and the stimulation of changes in attitudes and behavior
(Brooks-Harris and Stock-Ward 1999; Sork 1984; Steinert et al. 2006). In the
1970s, due to prevalent behavioral learning theories, workshops focused on
behavioral change that could be facilitated by instruction, practice and feed-
back. During the 1980s, influenced by cognitive learning theories, workshops
started to address the knowledge, beliefs and attitudes that underlie desirable
behaviors (Wilkerson and Irby 1998). Despite their rich variety in content and
focus, characteristics common to workshops include a limited time investment
(usually between a half and 2 days) from both participants and the organization,
a small group (usually less than 20) of active participants, and a facilitator
(Brooks-Harris and Stock-Ward 1999; Grossman and Salas 2011; Sork 1984;
Steinert et al. 2008).
Seminars (or short series of seminars) tend to focus on a single, primarily
cognitive topic, usually aimed at expanding the participants’ knowledge base (e.g. for
education in the health professions). A seminar is usually facilitated by an expert,
while participants acquire and share knowledge by interacting with each other and
with the facilitator. In practice, seminars may vary on numerous dimensions
(Schmitt 2011; Steinert et al. 2006; Stes et al. 2010) such as the intended outcomes,
the role of the facilitator, the composition, size and experience level of the
group, the duration, scheduling and number of sessions, and the use of instructional
design principles. For an appropriate understanding of the effects of a seminar,
a clear description of these dimensions is indispensable. When active learning
methods are utilized in a seminar, the distinction between seminar and workshop
can easily become blurred.
In this chapter, we will refrain from strict definitions of formats; rather, we
will focus on the process of faculty development design in order to reach desirable
learning outcomes and transfer to daily practice.
9.3 Evidence for Effectiveness of Workshops and Seminars
Reviews of programs for professional development in higher education, in general,

and in health professions education, in particular, offer useful insights into the
effectiveness of faculty development programs and activities. Steinert et al. (2006)
concluded that, in general, health professionals were not only highly satisfied with
faculty development programs, but they also reported and demonstrated improve-
ment of their teaching skills and behaviors. Both Steinert et al. (2006) and Stes et al.
(2010) found evidence that, compared to one-time events, longitudinal interventions
are more effective in achieving behavior changes. Remarkably similar conclusions
were drawn from several reviews (Davis et al. 1999; Flottorp 2008; Forsetlund
et al. 2009) focusing on the effects of formal continuing medical education on
professional practice and health care outcomes. These also showed that educational
interventions may improve professional practice and health care outcomes, especially
when the latter are perceived as serious. As in the educational setting, the effects on
professional behavior appeared stronger when (mixed) interactive methods were
used, especially the practicing of skills (Davis et al. 1999); educational meetings
were not found to be effective in influencing complex behavior.
Steinert et al. (2006) presented evidence that workshops can contribute to chang-
ing teachers’ attitudes, skills and behavior and can enhance teachers’ motivation, self-
awareness and enthusiasm. Participants also reported that workshops are helpful,
relevant and useful and that they improved their knowledge and skills and enhanced
application of newly acquired skills to their teaching practices. Based on these
results, Steinert et al. (2006) deduced five important characteristics of effective fac-
ulty development workshops: the use of experiential learning; the provision of feed-
back; effective peer and colleague relationships; the application of principles of
teaching and learning; and the use of multiple instructional methods. These findings
are supported by evidence cited by Wilkerson and Irby (1998) who state that
teachers’ knowledge, skills and attitudes can be enhanced by workshops of long
duration and by two or more types of interventions, followed by practice. Seminars
(especially a series of seminars) have proven to be particularly effective with respect
to acquiring knowledge and changing awareness and attitudes about teaching.
Steinert et al. 2006 concluded that participants are usually satisfied with this
modality and consider seminars to be useful for having a positive impact on: awareness
of teaching issues, teaching methods and theory; motivation and attitude towards
teaching; acquisition of new knowledge about teaching and related skills; and
stimulating cooperation between teachers. This pattern of outcomes is in line with
the results of a recent qualitative study about the effects of a seminar for new faculty
(Behar-Horenstein et al. 2008) which reported the acquisition of new knowledge,
intent to change, and increased awareness of educational topics (in this order of
importance), but only a few perceived changes in actual teacher behavior. Research
on seminars or similar learning methods in different contexts, such as undergraduate
education and continuing medical education (CME), suggests that the following
dimensions can explain the positive outcomes of seminars: interactivity and the
quality of the interaction in small groups; the use of multiple methods of small group
learning; the limited number of participants and stability of the group composition;
the focus on cases and the application of the acquired knowledge; the role of the
facilitator and adequate preparation for the seminar; and the scheduling of sufficient
time between meetings (Davis and Davis 2010; Spruijt et al. 2012). The emphasis
on interaction, the duration of the seminar series, and the stability of group composi-
tion are likely essential in bringing about attitude change.
Reviews have also indicated a need to describe the design of faculty development
practices. Guskey (2003) argued that describing good practices for a specific context
can result in new insights for effective faculty development initiatives. Amundsen
and Wilson (2012) recommended detailed descriptions of professional development
practices and their outcomes in relation to the objectives and format of the design.
They stated that these descriptions should focus on learning outcomes and
processes. Bakkenes et al. (2010) identified the importance of a conceptual frame-
work encompassing theories of teachers’ learning for designing professional
development activities. They also noted that the learning processes of teachers are
rarely described, even though the success or failure of educational innovations relies
heavily on their efforts.
Based on the above, we recommend two ways to improve the effectiveness of
workshops and seminars: to describe the activities in detail, in relation to their learning
objectives and design; and to ground faculty development activities in a theoretical
framework of teacher learning. In the next section, we propose a new framework
which can serve as a guideline for the design of faculty development activities such
as workshops and seminars based on these recommendations.
9.4 A New Framework for the Development

of Workshops and Seminars
When taking part in faculty development programs, faculty members adopt the
role of learners, and in line with the literature on adult learning (Cercone 2008),
we expect them to actively construct their own knowledge by undertaking learning
activities. We have therefore chosen to apply the theory of Vermunt and Verloop
(1999), which takes students’ learning activities as the starting point, to the design
of faculty development workshops and seminars. This theory, which is based on
empirical research on university students’ learning, has recently also been applied
to teacher learning (Bakkenes et al. 2010; Mansvelder-Longayroux et al. 2007;
Vermunt and Endedijk 2011; Zanting et al. 2001). In the context of faculty develop-
ment workshops and seminars, the challenge is to actively engage faculty members
in learning activities. Learning activities can be observable, overt activities such as
reading a book or article and making a summary, taking part in a discussion with
peers, teachers or facilitators, or working together on assignments or projects.
At the same time, if the participants are engaged, important, but invisible, mental
activities can occur. These include relating new knowledge to prior knowledge,
selecting relevant information from a text or presentation, or critically processing an

author’s conclusion (Vermunt and Endedijk 2011; Vermunt and Verloop 1999).
From this perspective, learning activities during the process of learning largely
determine the quality of the learning outcomes and, thus, whether or not the learning
objectives are achieved. Therefore, the design of faculty development activities
should begin with defining the learning objectives (i.e. what is to be learned). The
objectives should, in turn, determine the choice of teaching methods and the types
of activities to be used (i.e. how this content can best be learned) (Steinert 1992).
In this section, we provide a framework to guide workshop design based on
combinations of desired learning outcomes and related learning activities. The frame-
work consists of three main elements: (1) learning outcomes; (2) learning activities;
and (3) instructional methods to elicit specific learning activities.
We distinguish two learning outcomes on a cognitive level, that is, changes in
knowledge and beliefs (awareness, confirmed or new ideas) and intent to practice
(to try or continue to use new practices, or to continue using current practices) and
one learning outcome on a behavioral level, that is, changes in skills and behavior
(Bakkenes et al. 2010). We also distinguish three types of learning activities to
describe the learning process: (1) cognitive learning activities; (2) affective learning
activities; and (3) regulative or metacognitive activities. Cognitive learning activities
are those mental activities that learners use to process information, leading to changes
in knowledge and beliefs, (e.g. by relating or structuring information). In contrast to
affective and regulative learning activities, different cognitive learning activities are
required for different learning outcomes. Cognitive learning activities and related
learning outcomes and instructional methods are described in Table 9.1.
Affective activities include focusing attention, self-motivation and coping with feel-
ings of uncertainty, boredom or distraction. Regulative or metacognitive activities are
mental activities by which learners monitor, adjust and evaluate their cognitive and
affective learning activities. For example, learners can facilitate their own learning pro-
cess by starting to question which knowledge, skills and/or attitudes should be acquired.
Subsequently, they can select the appropriate learning strategy to achieve their learning
goals (e.g. to acquire knowledge of leadership styles, studying books and articles is
adequate; to experience various leadership styles, a workshop with role playing might
be appropriate; to apply a new leadership style, another strategy might be required,
including coaching on the job). Examples of these activities are described in Tables 9.2
and 9.3; instructional methods to stimulate these activities are also described.
9.5 Case Examples
9.5.1 A Teach-the-Teacher Workshop
To illustrate the use of learning activities, we describe a 2-day, small group (8–12
participants) workshop for clinical teachers who supervise students and residents.
This workshop is given at the Erasmus University Medical Center, in Rotterdam, the
9
Table 9.1 Learning outcomes, cognitive learning activities and instructional methods
Learning Cognitive learning activities Instructional methods to facilitate cognitive learning activities
outcomes Learners… The facilitator…
Changes in …analyze and concretize their knowledge …stimulates participants to articulate their knowledge and beliefs by questioning, mind
knowledge and beliefs concept mapping, responding to a statement, etc.
and beliefs …provides cases or scenarios to make participants aware of the limitations of their
knowledge and beliefs
…apply theoretical knowledge …presents learning and teaching theories, stimulates participants to study these theories
and elaborate on them by generating examples
…relate their own knowledge and beliefs …instructs participants to look for similarities and differences between their own
to those of others and to theories knowledge and beliefs, those of others and existing theories
…critically appraise different viewpoints …stimulates participants to make a choice from the different viewpoints or
and draw conclusions for their own to combine them
actions and theory of practice
Changes in skills …observe examples …or other participants demonstrate (new) skills and behaviors; other methods
and behavior may be used as well, such as video, role play, simulation
Workshops and Seminars: Enhancing Effectiveness
…creates cases or simulations in which participants’ skills and behavior are lacking
…elicit underlying ideas and principles …discusses the skills demonstrated, including the underlying choices that were made
…experiment/practice …invites participants to demonstrate their (adapted) skills while other
participants observe
…evaluate …gives feedback and invites the other participants and others, such as an actor involved
in role plays, to give feedback: what went well, what can be improved and how?
Intentions for …learners relate the outcomes of new …stimulates participants to discuss their daily behavior and specify their commitments
practice behavior and skills practiced during to change
the workshop to their teaching practice
…critically appraise whether the new …discusses opportunities and threats for application in practice with the participants
skills and behavior are useful and …formulates intentions to stimulate participants to apply new practices or go back
attainable in practice to old practices
…stimulates participants to reflect on/evaluate the effects of new practices
187
Table 9.2 Affective learning activities and instructional methods

Affective learning activities Instructional methods to create a promoting, affective climate
Learners… The facilitator…
…express their motivation …discusses the participants’ learning needs and integrates these
and expectations in the program of the workshop
…outlines the objectives of the workshop and their relevance,
and asks participants to formulate personal learning goals
…gives participants tasks they can handle
…relates the content to teaching practice to generate interest
…concentrate and …uses various teaching methods and breaks
exert efforts …activates participants by questioning them and involving them
in discussions
…gives participants challenging tasks and assignments
…attribute and judge …creates opportunities to observe other participants,
themselves to experiment, and to give and receive feedback
…appraise …emphasizes the relevance of the workshop objectives and tasks
for personal development and practice
…deal with emotions …enhances self- confidence through encouragement to explore
new ideas and practices
…gives feedback that emphasizes what participants are doing
well,
… ensures that the feedback is task-oriented, specific, useful and
gives tips for improvement
…creates a safe learning environment in which participants can
experience success, take risks, dare to experiment, and be
willing to ‘fail’
Table 9.3 Regulative learning activities and instructional methods

Regulative learning activities Instructional methods to facilitate regulation of learning
Learners… The facilitator…
…orient themselves and plan …first activates prior knowledge and experiences by questioning,
short presentations, and discussions about teaching concepts
and critical incidents
…subsequently introduces the content, learning objectives
and tasks of the workshop
…monitor, test and diagnose …lets participants present elaborated tasks and assignments
to each other
…gives feedback
…adjust …encourages participants to search for difficulties and solutions
for experienced problems, on their own or with others
…evaluate/reflect …allows participants to evaluate whether the (personal) learning
objectives are realized or not
…generate suggestions for future improvement
Netherlands, but is comparable in content and methods to the so-called ‘Teach the
Teacher’ workshops given at other Dutch medical centers (Busari et al. 2006).
The 2 days are scheduled 2 weeks apart to allow participants to apply new knowl-
edge, ideas, and skills learned in the first day to their teaching practice. Learning
objectives include acquiring and adjusting (new) knowledge and beliefs (e.g. active
and adult learning), acquiring and adjusting skills (e.g. observing, giving feedback
and assessing) and translating new skills to daily practice (e.g. innovations in super-
vision). The first day starts with an affective learning activity; in a plenary session,
participants describe their expectations and personal learning objectives. At the end
of this activity the facilitator asks the participants to reflect on it. Usually, the par-
ticipants report that they are more motivated to learn after having formulated their
own learning needs and goals, even if their attendance at the workshop was compul-
sory. The facilitator then explains that this was the purpose of the exercise and
indicates that participants may use the same approach when they are teaching them-
selves. To further increase the participants’ internal motivation, the facilitator incor-
porates the participants’ learning objectives in the program, whenever possible.
Changes in knowledge, ideas and skills are encouraged by asking the participants
to watch a video showing a clinician supervising a student or resident. Participants
are then asked to identify strong points and areas for improvement in the scenario,
thereby articulating their own knowledge and beliefs about supervision. By doing
this in a group, different conceptions of supervision are elicited and compared.
Participants experienced this mutual exchange of ideas as valuable and as a helpful
tool to develop or adjust their own beliefs about supervision. In the last part of this
exercise, the facilitator introduces adult learning and participants reflect on the
application of this framework to the video and their own knowledge and beliefs.
In this way, participants are stimulated to undertake various cognitive learning
activities aimed at (re)constructing their knowledge about teaching, such as
relating and processing information and ideas and applying theoretical knowledge.
Subsequently, participants practice component skills of supervision, such as
observing, giving feedback and assessing. At the end of the first day, the partici-
pants record their main learning outcomes, remaining questions and specific actions
for practice. In doing so, they apply regulative learning activities such as evaluating,
reflecting, orienting and planning.
Participants evaluated this workshop as useful for developing or adjusting ideas
about ‘good’ supervision and attributed success to the interaction between the
participants as well as between the facilitator and the participants. They stated that
their greatest challenge was to apply their learning outcomes and intentions in daily
practice. They also indicated that splitting the workshops into 2 days during 2 weeks
gave them the opportunity and the incentive to practise in the workplace.
9.5.2 A Seminar Series on the Integration of Technology Tools

in a Problem-Based Learning Curriculum
We will illustrate the basic principles of seminar design by describing a seminar that
focused on the integration of technology tools in a problem-based learning curricu-
lum at the Faculty of Health, Medicine, and Life Sciences, Maastricht University.
The seminar consisted of a series of six 1 h lunchtime sessions targeting a group of
12 experienced teachers from different disciplines. The meeting schedule and content
of the seminars was prepared in advance, in consultation with the participants.
The main aim of the seminar was to achieve more in depth evidence-based
knowledge about effective integration of technology into the curriculum and to
positively change teachers’ attitudes towards the use of technology in education.
All sessions were supported by expert resources in an electronic learning environ-
ment. Participants were expected to prepare for each meeting by studying selected
resources and watching demonstrations of each technological tool. Each meeting
focused on a specific tool such as blogs, wiki’s, audio response tools, collaborative
working tools, social bookmarking and social networking. The meeting began with
affective learning activities which included reflecting on perceptions and (possible)
experiences with the technological tool and discussions of the text accompanying
each tool. A technological expert provided explanations, presented information
found on the internet, and/or demonstrated the use of the tool. The participants had
the opportunity to ask questions about the tools and participate in a discussion. The
expert moderated this discussion, by summarizing, asking questions and taking
notes. Prior theoretical knowledge, personal opinions and prior experience with the
technological tool were activated, used and compared in the discussion. After this
initial phase of discussion, participants discussed the practical educational relevance
and possible application and conditions for implementation of the tool. In this way,
the participants made use of a diversity of cognitive learning activities to acquire
in-depth understanding and knowledge about the tool and possibly change their
attitudes about it. At the end of the session, participants assessed the learning goals
and developed action plans to experiment with, or implement, the technological
tool in education. In this way, they regulated their learning activities by means of
evaluation, reflection and planning. After the session, different experts supported the
participants in these activities to stimulate transfer of learning to actual behavior.
9.6 Factors Affecting Transfer of Training from Workshops

and Seminars to Educational Practice
The impact of faculty development on the learning of students and residents is

highly dependent on the ability of faculty members to transfer their newly acquired
knowledge, skills and attitudes to their teaching practices. In 1988, Baldwin and
Ford introduced a model to study transfer of training and described key factors
related to training inputs, training outputs and conditions of transfer. Since then,
many studies and reviews have been published (Blume et al. 2010; Burke and
Hutchins 2007; Grossman and Salas 2011) and have identified a wealth of factors
that can possibly influence the level and maintenance of transfer of training to the
workplace. However, not all results are unequivocal, and the relationships between
the factors are complex and may depend on the organizational context as well as
on the definitions and measurements of transfer (Blume et al. 2010; Burke and
Hutchins 2007). Therefore, Grossman and Salas (2011) selected factors from the
Table 9.4 Factors related to training transfer, based on Grossman and Salas (2011)
Training inputs Positive relationships with…
Trainee characteristics
Cognitive ability Processing, retaining, generalizing skills
Self-efficacy Confidence and persistence in application of acquired
skills; generalizing and maintenance of skills
Motivation to learn and transfer Facilitation of transfer
Perceived utility of training Application of acquired skills
Training design
Behavioral modeling Facilitation of transfer
Error management Facilitation of transfer
Realistic training environments Facilitation of transfer
Work environment
Transfer climate Application of acquired skills
Support Transfer
Opportunity to perform Success of transfer
Follow-up Facilitation of transfer
available literature which have a strong relationship to transfer and used these to
provide guidance for evidence-based training programs. They slightly adapted the
original model of Baldwin and Ford (1988) and restricted their analysis to factors
related to the training inputs, grouped in three categories (see Table 9.4). We will
use this guide to identify factors that have to be considered in order to enhance the
transfer of training when designing and executing workshops and seminars for
faculty development.
The most obvious of the three categories in Table 9.4 appears to be the training
design. Workshops are close to ideal in providing realistic environments for
participants to practice various strategies and learn from their own and others’
errors, ‘risk free’. The effectiveness may be further improved if follow-up meetings,
in which experiences from the work situation can be discussed and/or replayed in
role plays, are organized. The challenge for the designers and facilitators is to create
a safe atmosphere and environment that sufficiently resembles the work situation of
all participants, defining clear objectives, providing relevant content and giving
feedback (Carnes 2010). The challenge for the organization as a whole is to give the
learners opportunities to practice their newly acquired skills in authentic situations.
In the category trainee characteristics, motivation to learn, motivation to transfer,
and perceived utility form a cluster of related factors. These factors may be posi-
tively influenced if a careful needs assessment is performed preceding (or at the start
of) the workshop or seminar, a practice that currently appears to be neglected (Burke
and Hutchins 2007). A (pending) change in the educational environment, such as a
new teaching philosophy or curriculum change, may create a sense of urgency that
can be seized as an opportunity to train highly motivated learners for a new educational
working environment. The category of the work environment is largely beyond the
domain of educational workshops and seminars. However, workshops and seminars
may contribute to a bottom-up change in the work climate by a change in attitude

of the participants (e.g. a culture of giving feedback), and the development of
organization-wide networks and communities of learning (Steinert et al. 2006).
In addition, other faculty development activities, such as leadership and career
development workshops and seminars, may induce a change in the work climate as
well (Burke and Hutchins 2007; Steinert 2011).
9.7 Opportunities and Challenges for the Future

of Workshops and Seminars
The theory and evidence used in this chapter to describe and design workshops and
seminars (or a series of seminars), as well as knowledge about factors influencing
the transfer of training, can increase the learning potential of these approaches
and stimulate thinking about the relationship of workshops and seminars to other
approaches for faculty development. It is also an opportunity to design faculty
development programs where there is a mix of more formal approaches, such as
workshops and seminar series, and more informal approaches, such as work-based
learning. In addition, workshops can be combined with coaching, making these
different approaches complementary. It would also be worthwhile to find an optimal
mix of these approaches in more longitudinal faculty development programs.
The generally short duration of faculty development activities such as workshops
and seminars can limit their effectiveness for certain outcomes, particularly with
respect to those related to attitudinal and behavioral change. When attitudinal
change or new approaches for teaching are involved, time and attention to group
dynamics is mandatory. On the other hand, because of their brevity, these formats
can also be used flexibly in different faculty development activities and very often
‘just in time’. Thus, although the risk may be less effectiveness, workshops and
seminars provide an opportunity for flexibility in different faculty development
contexts, which can also enhance their effectiveness.
Another characteristic of workshops and seminars which determines their
effectiveness, but also heightens their risks and opportunities, is the small group
context, where interaction and active and experiential learning methods make
the difference. A risk is that workshops and seminar series sometimes decrease the
emphasis on interaction and active learning methods. As an example, seminars can
sometimes be reduced to one-way presentations with little or no interaction with the
audience. The challenge is therefore to create high quality interaction, incorporating
active learning in these approaches.
The facilitator in these formats plays a key role in their effective use, and attention
must be paid to the professional development of the facilitators to make these formats
work (O’Sullivan and Irby 2011). A train-the-trainer model which is theory and
evidence-based can be of help (Pearce et al. 2012).
Another challenge is to explore new uses of the above discussed formats, not only
for instructional development, but also for leadership and/or organizational development.
Workshops can play a role in the adoption, implementation and dissemination of

educational innovations. These new formats should be used and adapted in the
context of faculty development.
9.8 Conclusion
Workshops and seminars (or a series of seminars) have proven to be effective and
remain the dominant approach to faculty development. History has shown us that
these approaches have evolved and have been adapted to different circumstances.
In fact, workshops and seminars are fixtures in an ever changing landscape that is
shaped by new insights (e.g. learning theories) and new developments (e.g. technology).
The main challenge is to optimize the learning potential of these approaches. In this
chapter, we have provided some suggestions and recommendations for the use and
the design of these formats in enhancing the personal and professional development
and growth of faculty members.
9.9 Key Messages
• Incorporate theory and evidence in the description and design of workshops and
seminars. Specifically, define the goals, identify the required learning activities,
and select the appropriate instructional design.
• Experiment with and study the integration and effects of workshops and seminars
in more longitudinal approaches to faculty development.
• Experiment with new uses of workshops and seminar series in different
contexts, including leadership and organizational development, and assess their
effectiveness.
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Chapter 10
Intensive Longitudinal Faculty
Development Programs
Larry D. Gruppen
10.1 Introduction
Many faculty developers recognize that, in order to have a major impact on such
key faculty outcomes as educational leadership, scholarship, and skills, it is often
necessary to make substantial investments in these faculty members. Although there
are a variety of ways of making this investment, extending the duration and
increasing the frequency of faculty development activities is a straightforward
solution. Providing an intensive, longitudinal series of activities for a cohort of
faculty also fits well with institutional goals to develop faculty members with more
sophisticated levels of skill in particular domains, such as leadership, scholarship or
educational development.
This chapter describes some of the characteristics of faculty development
programs that are designed to provide faculty members with intensive training in a
specific set of skills over an extended period of time. Although such programs go
by many names, such as a ‘Teaching Scholars Program’ or ‘Medical Education
Fellowship’ or ‘Program for Physician Educators,’ we will refer to them generically
as intensive longitudinal faculty development programs. This chapter does not address
degree-granting programs in health professions education or higher education
(Tekian and Harris 2012), although there are a number of similarities.
L.D. Gruppen, Ph.D. (*)

Department of Medical Education, University of Michigan Medical School,
Ann Arbor, MI, USA

198 L.D. Gruppen
10.2 What Are Intensive Longitudinal Programs?
Searle et al. (2006b) define this kind of faculty development program as ‘a cohort of
faculty members selected to participate in a longitudinal set of faculty development
activities with the goals of improving the participants’ teaching skills and of building
a cadre of educational leaders for the institution’ (p. 936). They trace the origins of
this format back to the 1980s and the emergence of Family Medicine as a specialty.
Indeed, in the United Kingdom, these origins go back to the 1960s. At that time,
there was a significant need to develop a cadre of teachers to foster the development
of the specialty, often by focusing on residents as future faculty members. As such,
it was important to devote an intensive effort to faculty development and building
the culture of the specialty through a cohort of learners. Since then, intensive
longitudinal programs have proliferated and diversified in form and focus, both in
the United Kingdom and North America.
A 2005–06 national survey of 127 United States medical schools sought to determine
the scope and characteristics of this faculty development format (Thompson et al. 2011).
Almost half of the responding schools had an intensive longitudinal program, most
of which began in the 1990s or 2000s. In general, these are institutional investments,
with a minority sponsored by individual departments. All of these programs are
designed for working faculty members; that is, they are not ‘sabbatical’ activities
but are intended to be manageable in the context of routine clinical and educational
responsibilities. Although clinical faculty members tend to predominate as
participants, most programs are open to basic science faculty and some to residents
and allied health faculty as well. This survey identified almost 5,500 graduates of
all the programs.
10.3 An Illustrative Program
The Medical Education Scholars Program (MESP) at the University of Michigan

(Frohna et al. 2006; Gruppen et al. 2003) is representative of such intensive longitu-
dinal faculty fellowship programs. Established in 1998 to promote educational
scholarship, leadership and teaching skills among the faculty at the University of
Michigan Medical School, it admits an annual cohort of approximately 12 faculty
participants who apply to the program in a competitive admissions process.
Admission priority is given to medical school faculty members, but faculty from
other health professions schools and residents have also participated. Participants
meet weekly from September through May for approximately 40 sessions. Each
session is 3.5 h in length and emphasizes highly interactive instructional methods
and activities. There are approximately 25 workshop facilitators in the MESP
who come from numerous departments in the medical school and the university,
as well as guest faculty from other institutions. Each participant identifies a
curriculum development or educational research project to work on during the
course of the program. The MESP is administered by a director (20 % effort)
10 Intensive Longitudinal Faculty Development Programs 199
and an administrative coordinator (50 % effort) within the Department of Medical

Education. The MESP charges each participant a modest fee to help defray these
expenses, but the remainder of the program support comes from the Department of
Medical Education budget.
A typical session of the MESP begins with an interactive workshop on a topic
facilitated by a guest or local expert. A priority is placed on active participation and
contribution, practical application, and shared thoughts and perspectives among the
cohort of participants. The MESP Director is always present to ensure continuity
among the various sessions by pointing out linkages to prior discussions and relevant
implications to individual problems and projects. After the workshop, the facilitator
leaves the room and the MESP cohort engages in what is termed an ‘educational
autopsy,’ designed to not only evaluate the session but also to enter more deeply into
an analysis of the structure and process that the facilitator used for the workshop.
This autopsy provides feedback to the facilitator but also encourages the participants
to think beyond the content of the workshop to its underlying process and the
educational alternatives that might have been considered. The final hour of the
session is devoted to a ‘scholar’s hour’ in which a designated participant (in rotation)
can use this time for their own goals. This might include getting feedback on an
educational innovation, a journal club discussion, peer input on an educational project,
or any number of other creative activities.
These activities are feasible only in the context of an intensive faculty development
program in which participants have regularly scheduled, protected time to devote to
acquiring and practicing specialized skills and competencies. Defining the MESP as a
program for developing educational leaders and scholars reflects institutional priorities
and explicitly echoes the scope of other specialized training programs, such as in
biomedical research education or clinical administrative leadership development.
10.4 The Goals and Purposes of Intensive

Longitudinal Programs
10.4.1 Enhancing Teaching Skills
During the first half of the twentieth century, teaching expertise had traditionally
been assumed to be part of content expertise (Wilkerson and Irby 1998). In other
words, anyone who mastered the discipline was competent to teach it. More recently,
it has been recognized, both in education generally and in medical education
specifically, that teaching skill and expertise is not an automatic consequence of
disciplinary expertise (Harris et al. 2007; McLean et al. 2008; Shulman 1986).
However, the development of educational skills in addition to disciplinary expertise
has often been left to chance as individual faculty members learn to teach by observing
their own teachers (Skeff et al. 1997a, b; Thompson et al. 2011). The lack of formal
training in educational skills resulted in a haphazard learning process that produced
200 L.D. Gruppen
faculty members who varied considerably in educational skill and sophistication.

In their analysis of educational scholarship, Simpson and Fincher (1999) noted that
medical schools need clearer criteria for evaluating the educational contributions of
their faculty and need to provide an infrastructure to support the continuous devel-
opment of faculty members as educational scholars and effective teachers. The
intensive longitudinal faculty development program is one strategy for address-
ing these various institutional needs.
10.4.2 Supporting Educators
Faculty members must address many stressors in their roles as clinicians and educators,
and burnout is an all too common hazard (McLean et al. 2008). Additional challenges
in sustaining faculty productivity and vitality come from the growth of ambulatory
and community-based teaching and the participation of faculty members hired
primarily to provide patient care, who may not have planned a career that is primarily
academic (Searle et al. 2006a). Although faculty development in general is intended
to provide some protection against these risks by developing skills and support for
teaching responsibilities, intensive longitudinal programs likely provide a greater
degree of assistance by virtue of their intensity and community-building qualities.
A cohort of a dozen faculty members who meet periodically over the course of a
year invariably share their teaching frustrations and triumphs and come to recognize
that they are not alone. The ‘hidden curriculum’ of many such programs includes the
peer-mentoring and support of teachers who ordinarily work in isolation. The com-
munity-building potential of these programs is a major selling point and may contrib-
ute to the retention of valuable teaching faculty members (Moses et al. 2009).
Besides mutual support, participants in intensive longitudinal programs are
motivated by many other goals. One that emerges repeatedly is the belief that
participation in such a program will make them more competitive for educational
leadership positions in medical schools, hospitals, and professional organizations.
These positions carry with them greater expectations for being familiar and conversant
with new methods of teaching and assessment (Searle et al. 2006a). Pursuing these
positions and careers also requires evidence of productivity and quality that can be
used by promotions committees; this is an explicit goal of a number of programs
(Baldwin et al. 1995; Wilkerson et al. 2006).
10.4.3 Augmenting Education as a Scientific Discipline
Most programs strive to expand the participants’ perspective on education beyond

being just an area of practice to recognizing it as a scholarly discipline with a foun-
dation of theory and empirical evidence (McLean et al. 2008). All such programs
use this evidence base and relevant theoretical frameworks as critical resources and
structures for the participants to use in their practical application, but many programs
go further by seeking to enable participants to contribute to the scholarly foundation

of medical education as a discipline (Harris et al. 2007; Sheets and Schwenk 1990).
Many programs have sought to address this problem by including instruction in
educational research principles and practices (Gruppen et al. 2006; Robins et al.
2006). This aspect recognizes the expanded definition of scholarship that includes
teaching and educational innovation (Boyer 1990).
This emphasis seeks to promote teaching that is grounded in relevant theory and
in best practices from the literature, thus improving the education of medical students
and residents. It also seeks to foster a more thoughtful and informed use of the
medical education literature by these faculty members. However, another explicit
goal is to develop more and better educational researchers and to improve the quality
of the empirical evidence in medical education. Although programs recognize that
only a subset of participants are likely to devote much time to research, encouraging
and empowering participants to do so is important not only to the individual programs
and sponsoring institutions, but to the larger field of medical education as a whole.
It is worth noting that an explicit focus on faculty development for building research
capacity may require somewhat different considerations and structures than those
typical of most intensive programs. (See Chap. 4 for further details.)
10.4.4 Developing Educational Leadership
As noted above, many participants in intensive longitudinal programs have personal

goals to advance their own leadership roles, but many institutions have also recog-
nized the need for developing educational leadership for their own local purposes
(Hatem et al. 2006; Muller and Irby 2006). There is a growing need for and expecta-
tion of educational sophistication in many leadership positions, particularly those
in graduate medical education, as program directors and coordinators adapt to the
shifting focus on educational outcomes and performance instead of time on task
(Gruppen et al. 2006; Wilkerson et al. 2006). Whereas informal learning on the job
through years of experience might have been enough for success in these positions
in the past, there is a growing recognition that more formal knowledge in a wide
range of domains is becoming increasingly necessary. (See Chap. 3 for a discussion
of leadership development.)
10.5 Evidence of Success
Given the goals and objectives of intensive longitudinal programs, what evidence
exists that these goals are being achieved? Evaluating the impact of faculty develop-
ment programs is often challenging. There is seldom a comparison group to whom
to compare program graduates. In a rare example of a matched control group design,
Hewson and Copeland (1999) were able to demonstrate that teaching evaluations
202 L.D. Gruppen
from learners improved for faculty members in a relatively brief program focused
on improving teaching skills as compared to the control group, which were compa-
rable on teaching evaluation scores prior to the program. In addition, the outcomes
and goals are difficult to measure and assessment methods with compelling evidence
of validity are rare. As a consequence, many evaluations tend to rely on self-report
measures and satisfaction ratings from participants, even while acknowledging
that these data are among the less informative and useful for program evaluation
(McLean et al. 2008). Other sources of evaluation data included participant activity
levels (Elliot et al. 1999), analyses of professional networks (Morzinski and Fisher
2002; Moses et al. 2009), qualitative follow-up interviews (Burdick et al. 2010;
Elliot et al. 1999; Gruppen et al. 2003), peer observation and evaluation of participants
(Hatem et al. 2006), curriculum vitae content analysis (Gruppen et al. 2003;
Morzinski and Simpson 2003; Morzinski and Schubot 2000), and learner evaluations
(most programs). Some specific outcomes are also assessed through questionnaires
and other means, such as attitudes towards learner-centered learning (Gordon et al.
1990). What follows are some evaluation methods and results that can be considered
in judging the efficacy of this format of faculty development.
10.5.1 Satisfaction and Self-Efficacy
A repeated finding is that participants are highly satisfied with the experience and
judge that they have learned a great deal from it (e.g. Burdick et al. 2010; Lown
et al. 2009; Muller and Irby 2006). That this is so is perhaps unsurprising, given the
self-selection inherent in these programs. Nonetheless, the unsolicited testimonials
and the universal presence of high satisfaction indicate that these programs gratify
some goals and objectives of the participants. There is also some supportive validity
evidence available from interviews of secondary beneficiaries – individuals identified
by program participants who might be affected by their participation in the program
(Moses et al. 2006). The majority of these individuals acknowledged that the scholar
they knew had improved as a teacher and education scholar and had enhanced their
educational scholarship, educational programs, teaching, mentoring and leadership
in the department.
10.5.2 Leadership and Career Development
Another frequently cited outcome of intensive longitudinal programs is the frequency

with which graduates take on leadership positions, either within their institution or
in national professional societies and organizations (Muller and Irby 2006; Steinert
and McLeod 2006; Wilkerson et al. 2006). Up to 2/3 of these graduates attain such
leadership positions after participation. At the Medical College of Wisconsin’s
program, one of the oldest, leadership positions more than tripled when comparing
post-program rates with pre-program rates (Morzinski and Simpson 2003). This
positive picture needs to be tempered, however, with the recognition that programs
factor current or potential leadership into the admissions and selection process and
identify it as a goal for the program, so the sample is predisposed for leadership.
There is also some evidence that the presence of intensive longitudinal programs
increases the institution’s ability to recruit educators and educationally oriented
residents (Muller and Irby 2006). Other evidence points to a renewed interest in
academic medicine and medical education as a career (Steinert and McLeod 2006)
or increased faculty retention (Morzinski and Simpson 2003).
10.5.3 Developing a Community of Educators
As the development of a community of educators is a frequent objective of intensive

longitudinal programs, there is great interest in being able to document this outcome.
However, this is one for which there is no widely accepted or utilized measurement
method. One analysis of 351 participants in 49 faculty fellowship programs in
Family Medicine (Morzinski and Fisher 2002) indicated that participation was
associated with a significant expansion of the participants’ networks of collegial
relationships. The relationships were most often with peers but also frequently with
colleagues who could serve as mentors for various facets of career development.
Other colleagues served as academic consultants.
An alternative technique that has been adopted for this purpose from the social
sciences is network analysis. In a network analysis, program participants list the
individuals with whom they interact in specified roles or for specified purposes.
These identified individuals are combined for all the program participants and a
social network is built (using computer software) to reflect the extent to which
program participants interact as a community or in isolation from each other.
The University of Arkansas program (which admits an interprofessional cohort)
applied this methodology in a pre- and post-program design (Moses et al. 2009).
Their analysis indicated a large expansion in network size and complexity for
individuals and among the members of the program. This expansion was attributed,
in part, to greater shared interests and better knowledge of resources and people.
The members of the network were limited to those at the University, but others who
have used network analysis note expansions from local into regional and national
networks due to attending conferences that participants would not have attended
before the program.
10.5.4 Scholarship and Productivity
For programs which seek to not only improve participant teaching skills but also
their research and scholarship, the curriculum vitae (CV) is one source of outcomes
that can be probed for evidence of the impact of participation. Several programs
204 L.D. Gruppen
have developed methods for analyzing participant CVs to evaluate such program
goals as promotions, new educational leadership roles, new curricular resources,
scholarly publications, presentations and grants (Moses et al. 2009). When using
a pre- and post-program comparison of participant productivity, such analyses
frequently find statistically and practically significant increases in numbers of
publications, presentations and educational grants (Gruppen et al. 2003; Morzinski and
Simpson 2003; Rosenbaum et al. 2006; Simpson et al. 2006).
10.6 Characteristics of Intensive Longitudinal Programs
The preceding sections of this chapter have described the purposes of, and evidence
for, intensive longitudinal faculty fellowship programs as one solution to a range of
faculty development needs. For readers interested in pursuing this format further, it is
important to note that, although these programs share some basic characteristics, there
is a great deal of variation on how each one is designed and implemented. The present
section highlights some of these characteristics with the goal of enabling readers to
better frame their planning and decision-making.
10.6.1 Institutional Relevance
Most intensive longitudinal programs described in the literature begin with a careful
study of institutional values and needs. Common issues include the need for
accountability and effectiveness in the institution’s educational mission, fostering
and sustaining faculty in their educational roles, and adapting to the challenges and
opportunities in the health care environment (Gruppen et al. 2006; McLean et al. 2008).
Universally, these institutional goals appear in the program curriculum as segments
devoted to the development of the individual participant’s career, the instructional
programs of the institution, institutional leadership, and the organization as a whole.
Much of the variation among programs stems from the fact that each program is
designed to meet the needs of its local faculty and institution (Searle et al. 2006b).
A systematic review of faculty development programs (Steinert et al. 2006)
highlighted the customization of most programs to a particular group of faculty
members in a particular context. This customization increases the probability of
successfully reaching program goals but it also makes generalizing across programs
difficult. The importance of recognizing local contextual factors and the complexity
of the faculty development process leads to the need to examine institutional and
organizational factors, factors that have been largely ignored to date in many faculty
development efforts.
The dynamic nature of aligning the goals of an intensive longitudinal program
with the institution, and adapting to the inevitable changes in the institution
(Gruppen et al. 2006), is well illustrated in the evolution of long-established
programs. For example, the program at the Medical College of Wisconsin started in 1991
(Simpson et al. 2006). Its initial focus was on primary-care faculty and it emphasized
a tight linkage between the educational needs of these faculty members with insti-
tutional priorities and academic reward structures. This linkage was challenged over
the years as changes in institutional priorities, funding levels, new initiatives,
competition for faculty time, and program vision required various alterations in
program focus, structure, and logistics. Four tenets for adapting an intensive longi-
tudinal faculty development program to the local environment emerged from this
experience: (1) adaptability to changing environments and demands; (2) project-
oriented faculty development as a powerful instructional strategy; (3) risk-taking
role models in the program leadership; and (4) formative and summative program
evaluation to provide data on program effectiveness (Simpson et al. 2006).
Similarly, changes in the institutional environment may be reflected in changing
curricula, needs for improved or expanded assessment, and shifting philosophical
emphasis on education as a mission of the school (e.g. Wilkerson et al. 2006). In other
cases, particular institutional needs guide the focus and goals of the program at
inception. The program at the University of Iowa illustrates this in its very specific
program goal of training future faculty developers to do faculty development at the
departmental level (Rosenbaum et al. 2005, 2006).
A special case of adapting an intensive longitudinal program to a particular
audience is found in the Foundation for Advancement of International Medical
Education and Research (FAIMER) regional institutes (Burdick et al. 2011). The five
regional institutes, presently located in South Africa, Brazil, and India, share many
of the same goals as programs at individual medical schools, such as enhanced
leadership and management skills and improved teaching and assessment. However,
the institutes are designed specifically as a model for focusing faculty development
on community health outcomes. This model emphasizes the importance of social
networks within a transnational perspective and emphasizes building a global
community that is sensitive to resource-poor countries and institutions and addresses
needs in the public sector. (See Chap. 15 for a more detailed description.)
10.6.2 Scope of the Targeted Participants
Each program is designed for a specifically targeted set of participants. The majority
of programs are intended for faculty members at a single institution. However,
there are a few exceptions to this rule. One is the Educational Scholars Fellowship
program (Searle et al. 2006b), which is jointly sponsored by Baylor College of
Medicine, the University of Texas Medical School at Houston, and the University of
Texas Dental Branch at Houston. This collaboration is fostered by the close
geographic proximity of the three institutions and rotates the directorship of the
program among these institutions. In contrast, the Harvard Macy Program for
Physician Educators is explicitly designed to accept participants from other institu-
tions in North America and the world (Armstrong et al. 2003). The geographic
dispersion of this program’s cohort requires much more intensive periods of teaching
on site – 2 weeks intensive followed by another week 6 months later – because these
participants cannot readily gather for face-to-face sessions.
206 L.D. Gruppen
Most of the programs are open to both clinical and basic science faculty members,
but the preponderance of participants come from the clinical departments; basic
science faculty are greatly underrepresented (Rosenbaum et al. 2006; Steinert and
McLeod 2006). The highest proportion of basic science faculty seems to be 10 %
reported for the Baylor-UT program (Searle et al. 2006b). This disproportionate
participation may reflect the emphasis of most programs on the training of physicians
(medical students and residents) as contrasted with biomedical doctoral students.
This emphasis may also limit the perceived value of participation by basic science
faculty members. The imbalance may reflect differing perceptions between these
groups of faculty of the importance of, and rewards associated with, improved
teaching and educational scholarship. Similarly, most programs have originated in
medical schools, so other health professions make up only a minority of participants.
10.6.3 Duration and Intensity
Of the programs surveyed in 2006 (Thompson et al. 2011), the median number of
contact hours was 64, but there was a very large range (from 10 to 584). Overall
program duration had a median of 10.5 months, ranging from less than 1 to 48 months.
Most programs meet weekly or biweekly.
10.6.4 Curricular Elements
Virtually all of the programs are face-to-face and residential, although the program
at UCLA combines a mix of face-to-face and online discussion (Wilkerson et al. 2006).
The vast majority of programs provide the same curriculum to all participants in a
given cohort, although the curriculum changes somewhat from year to year.
The Teaching Scholars Program at McGill seems to be unique in its emphasis on
an individualized program for each participant (Steinert et al. 2003; Steinert and
McLeod 2006).
Teaching formats vary, but common methods are interactive presentations or
workshops, observations and observed teaching activities, and reflective exercises
(e.g. journals, written educational philosophies). Readings from the relevant literatures
are an important element for grounding the participants in the theory and practices of
education and related disciplines that are likely to be novel to them.
Projects are a major curricular element designed to provide participants with the
opportunity to put into practice the educational principles they learn in the program
(Beckman and Cook 2007). Many programs focus on curricular development projects,
but research projects are also common. Individual project work typically requires
consultation and input from program faculty and peers, but also from outside experts,
to whom the program usually fosters access. Projects are often defined and
implemented by individual participants, which enables them to express their personal
interests. However, the individual project may not be very representative of the fact
that most educational and research projects outside of the program are based on teams
Table 10.1 Primary foci, required products of fellows and program

evaluation strategies of medical education fellowships across the USA (n = 55)
(With permission from Thompson et al. 2011)
Primary focusa No. (%)
Teaching skills 43 (78.2)
Scholarly dissemination 32 (58.2)
Curriculum design 29 (52.7)
Educational theory 26 (47.3)
Education research methods 26 (47.3)
Networking with other faculty 25 (45.5)
Educational leadership 24 (43.6)
Program evaluation 23 (41.8)
Use of educational literature 22 (40.0)
Evaluation of learners 21 (38.2)
Career advancement 21 (38.2)
Reflective practice 14 (25.5)
Required products of fellowsb No. (%)
Completion of scholarly project 44 (80.0)
Presentation./publication of scholarly project 36 (65.5)
Design of a curriculum 24 (43.6)
Entries into a journal (i.e. reflective writing) 14 (25.5)
Creation of a career development plan 13 (23.6)
Development of a learning contract 10 (18.2)
Implementation of a curriculum 10 (18.2)
Presentation of a grand rounds session 4 (7.3)
Evaluation methodsb No. (%)
Satisfaction questionnaires 48 (87.3)
Self-assessment questionnaires 32 (58.2)
Follow-up interviews 31 (56.4)
Number of educational activities begun or led by participant 24 (43.6)
Type of educational activity in which participant is involved 24 (43.6)
Direct peer observation/evaluation of participant 20 (36.4)
Curriculum vitae content analysis 20 (36.4)
Course/clerkship/seminar evaluations of participants 12 (21.8)
Portfolios 12 (21.8)
a
Percentage of participants choosing ‘primary focus’
b
Totals equal more than 100 % because participants could select
and collaboration. There may also be value in considering projects that represent
institutional needs and priorities rather than only individual preferences.
The most common curricular content include teaching skills, curricular design
and various forms of scholarly dissemination, educational theory and research
methods, networking, educational leadership, and program evaluation (Table 10.1,
from Thompson et al. 2011). Some focus only on teaching skills (Hewson 2000) or
faculty development (Rosenbaum et al. 2005), but most include a range of other
skills and competencies.
208 L.D. Gruppen
10.6.5 Admissions Criteria
Most programs require applicants to document their interests in, and commitment
to, education, often through evidence of past activities. Evidence of institutional
(department or school) support (often in the form of a letter from the Chair or
Division Chief) is also typical and used to indicate the potential the participant
would have to make an impact after completing the program. Most programs require
a personal statement describing their interest in the program and their goals.
Cohort size is typically limited, with the size averaging around 10.
10.6.6 Communities of Practice
A characteristic common to virtually all of these programs is a focus on a community

of practice (Wenger 1998). Program directors and developers recognize the importance
of a supportive group of like-minded colleagues who can encourage and critique
ideas in an environment that may not otherwise foster thoughtful and scholarly
examination of critical educational problems. Developing such communities is
important for a variety of reasons. Most of the fellowship programs consider
learning to be a very social process that benefits from interchange and discussion
among peers as well as with the program faculty (Salomon and Perkins 1998).
Programs also recognize that medical education is inherently a ‘team activity’ that
requires both the participation but also the cooperation of many members of the
faculty. One might also predict that an expanded community of practice would
result in greater impact or productivity of the individual participant or the community,
but this link has not yet been demonstrated (Moses et al. 2009).
The nature of these communities varies among programs. Many programs bring
together participants from various medical specialties; others focus on a single
specialty. Some focus exclusively on physicians; others include multiple health
professionals. Some are restricted to faculty members; others include residents and
other levels of learners. All, however, explicitly foster the formation and health of a
community of educational colleagues. Programs may vary in how much effort
they devote to sustaining this community after participation in the program is
completed and may vary in the number and types of activities used to develop
these communities.
Participants benefit from the community of their peers but also need access to
specialized expertise and similar resources. Thus, it is important that these commu-
nities bring together colleagues from different disciplines and specialties to promote
a greater sense of connectedness within the institution, for building a community of
educators, and sharing solutions to common problems. Although it is the local com-
munity of practice that is the most frequent focus, most programs seek to augment
the larger national or international community of medical educators by encouraging
participants to get involved in activities at those levels. Some examples include
requiring attendance at a national or international medical education conference or

course (Steinert et al. 2003; Steinert and McLeod 2006) and encouraging the
submission and presentation of scholarly work at appropriate conference meetings
(numerous programs).
10.6.7 Scholarship
The great majority of programs (Thompson et al. 2011) require a scholarly project
as both a graduate requirement but also as an important vehicle for applying the
principles taught in the program to a practical problem of relevance to the participant
in their daily work responsibilities. Some programs also require the development of
a curriculum whereas less common expected outcomes were reflective writing
entries, or a career development or learning plan.
Getting participants to complete the projects is often a challenge. Some of the higher
rates of completion approach 90 % (Simpson et al. 2006), but many programs attain
much lower rates, nearer 60 % (e.g. Armstrong et al. 2003; Wilkerson et al. 2006).
It is also common for the majority of these projects to focus on curricular or
programmatic innovations rather than educational research. For example, the McGill
Teaching Scholars Program found that 62 % of the participant projects focused on
curriculum design or evaluation rather than educational research, as was the initial
expectation (Steinert and McLeod 2006).
10.7 Future Directions for Intensive Longitudinal

Faculty Development Programs
As these programs proliferate and mature, it is important to consider the issues and
opportunities they may have to address in the future.
10.7.1 Reinvent the Wheel or Share It?
A major issue is that of sharing resources across programs. Given the similarities in
curricula for most programs, it seems reasonable to consider the potential benefits of
developing more portable curricular resources that reflect the best expertise available
and make these a common, shared resource among programs (McLean et al. 2008;
Steinert et al. 2006; Thompson et al. 2011). In addition to curricular resources, the need
for content expertise as well as mentors for participants is a common need among
programs. To date, most programs have sought to meet this need internally or by
inviting visiting faculty from other institutions for a session. Whether there could be
a more broadly shared, pooled resource of faculty expertise is worth exploring.
210 L.D. Gruppen
One vehicle for promoting such sharing is the recent development of a Directors
of Medical Education Fellowship group, which meets during the annual meeting of
the Association of American Medical Colleges. Similar sharing of ideas takes place
among colleagues within other nations, and efforts to promote this sharing at an
international level are growing through such events as the International Conferences
on Faculty Development in the Health Professions in 2011 and 2013. Reasonable as
this sharing might seem, it must overcome the resistance to curricula that are not
locally developed and the considerable up-front costs of developing portable
resources with little prospect of a concrete return on that investment.
10.7.2 Financial Challenges
These programs represent a variety of financial models, including central funding,

reliance on departmental contributions, foundation support, and fee-based. Regardless
of financial model, there are never enough resources to do everything that the
program director, the institution, or the participants would like. It is also a common
phenomenon for programs to start off with a sustainable level of funding, but, as
time passes and novelty fades, to then see gradual reductions in their budget and
begin to face cost-cutting requirements (Frohna et al. 2006; Gruppen et al. 2003;
Robins et al. 2006). How programs address these constraints is not well documented
in the literature but is a frequent topic at meetings of program directors.
Paying participants a stipend to protect their time for participation is fairly
common, at least as programs start (e.g. Rosenbaum et al. 2006). However, it is often
one of the first program expenses to get cut as funding becomes more constrained.
Overall, it is not obvious that paying a stipend for participation is a necessity for
program success. Most programs that have lost that funding have continued to have
a good number of applicants. However, this change may have implications for a
given institutional culture and, perhaps, for the participation of some members
of the community.
Of course, these challenges pale in comparison to those faced in less resource-
rich environments in which the needs for faculty development far outstrip the
resources available. The Foundation for Advancement of International Medical
Education and Research (FAIMER) is exploring ways to offer intensive faculty
development in such countries (Burdick et al. 2010, 2011), but this is a challenge
that needs to be embraced by other institutions as well.
10.7.3 Demonstrating Program Effectiveness
Longitudinal, intensive faculty development programs represent significant institu-

tional investments in the growth and performance of its faculty members. Demons-
trating the value of this investment is likely to become an increasingly important
task for program directors. This requires both an assessment of program outcomes
important to the institution and the individual participant and an accounting of
the costs of these programs. As is true for most educational interventions and programs,
accounting for the costs is a complex and often uncertain process. Direct salary and
benefits costs for director and staff time are reasonably straightforward, as are other
program expenses, such as food, materials, program travel, project costs, and, for
some programs, stipends to participants for protected time to participate. However,
there are numerous indirect costs that directors will need to consider: lost clinical
revenue for participants, facilities costs, institutional resources, such as libraries and
librarians, educational technologies, project consultants, guest faculty and speakers,
and many more. Although difficult, efforts to document the costs of such programs,
particularly on an individual participant basis, are important reference points for
making decisions about the value of such investments (Bowen et al. 2006).
There also needs to be greater attention paid to institutional outcomes in addition
to the more common individual participant outcomes (McLean et al. 2008). Relatively
little is known about the impact of such programs on the institutional learning
environment for students and residents or the professional environment for faculty
members. Several programs document that their participants assume leadership
positions in the institution, but what impact on the institution does their leadership
provide? Do graduates of such programs have higher career satisfaction? Do they
stay longer at their institution? Do they become better teachers who might foster
better learning? (Griffith et al. 2000; Hewson and Copeland 1999) What are the
institutional benefits of building a community of skilled educators and scholars?
A repeated lament in the literature on faculty development programs is the lack
of outcomes evaluation and the limited scope of outcome data (McLean et al. 2008;
Steinert et al. 2006; Wilkerson and Irby 1998). Although not focused exclusively on
longitudinal intensive faculty development programs, Steinert et al.’s (2006)
systematic review of 53 evaluation studies of the impact of faculty development
programs on teaching effectiveness found that 74 % of the study outcomes were
classified as ‘reaction’ outcomes, according to Kirkpatrick’s framework (Kirkpatrick
and Kirkpatrick 2006). Knowledge gains were assessed in 77 % of the studies, but
virtually all of these were assessed through participant self-report, a notoriously
biased method with questionable validity (Eva and Regehr 2005; Ward et al. 2002).
Remarkably, 72 % of the studies assessed changes in teaching behaviors, but this
outcome was specifically targeted by the review’s search criteria. Behavioral
changes were assessed through both self-report and learner or peer observations of
teaching behaviors. A minority of the evaluation studies (19 %) examined the
impact of faculty development programs on changes in organizational practice
(3 studies) or changes in student or resident learning (1 study).
As in other domains of medical education, it is time to move beyond simple
descriptions of programs and demonstrations that they ‘work’ to more sophisticated
studies that compare alternative program formats or features. At present, such deci-
sions are a matter of preference on the part of the program developer or facilitator
rather than something guided by any empirical evidence of relative effectiveness.
Improving the evidence base for intensive longitudinal programs will require both
212 L.D. Gruppen
greater rigor in outcomes definition and measurement but, more importantly,

the difficult step of actually comparing programs and their outcomes. At present, the
evidence can be characterized as demonstrating quite clearly that an intensive
longitudinal program is better than short programs or one-time workshops. What is
needed is ‘comparative effective studies’ that directly compare programs with
differing characteristics (duration, frequency, selection criteria, etc.) to determine
whether these characteristics are critical to success. (See Chaps. 17 and 18 for
further details.)
10.7.4 Evolution of the Model
As described earlier in this chapter, the intensive longitudinal faculty development

model has many common features across various institutions. However, it is still a
fairly new model and is likely to undergo divergent evolution as people use it for
different purposes.
One branch of this evolution may be adapting the model to different outcomes
and audiences. For example, the University of Michigan has applied the intensive
longitudinal model to a program in health care administration for residents and is
planning a patient safety and quality improvement program that utilizes the same
model. One can speculate on other special domains or audiences that might fit the
model: other health professionals and interprofessional cohorts, research mentoring,
educational technology, biomedical PhD and postgraduate student educators, and
others. The FAIMER Institutes have already been cited as an example of how the
model can apply to a dispersed cohort of international participants (Burdick et al.
2010), but it is likely that other variants will be needed for programs that specifically
target a participant cohort that includes international learners.
Another branch in the evolutionary tree may be the relationship of intensive
longitudinal programs with other faculty development resources. Other chapters in
this book describe a variety of formats for faculty development that have different
goals, resource demands, and strengths and weaknesses. Ideally, these alternatives
should fit together into a spectrum of resources for faculty at a given institution.
One specific relationship that warrants more consideration is the link between
intensive longitudinal programs and formal degree-granting programs, such as
the expanding number of Masters’ degree programs in health professions edu-
cation (Tekian and Harris 2012). Some programs include graduate courses as part
of the curriculum (Steinert et al. 2003), whereas others have arrangements by
which participation in the program can count for credit towards a formal degree
(Gruppen et al. 2006; Robins et al. 2006; Searle et al. 2006b). At the other end of
the spectrum, creative links between intensive longitudinal programs and more
traditional ‘one-off’ faculty development workshops might be considered as a feeder
or recruitment mechanism for participation in an intensive longitudinal faculty
development program.
10.8 Implications for Practice and Research
For those contemplating establishing an intensive longitudinal faculty development

program, the characteristics of this model outlined above can serve as a framework
for planning and discussion. The evaluation literature for these programs provides
some guidance as to what outcomes can be expected and how success might be
fostered. However, what is perhaps most important is to learn from the experience
of these earlier programs. Hatem et al. (2009) summarized ten strategic steps in
developing a program that merit our attention:
1. Defining an operating philosophy, values, and goals.
2. Establishing a curriculum that reflects the roles and responsibilities of fellows
and faculty.
3. Employing a basic approach to adult learning.
4. Striving to achieve a balance between stated objectives and openness of
discussion.
5. Creating optimum learning opportunities for the fellows to acquire and practice
skills delineated in the curriculum.
6. Fostering interdisciplinary communication, team development, and the creation
of a learning community.
7. Developing mindfulness and critical self-reflection.
8. Systematically reviewing each session.
9. Evaluating fellowship outcomes.
10. Planning for the future.
For those who already have such programs, it is important to recognize that they
need to be periodically, if not continuously, evaluated for how well they fit the needs
of the participants and the institutional environment. Not only does the program
need to stay fresh and innovative, but the institution and its leaders need to be
reminded about the contributions the program makes to individual participants and
the institution itself. The argument for value of an intensive longitudinal faculty
development program is necessarily a local one, but it can benefit from the collective
experience, evidence, and purpose of the community of directors and facilitators
of such programs. This sharing should extend beyond justifying these programs to
sharing resources, assessment methods, and even comparisons among programs.
Such mutual support and prompting will move the whole community forward.
10.9 Conclusion
Intensive longitudinal programs are an important format in the faculty development

arsenal. This model allows for a greater depth of learning when compared with
single-session workshops and enables a more comprehensive curriculum that
addresses a range of integrated skills that can lead to a well-rounded health
214 L.D. Gruppen
professional and leader. Intensive longitudinal programs are more than just an
investment in the growth of individual faculty members; they are also investments in
the health of the institution. The faculty members who graduate from these pro-
grams frequently give back to the institution in many ways, including higher-quality
educational planning, better assessment methods, more informed decision-making,
and educational leadership that is based on educational evidence and principles.
The logistical details, curricular content, and primary goals of each program
described in this chapter reflect the culture and context of the home institution.
Although reasonable, this diversity highlights the need for further evaluation of the
impact of these programs and studies to identify the key features that lead to success.
10.10 Key Messages
• Intensive longitudinal faculty development programs have proliferated over the

past 15 years.
• These programs have reasonably good evidence for effectively achieving their
goals for improving leadership, educational foundations, scholarly productivity,
community building, and teaching.
• Although each program must adapt to the demands of its institutional home,
there are considerable opportunities for programs to share ideas, curricular
resources, and best practices.
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Chapter 11
Faculty Development Online
David A. Cook
11.1 Introduction
With the growing presence of computers and Internet technologies in our personal
and professional lives, it is no surprise that computer-assisted learning has shown
dramatic growth over the past decade. These technologies act as prostheses – enabling
activities that would otherwise not be possible (Amin et al. 2011). Interest in the
field of computer-assisted instruction (as measured by research publications)
continues to grow rapidly (Adler and Johnson 2000; Cook et al. 2008b). One study
suggests that online continuing medical education (CME) may dominate over half
of all CME activities by 2017 (Harris et al. 2010). Since Google, Facebook, YouTube
and smartphones are increasingly used by faculty and students, it seems timely to
consider how these and other electronic tools might be harnessed to promote faculty
development.
The broad field of e-learning encompasses all educational interventions that use
electronic technologies, including instruction using computers, Internet, mobile
devices, audio tapes or CDs, video tapes or DVDs, and satellite TV. Online learning
(also called Web-based learning) is e-learning that uses the Internet. This chapter
will first offer a brief introduction to online learning in general, followed by an
argument for online learning in faculty development, a review of what has already
been done, an overview of options and key principles for instructional design, and
next steps for current practice and future research. Although this chapter focuses on
online learning, many of the principles apply to other e-learning activities.
D.A. Cook, MD, MHPE (*)

Division of General Internal Medicine and Office of Education Research,
College of Medicine, Mayo Clinic, Rochester, MN, USA

218 D.A. Cook
11.2 Online Learning: A Brief Introduction
11.2.1 What Is Online Learning?
Online learning is, simply put, the process of learning with support from the Internet
or a local intranet. Virtually any use of the Internet could be construed as a learning
activity (for example, we learn something each time we read the news). However, as
commonly used and for the purposes of this chapter, online learning refers more
specifically to learning while engaged in online activities deliberately designed and
sequenced to achieve defined learning objectives. This can be accomplished in several
different ways, including the presentation of instructional materials (e.g. online
tutorials), communication systems that facilitate learning-focused discussions
(computer-supported collaborative learning), and activities that permit practice with
authentic scenarios (computer simulations). The Glossary (in Appendix A) contains
definitions for these and other terms.
It is also important to recognize what online learning is not. The Internet has
many applications in medical education in which the primary intent is not to directly
facilitate the achievement of defined learning objectives. These include online
postings of course information (syllabi or handouts), archives of face-to-face lectures
(e.g. PowerPoint slides or videotaped lectures), online administration of tests and
course evaluations, and administrative communications. Likewise, the Internet is
increasingly used for social (e.g. Facebook) and information-seeking activities that
do not constitute online learning as defined above. However, while these activities do
not constitute online learning by themselves, each could comprise an element within an
online learning course. For example, posting online the slides (or an archived video)
from a faculty development workshop would not constitute online learning; however,
these slides (or video) could be an integral part of a structured learning program
with defined enrollment, objectives, and post-course assessment.
11.2.2 Is Online Learning Better than Face-to-Face?
Since the origin of the computer, investigators have attempted to determine whether
computer-assisted learning – and more recently the subgroup of online learning –
is more or less effective in comparison with traditional approaches to learning
(Clark 1983). The conclusion of this research is that there is, on average, no significant
difference between computer and non-computer approaches. One systematic
review of 76 studies comparing online learning with traditional approaches found
negligible differences (Cook et al. 2008b). A website dedicated to this phenomenon –
www.nosignificantdifference.org – has catalogued hundreds of studies with the
same bottom line. Yet although the average difference approaches zero, for a given
study the differences vary widely, sometimes favoring online, and at other times
favoring traditional learning. The key factor appears to be not the medium
11 Faculty Development Online 219
(computer or traditional) but the appropriateness of that medium for the instructional
objectives, and the effectiveness of the instructional methods.
The implication for educators is that there is nothing magical about online learning
that makes it inherently better than other forms of instruction (such as face-to-face
lectures or small groups) (Cook and McDonald 2008). Online learning may solve
some problems but not others, and will typically create new problems as well.
Traditional methods frequently remain the better choice. In reality, the ideal option
often involves a blending of both approaches as discussed in Sect. 11.7.
The appropriateness of online learning for a given situation requires the alignment
of multiple factors including the instructional objectives, intended instructional content,
learners, and learning context. Making these decisions requires an understanding of
the potential advantages and disadvantages of using these technologies (Cook 2007),
as discussed below and in the Glossary. The other key factor, the instructional methods,
will be discussed in Sect. 11.4.
11.2.3 Advantages and Disadvantages of Online Learning
11.2.3.1 Advantages
The advantages and disadvantages discussed below pertain to online learning generally
(Cook 2007), although some are particularly salient to online faculty development.
Perhaps the most obvious advantage of online learning is that physical distances
become irrelevant. Faculty development courses have reached learners across the
state (Langlois and Thach 2003), country (Anshu et al. 2008; Wearne et al. 2011),
and world (Ladhani et al. 2011; McKimm and Swanwick 2010). Distance learning
also enables economies of scale for many courses: once an online learning tutorial
has been developed, class size is limited only by server capacity and bandwidth.
Moreover, an online tutorial or other individual course component (such as an
animation, video clip, or simulation) could subsequently be used again in another
course (e.g. ‘reusable learning objects’).
Online learning also allows flexibility in the timing of participation. Learners can
access an online learning tutorial or simulation at any time, day or night. Asynchronous
online discussions also offer flexibility, although participants need to respond to
communications from other group members in a timely manner and adhere to
agreed-upon schedules. For example, one group used an online approach to encourage
clinical assessment skills among busy surgical faculty (Pernar et al. 2012).
Since online course materials are housed at a central location, updates can be
implemented quickly and easily. Learning resources such as tutorials also persist
long after the course ends. Faculty members may thus return to a useful tutorial
when planning a course or conducting a research study, or reference the text of a
relevant online discussion when trying to solve a difficult leadership challenge.
Online learning offers the capability to individualize learning through self-
adjustment or automated adaptation. For example, most online courses permit
220 D.A. Cook
learners to take control of the learning environment by slowing down when material
is new or difficult, and moving quickly if material is familiar (self-pacing). Some
courses also allow learners to select among different learning opportunities within a
given course (self-selection). In computer-adaptive instruction, the computer uses
information about the learner (baseline knowledge, learning style, or motivation to
learn) to alter, and thus optimize, the learning experience.
Online learning also offers the opportunity to try creative new instructional
methods for engaging learners and encouraging deep and durable learning. For example,
an asynchronous online discussion might allow learners time to reflect on a question
and craft a thoughtful response. Online simulations could give faculty members the
opportunity to rehearse new skills in a simulated teaching or research experience,
as virtual patients do for clinical medicine. Other innovative approaches include
games, interactive models, computer animations, and incorporation of audio and
video clips. Creative methods in online faculty development include computer
simulations of organizational change (Richman et al. 2001) and interviewing
standardized patients using a videoconference feed (Kobak et al. 2006).
Finally, online learning facilitates learner assessment, tailored feedback based on
these assessments, and documentation that educational objectives were achieved
(Cook 2007).
11.2.3.2 Disadvantages
However, online learning is not without its disadvantages. Offsetting the potential
economies of scale are the large up-front costs associated with developing online
learning. Crafting an effective online course requires a substantial investment in
planning, testing, technical expertise, and computer infrastructure. At least one
faculty development program underestimated this investment, leading to delays and
frustration in program implementation (Lewis and Baker 2005). Also, economies of
scale are less apparent in online discussions, in which demands on instructor time
usually increase with each additional learner.
Technical difficulties are nearly inevitable in all teaching activities, but they may be
more important in an online course. An instructor could improvise in a face-to-face
course in which the DVD player malfunctioned. By contrast, even a minor technical
problem can have a substantial influence on the appearance, content, and functionality
of an online course, with resultant negative effects on satisfaction and learning
(Dyrbye et al. 2009). Moreover, problem recognition may be delayed, and trouble-
shooting may require substantial time from both learners and instructors.
Online learning unmasks inferior instructional design in the same way that it
magnifies technical problems. In contrast to a face-to-face course in which a talented
instructor can get by with minimal preparation, instruction in online learning must
be explicitly planned and implemented, as will be discussed below. While poor
instructional design is certainly not unique to online learning, online learning
appears to be much more sensitive to this problem.
The full potential of individualized instruction has only rarely been realized.
Computer-adaptive instruction is not as easy as it sounds (Cook et al. 2008a), and
when it has been accomplished, the benefits in comparison with non-adaptive

instruction are fairly minimal to-date (Landsberg et al. 2012). Self-driven adaptations
are simpler, but still require the development of alternate learning materials and
pathways, ideally with proven benefit for certain learner subtypes. Thus, in most
current online courses, the individualization consists only of the variation in the
timing and pace of instruction.
Flexibility in time and location means that the learner using online learning
tutorials and simulations is often studying alone, which can create a sense of
isolation. Even courses that require learners to collaborate, such as an online
discussion group, may be less engaging and less socially fulfilling than a face-to-
face equivalent. This is not a trivial issue, particularly when it comes to engagement
and satisfaction with faculty members as learners (Dyrbye et al. 2009; Steinert et al.
2002; Wearne et al. 2011). This problem may be more acute for faculty who are
less comfortable using computers (although this concern is largely hypothetical,
and in one study of continuing medical education no correlation was found between
age and online participation (Schoen et al. 2009)). Also, for some topics (e.g. ‘how
to lead a small group’) instructor modeling of behavior is an important element that
would be lost in an online course.
Finally, a transition to online faculty development could create political tensions
among faculty if, for example, online learning were perceived as yet another
unfunded mandate that consumes personal time for professional activities.
11.3 Innovations: Creative Approaches to Online Faculty

Development
Online learning addresses many of the barriers frequently encountered in faculty

development initiatives. Online learning can be designed to allow involvement
according to each participant’s schedule, which can be a significant impediment
for faculty members with busy clinical calendars, teaching schedules, administra-
tive responsibilities, and travel commitments. Similarly, the capability to involve
learners regardless of physical location addresses another significant obstacle
when reaching out to faculty members at rural and community sites and at other
institutions. Online learning also permits access to ‘just-in-time’ education.
Documentation of completion is often helpful, especially for those requiring con-
tinuing education credits.
The topics and key modalities of 20 online faculty development initiatives are
summarized in Table 11.1. A more detailed analysis of this evidence has been pre-
sented elsewhere (Cook and Steinert 2013). Online learning has been most often
described for faculty development in clinical teaching and assessment. However, it
has also been used to train in business administration (Dean et al. 2001; Fox et al.
2001), financial planning (Richman et al. 2001), critical appraisal of the literature
(Macrae et al. 2004), and research skills (Kobak et al. 2006; Kotzer and Milton
2007). These studies employed a wide variety of online modalities and instructional
designs, including tutorials, online discussions via discussion board, chat, and email
222
Table 11.1 Articles describing computer-assisted faculty development activities

Author (Year) Scope Topic Description
Dean et al. (2001) Distance learning program Business administration Virtual (online) classroom, online homework
in the USA assignments, face-to-face sessions
Fox et al. (2001) Distance learning program Leadership (change management) Online tutorial with discussion board
in the UK
Richman et al. (2001) Distance learning program Financial planning Computer simulation of budgeting
in the USA (part of larger leadership course) and strategic planning
Janicik et al. (2002) 1 school in the USA Assessment and feedback Web module: video clip, survey, tutorial
Steinert et al. (2002) 1 school in Canada Small group teaching Discussion board and e-mail listserv
following face-to-face workshop
Langlois and Thach (2003) 16 counties in 1 state in the USA Clinical teaching 8 Web modules; also videotape, paper
handouts, and face-to-face workshops
Macrae et al. (2004) Surgeons scattered across Critical appraisal of literature Internet-based journal club (e-mailed
Canada (academic and articles and discussion)
community sites)
Lewis and Baker (2005) Distance learning program Master degree in education Various online courses in the graduate
in the USA for health professionals degree program
Coma del Corral et al. (2006) Distance learning program Research methods Online chat (synchronous discussion),
in Spain Web-based resources
Kobak et al. (2006) Distance learning program Rater training (for clinical research) Online tutorial, practice interview with
in the USA ‘patient’ via Internet videoconference
Bramson et al. (2007) Clinical preceptors Clinical teaching Face-to-face workshop, e-mail listserv,
(site not specified) discussion board, video, CD-ROM
Kotzer and Milton (2007) 1 hospital in the USA Research (review board policies) 12 brief e-mails
Anshu et al. (2008) Multiple medical schools Teaching and assessment E-mail listserv discussion
spread across India (part of FAIMER fellowship
D.A. Cook
in medical education)
11
Dyrbye et al. (2009) Distance learning program Master degree in health professions Various online courses in the graduate
in the USA, learners education degree program
from multiple countries
Anshu et al. (2010) Multiple medical schools spread Teaching and assessment E-mail listserv discussion
across India (part of FAIMER fellowship
in medical education)
McKimm and Swanwick (2010) 155 countries Clinical teaching 16 online modules
Paulus et al. (2010) 1 school in the USA Online teaching Face-to-face and virtual (online) workshops;
online discussion board
Ladhani et al. (2011) 30 countries Community-based medical Online discussion board role play
education (part of FAIMER (part of larger online course)
Faculty Development Online
fellowship in medical education)

Wearne et al. (2011) Multiple rural and urban sites Clinical teaching Not defined
across Australia
Pernar et al. (2012) 1 school in the USA Clinical teaching and feedback 27 very brief e-mailed ‘bullets’ on effective
strategies
223
224 D.A. Cook
listserv, computer simulations, video clips, role playing, and live assessments of a
training subject at a distance.
The most common problem encountered with online faculty development is lack
of participation. Several reports note low faculty engagement (Bramson et al. 2007;
Langlois and Thach 2003; Steinert et al. 2002), leading one group to describe their
initiative with online discussion as ‘an experiment that failed’ (Steinert et al. 2002).
Some courses, however, have had great success (Macrae et al. 2004; Ladhani
et al. 2011). The reasons for these differences remain uncertain, but several
solutions have been proposed. Some authors suggest that only when courses
successfully meet a need perceived by faculty will they invest the necessary time
and energy to participate in an online course (Paulus et al. 2010; Steinert et al. 2002;
Wearne et al. 2011). Others reported that careful organization, clear communica-
tion, and assistance with technical problems were key (Dyrbye et al. 2009; Janicik
et al. 2002; Langlois and Thach 2003; Ladhani et al. 2011; Lewis and Baker 2005;
Wearne et al. 2011). Yet others suggested that time to complete course activities,
clear expectations, and relevance to near-future teaching activities were essential
(Ladhani et al. 2011; Langlois and Thach 2003; Paulus et al. 2010; Pernar et al.
2012). Given the absence of clear evidence to support one solution over another,
perhaps the most important lesson is that those responsible for faculty development
must be aware of the potential for low participation, anticipate this, and plan in
advance to address this challenge.
A related but distinct problem regards online communication and the develop-
ment of a sense of community. Several studies found that online communities can
enhance interactions among faculty (Anshu et al. 2008, 2010; Bramson et al. 2007;
Wearne et al. 2011), while others found the opposite (i.e. that faculty members met
the online initiative with opposition, disinterest, and lack of engagement (Fox et al.
2001; Ladhani et al. 2011; Steinert et al. 2002)). The key difference appears to be
the motivation behind the online community. Online communities seem to prosper
when they meet an otherwise unfulfilled need, such as bridging the distance among
rural physicians (Wearne et al. 2011). Less successful initiatives attempted to
replace existing face-to-face interactions, or lacked a cohesive structure (Bramson
et al. 2007; Langlois and Thach 2003; Steinert et al. 2002). Online communication
has also been noted to be a challenge, with at least one study noting that the absence
of voice inflection or body language can breed misunderstanding (Dyrbye et al.
2009), although at least one group overcame these barriers by using a conversa-
tional communication style and encouraging contributions from all participants
(Anshu et al. 2008).
In summary, educators have used online learning for faculty development on
multiple topics in diverse locations using a variety of creative approaches. However,
these initiatives have not been equally effective, and the reasons for this variation
are only partially understood. Going forward, health professionals engaged in online
faculty development should: (1) learn from what others have done (see Table 11.1);
(2) anticipate and plan to address low participation, which might include providing
adequate time and emphasizing educational needs; (3) optimize communication;
(4) implement current best practices (see Sects. 11.4 and 11.5); and (5) consider
conducting new investigations to advance our understanding of best practices
(see Sect. 11.8).
11.4 Instructional Design Part 1: Options
Online learning comes in many flavors or configurations, including tutorials, online

communities, simulations, and performance support. While these classifications are
neither mutually exclusive nor collectively comprehensive, they provide a useful
framework to discuss this technology and its educational applications. Each of these
will be discussed in turn. (These and other key terms are defined in the Glossary
in Appendix A.)
11.4.1 Online Tutorials
Just as a face-to-face lecturer might use a chalkboard, PowerPoint slides, a video clip,
and a brief case scenario, an online instructor might design a tutorial incorporating
a variety of technologies and instructional approaches such as multimedia, interactive
games, practice cases, and self-assessment tools. Online tutorials possess all of the
advantages and disadvantages listed above, most notably the advantages of flexibility
in time, location, and pace of instruction, but with the disadvantage of large up-front
development costs. A simple online faculty development tutorial on the topic of
learner assessment might consist of learning objectives, PowerPoint slides (designed
for this purpose – not borrowed from a face-to-face course!), and a self-assessment
with feedback. A more advanced module might additionally ask faculty members to
rate several video clips, and then compare their scores with those of an expert.
When to use online tutorials? Computer-based tutorials will be most useful when
learners are separated in time or space (such as conflicting schedules or working at
physically distinct sites).
An effective online tutorial requires more than simply taking the slides or video
of an existing face-to-face course and posting them on the Web. As noted below, the
science of online tutorials is fairly well-developed, and applying this science
requires considerable planning and attention to implementation. Remember that
the goal of instruction is mental activity on the part of the learner; information
processing and construction of new knowledge. Since physical activity (such as
clicking the mouse) does not guarantee mental activity, effective instructional designs
focus on facilitating mental activity. Opportunities for self-assessment and feedback,
reflection, and interaction with other learners can facilitate this. The development
cost and other disadvantages should be balanced against potential advantages.
Technical support is essential. Learning management systems such as Blackboard
or free, open-source Moodle can be helpful in organizing the course.
11.4.2 Online Collaboration: Blogs, Wikis

and Discussion Boards
Internet-mediated communication has facilitated the development of so-called

online collaborative learning communities (Sandars et al. 2012). This approach is
226 D.A. Cook
common in faculty development, with half of the courses shown in Table 11.1
incorporating online collaboration. Online collaboration can use a variety of tools
including wikis, blogs, discussion boards, instant messaging, social networks and
virtual worlds. In the virtual equivalent of a face-to-face small group, learners can
interact to share experiences and information and learn together. As with face-to-
face small groups, online learner interaction serves both a social function and as a
stimulus to active learning. In both online and face-to-face discussions the teacher
may offer some didactic teaching (e.g. a brief tutorial), but most of the learning
occurs in the group conversation. Teachers assume the role of facilitators – defining
the scope of the discussion, monitoring the discussion and providing guidance as
needed, and steering learners to useful resources.
When to use online collaboration? Collaborative learning is particularly effective
during the integration phase of instruction (reflection and debate), when opinions
and practices vary, and when deliberately developing relationships among learners.
Some learners feel more comfortable contributing to a conversation online rather
than face-to-face, and asynchronous discussion allows time to reflect and pursue
further study before responding. Many online communication tools create a permanent
archive of the conversation.
Face-to-face groups can meet with the instructor for a small group discussion, or
the instructor can simply give an assignment and let the learners decide the timing,
location, and frequency of group meetings required to complete the final product.
Similarly, there are a variety of approaches to online collaboration. As noted
above, online collaborative faculty development activities have not always been
successful. While the evidence base is inconclusive, it would seem that key ingredients
include faculty buy-in (best achieved by focusing on a perceived need), clear objectives,
and explicit expectations in terms of participation and final product (Lewis and
Baker 2005; Paulus et al. 2010; Steinert et al. 2002; Wearne et al. 2011).
Most online communication is asynchronous, with a delay between sending a
message and receiving the response. Tools for asynchronous communication include
e-mail, discussion boards, blogs, and wikis. Synchronous communication is real-time,
and is mediated through live audio or audio-video communication (e.g. Skype) and
instant text messaging. The degree of instructor involvement and observation varies
greatly among these options; that is, the instructor can easily monitor all activity on
a school-sponsored discussion board, whereas if learners use a social network
discussion board the instructor may have no information about the group activity.
This isn’t necessarily bad, but it does change course operations and limit the infor-
mation available to the instructor for assessment.
11.4.3 Online Simulations
Online simulations attempt to emulate real-life events on a computer screen.

Evidence suggests that efficient application of knowledge requires experience with
a large number of similar problems. Rather than wait for such problems to occur
in real life, supplementing the mental ‘case library’ with simulated experiences
may encourage knowledge application to new settings. Online simulations provide
an efficient way to provide such experiences. Online simulations for faculty
development could replicate a faculty-on-learner clinical assessment, the analysis
of research data, or a sticky administrative problem.
When to use online simulations? Face-to-face and online lectures, tutorials, and
discussions are probably more efficient for the development of core knowledge.
The role for online simulations, then, is to allow learners to consolidate this
knowledge and practice applying it in a variety of situations.
The key consideration in teaching with online simulations involves the selection,
sequencing, and implementation of cases. Ideally, cases on a given topic would start
off relatively simple (and perhaps with some guidance in decision-making) and
progress to more challenging cases with greater complexity and less guidance.
Technological sophistication does not equate with better learning. Much attention is
paid to the fidelity or realism of the online simulation, but these concerns are likely
ill-founded. Not only is high fidelity expensive, but there is some evidence to
suggest that it can paradoxically impede rather than enhance learning. Written case
studies have been used for decades in law, medicine, and business administration,
and in many situations a simple text narrative may yet be sufficient. Some educators
have found that working through a virtual case as a group is more effective than
working alone, or that online simulations are most effective as part of a blended
learning activity (e.g. having a face-to-face group discussion once everyone has
completed the case).
11.4.4 Performance Support (Just-in-Time Learning)
Performance support (just-in-time learning) involves delivering educational infor-

mation just when the learner needs that information. A faculty member might need
support, for example, when planning a course, teaching or assessing learners,
conducting research, or writing a manuscript. Information delivery can be triggered
by some observed or planned event (‘pushed’ to the provider during or just prior to
the moment of need) or requested by the faculty member (‘pulled’ from online
searchable resources). The educational advantages of just-in-time delivery are at
least two-fold. First, this is a moment when learners will be receptive to the material,
since it (hopefully) will enable them to complete the required activity more effec-
tively. Second, because a knowledge gap has been identified and prior knowledge
activated, learners are primed to integrate this new information into their existing
knowledge structure.
As useful as this sounds, it has limitations. It takes time to read, digest, and
assimilate this information, and if ‘pushed’ information arrives at an inconvenient
time (e.g. during a pressing manuscript deadline or on a busy clinical workday),
faculty members may ignore or even resent the information. Also, just-in-time
learning may not substitute for other instructional approaches because the ad hoc,
228 D.A. Cook
unstructured information may be improperly integrated with what the learner

already knows. Thus, performance support – at least at present – is just that: support.
It should not replace other instructional methods.
11.4.5 Emerging Technologies: Online Games, Immersive

Environments, Social Networks and Mobile Devices
Technologies continually evolve and change, and with each evolution come
challenges in determining the new technology’s role and redefining roles for older
technologies (Sandars 2012). Three new technologies are emerging within the field
of online learning with potential to permanently alter the landscape. Online games
(Graafland et al. 2012) and immersive environments (Wiecha et al. 2010) can engage
learners intensely, and to the degree that this promotes learning they may be a highly
effective learning tool. Social networks have revolutionized how relationships are
formed and maintained, and show great promise in facilitating online learning
communities (Sandars 2010; Sandars et al. 2012). Mobile devices have transformed
our use of computers, and for many people have become part of their moment-
to-moment existence; yet it remains unknown how the small screen and typically
brief interactions will impact learning.
These technologies, and others that will undoubtedly arise in the future, will
make instructional design a continuously moving target. Fortunately, teachers can
be successful using both old and new technologies if they focus on the fundamentals –
as discussed in the next section.
11.5 Instructional Design Part 2: Evidence-Based Principles
11.5.1 Fundamental Principles
The fundamental principles of effective learning are the same for online approaches
as for face-to-face. However, while these principles are often instinctively or
extemporaneously applied in face-to-face instruction, online instructional designs
must be explicitly planned and implemented. The pages that follow will first provide
a brief review of general principles of instruction, followed by some principles
specifically developed for multimedia instruction (i.e. online learning).
The ultimate goal in faculty development is the same as in instruction for other
learners – namely, to help learners develop new knowledge, and then recall and
apply this knowledge in real-life settings (i.e. so-called ‘transfer’). This involves
more than just effectively transmitting information. Learning is more than
accumulation of information, but rather involves organizing, reorganizing, and
linking new information and experiences with prior knowledge and past
experience. This process, known as elaboration, constitutes the core of all learning
(Bransford et al. 2000) and plays a critical role in faculty development.
Current models of the learning process postulate three distinct regions of

cognitive activity: sensory input (primarily visual and auditory), working memory,
and long-term memory (van Merriënboer and Sweller 2005). Elaboration takes
place in the working memory, where it merges new information (from the senses)
and old knowledge (from long-term memory). Online learning will be most
effective to the extent that it encourages learners to elaborate robust, meaningful
knowledge structures.
11.5.2 First Principles of Instructional Design
Countless theories attempt to explain how learning occurs, but although these
theories differ in fundamental ways, they actually share many common elements in
their implications for the design of instruction. Merrill (2002) reviewed dozens of
educational theories and models in search of such common themes, reasoning that
themes present in multiple theories are likely to be true. In so doing, he identified
five ‘first principles of instruction,’ namely:
1. Problem-based: Instruction should be situated in the context of real life problems.
Such problems should reflect the range of tasks the learners might encounter in
practice. The level of difficulty should be commensurate with the learners’ level
of training, and ideally would progress (i.e. become more challenging) over the
course of instruction.
2. Activation of prior knowledge: ‘learning is promoted when relevant previous
experience is activated’ (Merrill 2002, p. 46). Activation brings knowledge and
experiences from long-term memory back into working memory, where these
can be integrated with new information and experiences. Knowledge can be
activated by analyzing or trying to solve problems, responding to questions,
generating questions on the topic, or engaging in hands-on experience.
3. Demonstration: ‘learning is promoted when the instruction demonstrates what is
to be learned, rather than merely telling information about what is to be learned’
(p. 47). Demonstrations might involve providing a verbal or written example of
a concept, a picture or video of a procedure, or a diagram of a process. Multiple
examples (and contrasting counter-examples) illustrating different perspectives
are often helpful. Demonstrations are intended to build accurate mental models
of how to apply knowledge in practice.
4. Application of learning: ‘learning is promoted when learners are required to use
their new knowledge or skill to solve problems’ (p. 49). Evidence suggests that
novice learners benefit from guidance and coaching during early stages. However,
guidance should be gradually withdrawn as they progress, such that in the end
they solve problems independently.
5. Integration: ‘learning is promoted when learners are encouraged to integrate
(transfer) the new knowledge or skill into their everyday life’ (p. 50). This occurs
most directly when they apply it in real practice, but integration can also be
encouraged when learners actively reflect on what they have learned, teach a
principle to others, or defend or debate their newfound knowledge.
230 D.A. Cook
For example, in an online course on research design, a junior faculty member

might first be asked to read a journal article and identity strengths and weaknesses
of study design (activation of prior knowledge). Later, the instructor might provide
examples of several different designs, contrasting their strengths and weaknesses
and showing examples from recent literature (demonstration). Next, the faculty
member might complete a series of practice exercises requiring the selection and
justification of an ideal study design for a given situation (application in the context
of real-life examples). As a final step, the faculty member could apply this new
knowledge to his or her own research project, or engage in a mock debate with
another course participant on the ideal study design for a given scenario.
Or, in an online course on learner assessment, a faculty member might start by
rating a videotaped clinical encounter between a medical student and a patient.
Identifying areas of disagreement in comparison with an experienced rater and
using these to generate a personal list of learning objectives would activate prior
knowledge. Next, the faculty member could view a series of short clips extracted
from other clinical encounters that illustrate both good and inferior performance
(demonstration). Later, he or she might rate additional clips of unknown skill
level (application) and discuss and defend ratings with other course participants
(integration).
11.5.3 Designing Effective Multimedia
Once an overall instructional plan has been developed using Merrill’s first principles
or an alternative model, the online instructor must create a website that encourages
learning. To guide such decisions, Mayer (2005) has developed a theory of multimedia
learning based on decades of empiric research. These evidence-based principles are
relevant to computer-assisted instruction, PowerPoint presentations, and other uses
of audio and video in instruction. A very brief summary of selected principles is
offered below; for a more complete discussion of the underlying evidence and how
to implement these principles, readers are encouraged to consult Mayer’s original
works (Clark and Mayer 2008; Mayer 2005).
11.5.3.1 Multimedia Principle: People Learn More from Graphics

and Words than from Words Alone
A picture is worth a thousand words, and it comes as no surprise that graphics,

photographs, animations, and short video clips can greatly enhance learning. Images
and videos can be used to provide examples (and non-examples) of an object, to offer
a topic overview or organization scheme, to demonstrate steps in a procedure or
process, or to illuminate complex relationships among content, concepts, or time or
space. However, not all graphics are created equal: as noted below, poorly designed
or irrelevant graphics add nothing or may actually impede learning.
11.5.3.2 Modality Principle: When There Are Graphics,

Present Words as Speech Rather than Onscreen Text
Working memory receives new information through separate visual and auditory
pathways. Just as traffic moves more efficiently on a four-lane highway, learning
improves when both input pathways are optimally used – i.e. both graphical (visual)
and spoken (verbal) communication. Thus, it would be more effective to show a
picture, chart, or diagram, and use narration to explain the salient teaching points,
rather than using text alone.
However, it is usually counterproductive to narrate on-screen (akin to when a live
lecturer reads their slides verbatim). Such redundancies actually impede learning
because the working memory must reconcile differences between these two input
streams (including, for example, if the learner is reading faster than the narrator).
Exceptions to this rule include when learning in a non-native language, if the learner
has a learning disability, or if the information is particularly complex. Otherwise,
avoid narrating on-screen text.
11.5.3.3 Contiguity Principle: Related Information

Should Be Located Together
It is common to include an explanatory legend at the bottom of a figure. However,

this separation of information consumes cognitive capacity that could be directed
towards elaboration (identifying relationships within the new information and linking
these with prior knowledge). To lower cognitive load, the contiguity principle suggests
locating words adjacent to or embedded within relevant parts of the figure. The same
principle applies to non-graphical elements, such as carefully synchronizing spoken
words with graphics (especially animations), putting the directions for an exercise
on the same page as the exercise itself, or presenting the question and the answer/
feedback together when providing formative feedback on an online test.
11.5.3.4 Coherence Principle: Avoid the Extraneous (Less Is More)
Teachers in both face-to-face and online settings often add cartoons or photos to
presentations for aesthetic value (to ‘spice up’ a lecture), but such decorative graphics
can actually impede learning rather than enhance it. The same applies to extraneous
sounds, interesting but irrelevant stories, unnecessarily detailed descriptions, and
most animations. Interesting but irrelevant details detract from learning.
Why is it wrong to show a photo of my last Caribbean vacation? First, it probably
doesn’t really help to motivate learners. As John Dewey once stated, ‘When things
have to be made more interesting it is because interest itself is wanting. The thing,
the object is no more interesting than it was before’ (Dewey 1913, pp. 11–12). More
importantly, extraneous information taxes cognitive capacities, distracts learners
from more relevant material, and disrupts the elaboration of appropriate mental links.
232 D.A. Cook
The learner might also (subconsciously, in working memory) attempt to make the
extraneous information part of the permanent knowledge structure, or activate and
then incorporate inappropriate prior knowledge. The end result is weak or flawed
knowledge structures. The instructional purpose of words, graphics, and multimedia
is to help learners construct mental representations. Anything extraneous to this
purpose should probably be removed. If it doesn’t facilitate learning, leave it out.
11.5.3.5 Personalization Principle: A Conversational Tone and

Relationship with the Instructor Improves Learning
Of course, the coherence principle doesn’t mean the teacher shouldn’t share personal
information and stories; feeling connected with the instructor improves learning.
A conversational (rather than formal) tone also helps promote learning. In addition,
it helps for the instructor to share appropriate background information about
him or herself.
11.6 Implementation
Developing an online course requires the coordination of content expertise, technical

expertise, financial support, and technological infrastructure. However, successful
implementation requires more than just successful development. Encouraging and
enabling learner participation, ensuring appropriate instructor and technical support,
and course evaluation all require additional planning and resources. A full consider-
ation of these issues is beyond the scope of this text, but a list of ten tips is provided
in Table 11.2.
Table 11.2 Ten tips for successful online learning

Recommended strategies
Perform a needs analysis and specify goals and objectives
Determine technical resources and needs
Evaluate commercial or open-source software and use it if it fully meets local needs
Secure commitment from all participants and identify and address potential barriers to implementation
Develop content in close coordination with website design and encourage active learning (adhere to
fundamental principles of instructional design described in text)
Follow a timeline
Facilitate and plan to encourage use by the learner (make website accessible and user-friendly,
provide time for learning, and motivate learners)
Evaluate learners and course
Pilot the website before full implementation
Plan to monitor online communication and maintain the site by resolving technical problems,
periodically verifying hyperlinks, and regularly updating content
Adapted from Cook and Dupras (2004)
Three points are sufficiently important and frequently forgotten as to warrant

specific mention. First, given the flexibility in time and location, online learning
activities are often simply added to existing schedules. This should be avoided
whenever possible. Not only will time barriers reduce participation rates, but failure
to commit appropriate resources sends a message to learners that the course goals
are unimportant.
Second, health professionals should not underestimate the time required to
develop and maintain an online course (Cook and Dupras 2004). Whenever possible,
it is helpful to borrow or purchase previously-developed content (‘reusable learning
objects’ or entire courses) rather than develop these from scratch (respecting, of
course, copyright and other legal rights).
Third, those involved in the development and delivery of online instruction will
likely require faculty development themselves. Training needs include both technical
skills and instructional design skills. Technical skill development should address
how to use specific devices (e.g. desktops, tablets, smartphones, etc.) and software
applications (e.g. course development applications such as Articulate, learning
management systems such as Blackboard and Moodle, social networking tools such
as Facebook, and other online tools such as YouTube and Google). Even when an
institution has a strong team of technical experts, those engaged in online teaching must
possess at least a basic understanding of the tools they intend to use. Yet perhaps more
important than technical expertise are skills in instructional design – understanding
when to use an online vs. traditional approach, when to use one online modality
over another, and how to design the online experience to effectively promote learning
(as discussed in detail above). Consider implementing an online component to the
faculty development activity, as this facilitates learning not only through didactic
instruction, but also through the experience itself (Paulus et al. 2010). Nothing will
acquaint a teacher with how to facilitate an online learning discussion quite like
engaging in an online discussion as a student!
11.7 Integrating Online and Other Learning Activities
The central decision in the development of online learning is not whether or not
educators should use it – they should. Rather, the germane questions are when to
use it, and how to use it effectively once that choice has been made. Merrill’s (2002)
and Mayer’s (2005) principles address the ‘how’ question. There is less empiric
evidence to answer the ‘when’ question. However, I believe this is primarily a deci-
sion of convenience and need (Cook 2006). As noted above, both face-to-face and
online approaches can be effective, and both have advantages and disadvantages.
The choice to use one or another should consider instructional objectives, logistic
constraints (e.g. time, learner location), and available resources (e.g. technical
support and infrastructure).
However, this is rarely an either-or decision. This chapter might have given
the impression that instructors must choose between online and face-to-face
learning activities. On the contrary, so-called blended learning – combining multiple
234 D.A. Cook
modalities such as face-to-face, computer, video, and simulation – has been historically
used in at least one-fourth of online courses (Cook et al. 2010). Many of the faculty
development initiatives listed in Table 11.1 included both online and face-to-face
elements. In the future, blended learning will become even more common and the
boundaries differentiating online from other modalities will be increasingly blurred.
Soon, we will no longer distinguish online and face-to-face approaches any more
than we currently distinguish lectures that use slides or chalkboards.
In developing blended learning, instructors should carefully consider the selection,
sequence, and relative proportion of online vs. other activities (Hull et al. 2009).
Ideally, activities will target the strengths of each modality. For example, a blended
course on assessment might include a face-to-face baseline test, online tutorials
with core information, online discussion to define and recognize key rating criteria,
online practice with video clips, face-to-face role play with other faculty members,
and a face-to-face final test.
11.8 Evaluation and Research
A detailed exposition on evaluation is beyond the scope of this chapter. More

detailed discussion can be found elsewhere in this book (see Chaps. 17 and 18) and
in other sources (Cook 2010; Cook and Dupras 2004). However, all online courses
should be evaluated for at least two purposes: to identify areas for improvement the
next time the course is offered (formative evaluation), and to determine if course
objectives were achieved (summative evaluation).
Many educators wonder if their online course could be the subject of formal
research. Of course, the answer is yes – but it is important to consider the research
question. The majority of studies (well over 100) have asked ‘Does online learning
work [in comparison with no intervention]?’ The answer is, almost without exception,
‘Yes.’ (Cook et al. 2008b) Numerous studies have also asked, ‘Is online learning
better/worse than traditional instruction?’ Here the answer varies widely, but as
noted above the answer is that, on average, there is no significant difference.
Unfortunately, both of these questions do little to inform the development of future
online learning activities. The key questions proposed above are ‘When should we
use online learning?’ and ‘How can we use it effectively when we do?’ These questions
should constitute the focus of future research in the field. Answering these questions
will require comparison, not with a placebo arm or traditional instruction, but with
alternate online instructional approaches. Useful information will also derive from
rigorously conducted qualitative research (Lingard 2007), and from so-called ‘realist’
approaches (Wong et al. 2012). Of course, there may be room for descriptions of
innovations such as those in Table 11.1. But as online learning for faculty develop-
ment becomes less of a novelty, such reports will less often meet the bar required for
peer-reviewed publication. Those contemplating formal research in online learning
are encouraged to consult previously published research agendas (Cook 2005;
Cook et al. 2010) and experts in the field as they plan their study.
11.9 Conclusion
The future looks promising for online faculty development. Although the studies
reporting such experiences are few, and not all were successful, the number of successes
appears to be improving in recent years. Online tutorials, collaborative communities,
simulations, and even games could help to overcome existing barriers and thereby
add substantial value to faculty development initiatives. Those charged with devel-
oping such initiatives should not feel obliged to use online learning if it does not
address a perceived need. Yet when needs do exist, online learning can resolve many
barriers, particularly those of distance, scheduling, and self-pacing. In many cases,
the ideal approach will blend activities from both online and other learning approaches
to capitalize on the strengths of each. Blurred boundaries between online and
‘traditional’ approaches will increasingly be the norm.
Much remains to be learned about how to effectively implement online faculty
development activities. For the moment, educators can rely on evidence from
other fields. Going forward, it would be highly desirable for educators to collect
evidence to inform when to use online learning for faculty development and how
to use it effectively.
11.10 Key Messages
• Online learning is neither better nor worse than face-to-face instruction. Health
professionals should use the approach most appropriate to local needs.
• The success of online faculty development initiatives varies widely. Keys to
success include focusing on a perceived need, careful planning, facilitating clear
communication, and developing a sense of community.
• Evidence from other fields can inform effective instructional design.
• Blending online and face-to-face instruction is increasingly common, and boundaries
between these two options are increasingly blurred. Blended learning, properly
done, capitalizes on the strengths of both approaches and is often more effective
than either approach alone.
Appendix A: Glossary of Terms
Computer Tutorials
The online equivalent of a lecture; typically comprised of varying combinations of

multimedia (see below). Online tutorials might also include activities to encourage
engagement and deep learning such as computer simulations, interactive games and
models, self-assessment tools, and hyperlinks to full-text journal articles or other
online resources.
236 D.A. Cook
Online Discussion Boards
Discussion boards facilitate online group activities by providing a place to post

messages and documents as part of an ongoing discussion. The group could alterna-
tively do this using email, of course, but the key with a discussion board is that
conversations are threaded; meaning that a response message (post) is linked with
the post that prompted the response. It winds up looking like the branches of a
tree – the first question is the main trunk, each response is a branch from that trunk,
subsequent posts are branches from that branch, and so forth. Nearly always, teachers
monitor the discussion board to observe the direction and depth of the discussion,
keep people on track, and mediate the occasional online ‘disagreement.’
Online Simulations
Online simulations are case-based computer programs that simulate real-life clinical
scenarios. In clinical education, the most common computer simulations are virtual
patients (Cook and Triola 2009). Simulations for faculty development might include
virtual students (for practicing assessment or teaching), virtual research studies, or
virtual leadership case scenarios.
Online Games
Online educational games are ‘voluntary [online] activit[ies] structured by rules, with
a defined outcome (winning, losing) or other quantifiable feedback (e.g. points) that
facilitates reliable comparisons of in-player performances’ (Thai et al. 2009, p. 11).
Games typically have explicit goals and a compelling storyline (Tobias et al. 2011), and
thus have the potential to engage learners and encourage their continued practice
with the objective of improved knowledge and skill acquisition and application.
However, the benefits of online educational games in medical education are still
largely hypothetical, with only a few descriptions and even fewer comparative studies
(Graafland et al. 2012).
Learning Management Systems
Learning Management Systems (LMS) are web-based software packages that

facilitate the management and delivery of learning content and resources to learners.
They provide important features such as secure log on, administration and tracking
of tests and surveys, submission of assignments, monitoring of course participation,
and content reuse and sharing across modules. Many also offer tools to facilitate
learning such as discussion boards, wikis, and blogs. Examples include Blackboard,
Sakai, and Moodle (an open-source [free] LMS).
Multimedia
Multimedia refers to the use of text, narration, other sounds, videos (with or without
sound), slideshows, images, animations, and more. Appropriate use of multimedia
can dramatically enhance learning over text alone. However, inappropriate use of
multimedia can actually detract from learning.
Web 2.0
Web 2.0 represents a collection of web-based technologies that enable and

encourage a collaborative, user-focused approach to design, maintain, and evaluate
material. Blogs, wikis, social networks, and virtual worlds (discussed below) are
Web 2.0 technologies. The content of these sites is determined by the collective efforts
of its users and is in a constant state of change. Most Web 2.0 technologies were
initially developed for entertainment and social functions (YouTube, Wikipedia,
Facebook), but educators have begun to explore their potential for interactive
instruction and assessment.
Social Media: Wikis, Blogs, Whiteboards, Instant Messaging,

Social Networks and Virtual Worlds
Social media software refers to a variety of tools that allow individuals to easily
produce content and/or communicate with others through online virtual networks.
In education, these methods can promote and facilitate online collaboration for
groups separated by distance and, except for whiteboards, time. In addition to
discussion boards (above), options include:
• Wikis: Web sites or documents that groups create together. Everyone can edit the
same document, making it a true group effort. Wikis can be created synchro-
nously (everyone working at the same time) or asynchronously (individuals each
contribute at a time convenient for them).
• Blogs: dated message postings organized chronologically (in contrast to discussion
boards, which are threaded). Blogs are often individual (similar to a diary) but they
can easily be used for group activities. Group blogs are usually asynchronous.
• Whiteboards: essentially the same as whiteboards in face-to-face classrooms –
namely, participants can write or draw whatever they want. As participants view
online, the image of the whiteboard is constantly updated. Whiteboards are, of
necessity, synchronous – everyone must be participating ‘live.’
238 D.A. Cook
• Instant messaging: real-time text communication between one or more individuals.

The conversation is usually archived. Many online tools, educational and otherwise,
offer instant messaging.
• Online social networks: an online service or site designed to promote communi-
cation and networking. Facebook is currently the leading example, and incorporates
elements of blog and instant messaging along with media sharing (photos, audio,
and video clips).
• Virtual Worlds: simulated environments in which users ‘live’ and interact via
graphical representations of a real person called avatars. Some educators have
used virtual worlds such as Second Life for presenting educational materials.
Reusable Learning Objects
Digital reusable learning objects are collections of instructional materials – text and
multimedia – designed to meet a specific instructional objective, with little depen-
dence on the surrounding educational context. This permits them to be repurposed
for multiple learning applications. For example, a reusable learning object on how
to perform a t-test could supplement a first-year medical school epidemiology
course, be made available to residents as a resource for their scholarly projects, and
comprise a core part of an online faculty development course.
Authoring Software: Technology for Rapid Multimedia

Development
In recent years, a number of user-friendly software applications have been developed

to assist non-programmers to easily develop professional-appearing online
learning courses. Such ‘authoring software’ assembles digital media files into
polished, interactive presentations, and makes online course development accessible
to do-it-yourself teachers.
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Part IV
Practical Applications
Chapter 12
Faculty Development to Promote
Role-Modeling and Reflective Practice
Karen V. Mann
12.1 Introduction
Role-modeling and reflective practice are increasingly recognized as important

elements in teaching and learning in the health professions. As our understanding of
these areas of practice grows, we appreciate that faculty members need preparation
and support to use them effectively. In this chapter, role-modeling and reflection
will be addressed, and the underpinning literature and theory will be summarized.
Each will be addressed individually; however, as we explore these two important
areas, their integral relationship to each other will become apparent. Implications
for faculty development practice will conclude the chapter.
Reflection and role-modeling are important in all faculty roles: however, this
chapter will focus on the teaching role of faculty members as the vast majority of
literature about faculty development for these topics addresses their effective use in
teaching and learning. The principles, however, may be applied in the context of
other faculty roles and practices.
12.1.1 Why Is Faculty Development for Role-Modeling

and Reflective Practice Important?
Role-modeling remains an extremely influential method of teaching and learning.

Yet, Kenny et al. (2003) noted that ‘conceptually, role-modeling is a ‘black box’ for
K.V. Mann, BN, M.Sc., Ph.D. (*)

Division of Medical Education, Faculty of Medicine, Dalhousie University,
Halifax, NS, Canada

246 K.V. Mann
both teachers and learners. Educators lack an adequate understanding of the process
through which learners respond to models and of how practitioners of varying
quality and commitment exert their influence’ (p. 1205).
Traditionally, role-modeling has been accepted as a naturally occurring teaching
process, one that ‘happens’ spontaneously rather than being planned. Learners can
learn implicitly from role models through observations of their behavior and its
consequences (Bandura 1986); however, learners also have an active role in learning
from role models, ultimately creating for themselves a configuration of attitudes,
behaviors and orientations, gleaned from the multiple and varied examples they
have encountered. Faculty members are often unaware that role-modeling can be a
deliberate activity and that we are always role-modeling even when not intending to
do so (Hafferty and Franks 1994). The concept of role-modeling is important, as
professionals are not acting a role; they are embodying it (Bleakley et al. 2011).
Faculty development for reflection and reflective practice is important at more than
one level. First, it is important for faculty to be able to help learners to reflect, to
enhance their learning, and to prepare for the self-regulation required in practice.
Reflection and self-awareness are critical to developing professional identity.
Second, learning about and experiencing reflection is important for faculty members
themselves, as it allows them to explore their teaching practices, understand their
underlying values, and learn from their practice. This can in turn effect change in
teaching practice and also in role-modeling.
12.2 Role-Modeling
12.2.1 Why Is Role-Modeling Important?
Role-modeling is identified by faculty members as integral to their teaching and cited

by students as a major influence on their learning all aspects of their professional role.
Indeed, it is suggested that role models are central to the moral enculturation of devel-
oping professionals who take on the attitudes, values and attributes of their chosen
profession (Hafferty and Franks 1994). The influence of role models is generally
viewed to be at the individual level, in helping the learner to develop desired skills and
attributes. However, role-modeling is also important at the collective level, as models
play an important role in helping learners enter the community of practice of their pro-
fession. Learners gradually become more involved in the community while developing
their professional identity and competence (Cooke et al. 2010). Activities, roles and
relationships are modeled by more senior peers, other health professionals and other
learners. The literature also supports that professional caring and patient-centeredness
can be modeled effectively in the learner-teacher relationship, and that such modeling
can have long-lasting effects (Cavanaugh 2002; Haidet and Stein 2006). Novice teach-
ers report that role models were important in their non-formal learning at work and
their professional development (Cook 2009). Lastly, Weissmann et al. (2006) suggest
that role models may counter the negative effects of the hidden curriculum.
12 Faculty Development to Promote Role-Modeling and Reflective Practice 247
12.2.2 Conceptual Approaches to Understanding

Role-Modeling
Role-modeling is a fundamental process, and our understanding of it draws from

several fields. The goal of this section is to summarize some relevant understandings
of role-modeling to provide a foundation for designing effective faculty development
programs and activities.
The idea of ‘role’ originates in sociology and the roles that individuals perform
in their everyday lives in society. Generally, people have and manage multiple roles
in the various aspects of their lives. Roles carry with them ways of behaving, rights
and obligations. The concept of role-modeling addresses how roles are enacted, and
how others learn to enact those roles through observation. In contemporary medical
education, the concept has been operationalized by the Royal College of Physicians
and Surgeons of Canada as a group of roles the individual physician enacts as
part of the overall role of ‘physician’ (Royal College of Physicians and Surgeons of
Canada 2012).
Role-modeling is also an important concept in psychology and learning. Bandura
(1986) described the powerful learning that occurs from observing the actions of
others and the consequences of their behavior. Learning in this way is referred to as
‘observational’ or ‘vicarious’. Examples of this abound in our lives.
Role-modeling also contributes to building self-efficacy, or people’s expecta-
tions that they can successfully execute a particular task or set of tasks in a domain
(Bandura 1997). Bandura asserts that self-efficacy can be learned through observing
the performance of others.
Lastly, social anthropology has evolved the theory of Communities of Practice
to broaden our understanding of apprenticeship (Lave and Wenger 1991). In this
conception, learners develop not only skills and knowledge; they also develop their
professional identity. Learning is a process of joining a community and learning
occurs by participating in the authentic activities of the community. Along their
journey toward full membership in the community, learners participate through doing,
but also through watching and listening. They learn from talk, through listening to
community members talk about their practice and their world; they also learn to
talk, as this is key to their participation in the community (Lave and Wenger 1991).
These varying conceptual perspectives illuminate the complexity of learning
from role models. Certain assumptions underpin the belief that role-modeling is an
effective means of learning. First, especially regarding professional behavior and
development of professional identity, we may assume that the values of the teacher
and the learner are similar. However, historical events, culture and societal influ-
ences result in changes in societal values; these are sometimes most evident across
generations. Second, we may assume that those observing will understand the intent
of the role model’s behavior. However, observing a role model cannot be equated
with understanding exactly what the model intended. To ensure understanding, the
model must be capable of and willing to reflect with learners to clarify what was
intended, especially since not all observed situations have the desired outcome.
248 K.V. Mann
Particularly where values and professional behavior are modeled, reflecting openly
allows the model to make explicit the values and standards guiding his/her behavior.
Learners, in turn, can consider these against their own developing values (Kenny
et al. 2003). Importantly, modeling does not require one way of doing things; it
requires adaptability and recognition that what needs to be modeled is the approach
that has the most explanatory value in the current context (Bleakley et al. 2011).
Cruess et al. (2008) classified the characteristics of effective role models, including
clinical competence, teaching skills and personal qualities. Others have identified
similar characteristics (Jochemson-van der Leeuw et al. 2013; Wright and Carrese 2002).
Cruess et al. (2008) propose an iterative process of learning from role-modeling
which involves: active observation of a role model; making the unconscious
conscious; reflection and abstraction; translating insights into principles and actions;
and generalization of learning and behavior change. This model draws on the cycle
of experiential learning described by Kolb (1984); it also explicitly recognizes the
process of unconscious incorporation of values by observers. Eraut (2004) has also
described ‘learning without being aware that we have learned’ as part of the informal
and non-formal learning that occurs at work. Bleakley et al. (2011) argue that our
traditional approaches to role-modeling are no longer adequate; for the transformation
of medical education to occur, we must move from role-modeling based on charisma
to role-modeling based on capability.
Through the many experiences encountered throughout their education, learners
construct a professional identity. Identity is shaped by the interactions with the
entire culture of medical education, both specifically and generally. Through modeling,
members of the practice community enact the community’s values. This includes not
only the particular aspects of the physician’s knowledge and skills, but also the quality
of team interactions, teaching, coaching and assessment. In Bleakley et al.’s (2011)
view, moral commitment to the highest levels of patient care and commitment to
high standards of role-modeling within the community are required. For faculty, this
also involves an understanding of the cultural history of our actions and the hidden
curriculum – how it shapes professional identity for both teachers and learners.
The research literature consistently supports role-modeling as an integral form of
learning, highlighting the potential benefits of faculty development to help faculty
to be more mindful and deliberate in their teaching through modeling. Three examples
illustrate this. Riley and Kumar (2012) asked doctors and medical students to first
define and then indicate how they had learned professionalism and how they thought
it best taught. Role models were the second most often reported source of teaching
and learning about professionalism, second only to experience; learning from role
models was not always through positive examples. Goldie et al. (2007) identified
role models as important in the socialization process, allowing medical students to
enter the community of practice of the medical profession.
Faculty members and residents in surgery reflected on how they had learned
professionalism (Park et al. 2010). Both role-modeling and reflection were included.
Learners in surgery described that effective learning from role models involved
three elements of observation, reflection and reinforcement. They noted the importance
of being able to observe faculty members, to reflect on what they had seen or experienced
followed by an opportunity to practice these behaviors, and most importantly, to

have them reinforced by faculty. Understanding role-modeling as a process rather
than an event could help faculty members to maximize its learning potential.
12.3 Reflection and Reflective Practice
This section of the chapter focuses on reflection and reflective practice. The goal in
so doing is to highlight its importance, illuminate our understanding of its conceptual
underpinnings, and identify important issues for faculty development.
12.3.1 Why Are Reflection and Reflective Practice Important?
Reflection and reflective practice are deemed by many to be integral to professional

practice. Epstein and Hundert (2002) define competence as ‘the habitual and judicious
use of communication, knowledge, technical skills, clinical reasoning, emotions, values,
and reflection in daily practice for the benefit of the individual and community being
served’ (p. 226). In their definition, reflection becomes a ‘habit of mind’.
The literature regarding the role of reflection in teaching, learning and practice has
been developed in several fields (Boud et al. 1985; Moon 2004; Schön 1983, 1987).
Reflection has been proposed as a critical means of learning from experience, both
in the moment, following an event, and in anticipation of events. Reflection has
been associated with enhanced learning, deep learning, making meaning of events,
and understanding one’s practice in a larger context (Mann et al. 2009). It has also
been associated with improved diagnostic accuracy in complex problems (Mamede
et al. 2008). Reflection is intimately related to self-assessment, as effective self-
assessment and self-regulation rely on the capability to reflect on one’s practice.
Lastly, reflection plays an important role in facilitating the acceptance of feedback
and its incorporation into practice (Sargeant et al. 2009).
Reflection on both successes and failures can be used by teachers to improve
their practice (Pinsky and Irby 1997; Pinsky et al. 1998). Reflection is also a means of
uncovering one’s expertise and building upon it by exploring beneath the everyday
activities and experience of practice, thus learning to understand its underlying
values and foundations. Although the literature suggests that some individuals may
inherently be more oriented toward reflection than others, there is evidence that
these capabilities can be learned and that they can impact practice (Mann et al. 2009).
Reflection can be both an individual and a collective activity. Reflection at a group,
or collective, level allows for sharing of norms and reflecting on values; it can also
lead to transformation at an institutional level (Frankford et al. 2000).
Preparing faculty for reflection and reflective practice in their teaching addresses
three goals. The first goal is to assist faculty members to develop skills to reflect on
their own teaching experience and practice, both to identify future goals, and to
250 K.V. Mann
understand and uncover the expertise, attitudes and values which underlie it. The second
goal is to enable faculty to support and guide learners to acquire these capabilities,
to prepare learners effectively for a lifetime of maintaining and improving profes-
sional competence. The third goal (related to the first) may be to enable the faculty
members to situate their teaching as a social process, in the context of the society
within which it occurs.
Bleakley et al. (2011), writing in medical education, have described the need for
medical educators to experience and understand the dynamic process of which they
are a part. They suggest that reflection in and on practice is essential to teachers in
developing themselves and becoming involved in the scholarship of teaching.
12.3.2 Conceptual Approaches to Understanding Reflection
The definition of reflection has been complicated by its origin in different

fields of study. In 1995, Brookfield, in his book, Becoming a Critically Reflective
Teacher, suggested:
Reflective practice has its roots in the Enlightenment idea that we can stand outside of
ourselves and come to a clearer understanding of what we do and who we are, by freeing
ourselves of distorted ways of reasoning and acting (Brookfield 1995, pp. 214–215).
Two assumptions are present in this definition: the first is that reflective practitioners
can examine their own practice to understand it better, and uncover the values,
assumptions and experience that drive it, and second, that a plurality of models of
good teaching exist. Brookfield cautioned that reflection had become a catch-all
term, overused and in danger of becoming ritualized and trivialized. Boud and
Walker (1998) also identified the challenges of teaching reflection in a professional
context, and identified ritualization as a potential risk.
Models of reflection have their origin in education (Boud et al. 1985; Dewey
1933; Schön 1983) and more recently have been linked to cognition and cognitive
psychology (Moon 2004). Models which have been most influential share certain
characteristics which include: an iterative dimension within which there is a return
to experience to critically analyze and learn from it; and a vertical dimension incor-
porating different levels and depths of reflection, from a superficial description of
events to a more profound and deeper analysis (Mann et al. 2009).
Schön (1987) described reflection as a means by which teachers might under-
stand their relation to their learners, thus potentially altering the traditional power
relations in apprenticeship. By helping the learner to acquire different approaches to
reflection, the teacher can facilitate the learner becoming more self-directed, more able
to account for the work they are doing, and therefore more equal in the relationship.
However, Bleakley et al. (2011) cautioned that reflection is really ‘appreciation’
of a situation. Critical reflexivity, which can bring about change in our educational
practice and systems, involves looking at what values inform our practice. These
authors further underlined that developing skills of reflection and reflexivity is a
learning process.
Schön’s (1987) model of reflection is probably the best known in professional

education. This model includes an iterative process of reflection-on-action after an
event and reflection-in-action during an event or experience. Although predominantly
associated with reflection ‘on’ events, Schön also emphasized reflection ‘in the
moment’, a moment-to-moment awareness of our actions in the context and of the
responses we make to those conditions. This aspect of reflection, or self-monitoring,
has been further explored by several authors (Moulton et al. 2007).
Further, although his work was mainly associated with individual reflection,
Schön (1987) also described ‘reflection in community’, or collective reflection, where
professionals can learn together through sharing good practices and offering peer
support in democratic structures. Collective reflection also offers the opportunity for
learning vicariously, improving group members’ self-efficacy and sharing and
constructing group norms and values.
An essential aspect of teaching practice is ‘phronesis’ or practical knowing.
Practical knowing and ‘the way we do things’, have been described as contributing
to our personal ‘theory in action’ which underlies our actions (Argyris and Schön
1974). Reflection and critical reflexivity allow us to uncover what those theories are.
Sfard (1998) reminds us that learning theories are not value free, and that under-
standing our values and what drives our practice are essential to bringing about
change in our learners, ourselves and our institutions. Sfard (1998) identified two
predominant metaphors for learning which underlie our practical knowledge: acqui-
sition and participation. These two models are particularly relevant to faculty devel-
opers. Our programs must balance acquisition – or the building up of skills and
knowledge which are the property of the individual alone – with participation,
where the faculty member participates in the collective work of building a shared
construction of knowledge.
12.4 Faculty Development for Role-Modeling

and Reflective Practice
The literature describing approaches to faculty development can be clustered into

three areas. These are: approaches to enhance humanistic teaching through personal
and professional growth; approaches to improve role modeling; and approaches to
enhance reflection. This section will address each in turn.
12.4.1 Approaches to Enhance Humanistic Teaching
There are several examples of faculty development to enable faculty to better teach
attributes of humanistic care. Role-modeling is but one; however, it is a critical
aspect of that teaching (Haidet et al. 2008).
252 K.V. Mann
Programs that address role-modeling and reflection share certain characteristics:

they are longitudinal, extending over a period of time; they involve a stable group of
faculty so that an atmosphere of safety and trust may be built; and they alternate or
combine sessions on particular aspects of humanistic care with those that focus on
individual and shared reflection. These approaches have been replicated across
several schools, and have been evaluated carefully and regarded as successful.
Enhancing the human dimensions of care. Branch et al. (2009) describe such a
program which may serve as an illustrative example. Although drawn from medical
education, its structure and outcomes seem applicable across the health professions.
This longitudinal faculty development program was offered in five US medical
schools and involved promising teachers chosen from volunteers. The facilitators
together developed and implemented a faculty development curriculum to enhance
humanistic teaching. The program content and structure reflected both the literature
and an analysis of teaching encounters of highly regarded role models.
The program occurred over 18 months to support group process that would foster
reflection; it included an experiential learning component to allow for practice of
new skills relevant to role-modeling and alternating sessions for reflecting on values
and attitudes. Reflective activities included narrative writing, Balint groups, and
opportunities to discuss renewal and meaning. Participants discussed critical incidents,
appreciative narrative enquiries and personal goals.
A variety of outcomes and measures were reported. Branch et al. (2009) devel-
oped and utilized a previously validated 10-item questionnaire, the Humanistic
Teaching Practice Effectiveness Questionnaire, which included questions about lis-
tening skills, personal inspiration, stimulating reflection and illustrating humanistic
care. They found that, when rated by students, participants outperformed a group of
peer controls who had not participated in the program, scoring significantly higher
on all ten items (p < .05). Importantly, the authors found a difference of 8–13 %,
which they considered sufficiently robust to make the results of practical signifi-
cance as well.
In programs using reflective activities such as those described above, reflections
have been triggered by individual experience and group events, and have taken the
form of appreciative inquiry (e.g. Quaintance et al. 2010) Appreciative inquiry
chooses not to focus on things that are not going well and need improvement;
instead, it focuses on successful processes and outcomes, and analyzes them critically
with a view to creating more of them (Kowalski 2008).
Learning about professionalism. Quaintance et al. (2010) described a method for
teaching professionalism that helped faculty to consider not only what they teach,
but how they teach, through introducing such constructs as situated learning, explicit
role-modeling and appreciative inquiry. In their approach, students interviewed fac-
ulty members about their experiences of professionalism, following which the
students reflected upon and then wrote about the teachers’ stories. Rich and gener-
ally positive stories resulted that conveyed the major principles of professional-
ism, including humanism, accountability, altruism and excellence; similarly, the
students’ reflections demonstrated awareness of the same principles. The authors
concluded that narrative reflective storytelling could both assist faculty to reflect on
their experience and deepen students’ understanding of professionalism.
Reflective learning for junior faculty. Faculty development of this nature may also
be effective when offered to junior faculty. Higgins et al. (2011) demonstrated benefits
from such a program and described a phased model of development over 4 years of a
group’s work. The three phases included: becoming caring, humanistic doctors;
becoming humanistic role models while teaching; and becoming empathetic leaders.
Group norms also developed, moving through empathy, compassion, fairness
and courage. Courage related to the participants’ ability to articulate their values
and to live by them in their professional work. The authors suggest that group sup-
port, cohesion and validation encouraged adoption of common values among the
participants that informed their professional development over the 4 years, and sub-
sequently influenced them as their careers progressed.
The literature on excellence in clinical teaching demonstrates the relationship of
role-modeling and reflection. Weissmann et al. (2006) found that awareness of one-
self as a role model is an attribute of excellent clinical teachers. These authors
described a wide range of behaviors modeled by faculty members, which they clas-
sified as nonverbal behaviors; demonstrations of respect; building a personal con-
nection; eliciting and addressing patients’ emotional responses to illness; and
faculty self-awareness. Teachers reported reflecting on their own behavior as well as
reflecting with learners. Self-awareness as a role model was underpinned by reflec-
tion, which allowed faculty members to act more deliberately to make changes to
the clinical environment to facilitate compassionate care. The authors suggest that
role models may counter the effects of the hidden curriculum.
It appears that faculty development for role-modeling and reflection positively
impacts faculty behavior in these areas. Although several reports are iterations of
the same program and principles, it is notable that positive outcomes were seen at
all five sites, suggesting a broader applicability. The significance of these results is
that benefits may accrue not only to learners, but to faculty members who experi-
ence professional development and renewal.
Two studies described reflection in clinical teaching in medicine (Pinsky and Irby
1997; Pinsky et al. 1998). Distinguished clinical teachers were surveyed regarding the
role of reflecting on both instructional success and failure in their professional devel-
opment as teachers. They identified using both reflection-in-action and reflection-on-
action. However, they most frequently described ‘anticipatory reflection’ or learning
from and incorporating previous experience into teaching. Reflecting on failures was
seen as equally important to reflecting on successes. Both studies support the role of
reflection in the ongoing professional development of teachers.
12.4.2 Approaches to Support and Improve Role-Modeling
Cruess et al. (2008) describe strategies to improve role-modeling at both the indi-
vidual and the institutional level. Strategies to improve individual performance
254 K.V. Mann
include: awareness of being a role model; making and protecting time to teach;
awareness of reflection; the need to make the implicit explicit; and participating in
staff/faculty development.
Kenny et al. (2003) recommended faculty development which clarified the mean-
ing of roles and role-modeling, discussed standards, assisted faculty to reflect, and
provided safe spaces for reflection and debriefing.
Steinert et al. (2005) developed a systematic, integrated faculty development
program to support the teaching and evaluation of professionalism. The pro-
gram’s main messages were making the implicit explicit and the importance of
role-modeling. Program evaluation, using participants’ intended changes to their
teaching, indicated that role-modeling would be the teaching strategy of choice
for many participants.
Boerebach et al. (2012) studied the relationship between teaching performance
and residents’ perceptions of a teacher as a role model. Of the many factors which
might influence how the physician was viewed, the largest predictor was the faculty
member’s teaching performance. There were some specific relationships between
particular teaching skills and effects on role-modeling. The authors suggested that
one effective approach in improving role-modeling was to invest effort in improving
faculty’s teaching performance.
Importantly, improving role-modeling cannot be accomplished at the individ-
ual level alone. The institution plays a key role. Efforts have been made to under-
stand the learning environment on the premise that the context of student learning
interacts with their experience and affects not only the student’s development as a
professional but also the ways in which faculty members can and do act. Haidet
et al. (2005) report the development of the ‘C3’, an instrument to characterize the
patient-centeredness of clinical learning environments. At the institutional level,
Cruess et al. (2008) suggest that faculty work together to improve the institutional
culture, particularly to affect the structure so that teaching is valued and time is
available to teach. The goal is to create an environment which supports positive
role-modeling.
Faculty development efforts can support initiatives such as those described and
can assist faculty to reflect on the information to improve both their own individual
practice and the larger institutional environment.
12.4.3 Approaches to Improve Reflection
Faculty development approaches to improve reflection have been developed in

two broad directions. In the first, the goal is to improve faculty’s ability to use
reflection with their learners. In the second, the focus is on enhancing faculty’s
ability to develop reflective practice in their own work, arguing that by learning
and using these approaches, faculty members will be more able to deliberately
modify their own approaches and to facilitate learners’ use of the same reflec-
tive activities.
12.4.3.1 Helping Faculty to Use Reflection with Learners
Defining and assessing reflection in learners. Acquisition of reflective skills has

become increasingly emphasized in nursing education. Yet little has been written
about preparing teachers to promote development of those skills in learners and
novice teachers report feeling unprepared (Braine 2009). Dekker-Groen et al. (2011)
used a Delphi process to define reflection and to identify a framework of required
teaching competencies. The resulting framework identified six domains, the most
important of which were coaching students and stimulating student thinking.
Aronson et al. (2009) recognized that a wide variety of activities may be labeled
as ‘reflection’; further, although the literature on reflection identifies analytic,
evidence-based and temporal or behavioral change components, the authors found
many reflective activities in their faculty to be unstructured and poorly evaluated. In
response, they designed a 3 h faculty development session to: define reflection;
describe the five applications of reflection in medical education; evaluate written
reflections for reflective ability; and discuss a rubric for the evaluation of reflective
ability. Despite a small number of participants, the authors found evidence that a
single session resulted in educators being able to design exercises to develop reflec-
tive ability in their learners. These authors subsequently developed resources which
are available to assist both teaching and evaluating reflection (Aronson et al. 2012;
O’Sullivan et al. 2010).
Wald et al. (2012) have also developed and evaluated a rubric entitled the
Reflection Evaluation for Learners’ Enhanced Competencies Tool (REFLECT) to
both assess learners’ reflection, but also to assist faculty in providing feedback that
will promote reflective capacity.
Using Reflection to Foster the Acceptance of Feedback. Another important role
of reflection is as a vehicle allowing exploration of feedback and enhancing the abil-
ity to accept and incorporate feedback to improve practice. This is important both
for faculty members’ practice and for their ability to help learners use feedback
effectively. A recent model to assist learners to utilize reflection is the ECO model
(Sargeant et al. 2011). This model outlines three steps to help the facilitator improve
the learner’s ability to accept and use feedback: emotion, content and outcome. By
processing and acknowledging the emotion, the learner/recipient can be assisted to
reflect on the feedback and to make a plan for how it might be used. This model can
be useful for both faculty and students. Faculty can use such an approach to help
learners accept feedback and incorporate it. Understanding this model may also
assist faculty to be better able to reflect on feedback they receive.
Modeling Reflection and Reflective Practice. Weissmann et al. (2006) studied
excellent clinical teachers from four US medical schools. These teachers taught
mainly through modeling a variety of humanistic behaviors in their interactions
with students and patients, and by modeling self-awareness and reflection. The
faculty members identified self-reflection as the primary method by which they
developed and refined their teaching strategies; they also noted the importance of
modeling reflection for learners.
256 K.V. Mann
12.4.3.2 Becoming a More Critically Reflective Teacher
A rich literature exists in general education about faculty development to promote

reflection, which helps to situate faculty development in the health professions
within a larger context. This literature focuses on assisting faculty members to
develop as reflective practitioners, believing this to be fundamental to any sus-
tained change in teaching practice, and that focusing only on skills or methods is
insufficient.
Amundsen and Wilson (2012) published a conceptual review of the educational
development literature in higher education. There were 29 papers identified where
the goal was to engage faculty in a process of reflection, both individual and col-
laborative, with the purpose of changing or clarifying their conceptions of teaching
and learning and linking this to change in their teaching practices.
Faculty participants in these initiatives engaged in reflection and discussion in a
variety of ways, sometimes prompted by reflecting on their own practices in relation-
ship to a personal goal, to a colleague’s practice, to literature, or to newly developed
knowledge. The review raised the question of individual improvement of teaching
practice versus engaging teachers in the improvement of teaching as a socially situ-
ated process. Initiatives promoting reflection are among those that focus not only on
the individual’s teaching but on changing teaching at a more transformative level.
An example may be informative. Hubball et al. (2005) explored how faculty
members used reflection and incorporated it into their ‘real life’ work. This study,
which involved faculty from several higher education disciplines, both mirrors
reported experience in health professions education and exemplifies the out-
comes that we wish to achieve: improved teaching and learning. The authors
defined reflection as ‘thoughtful consideration and questioning of what we do,
what works and what doesn’t work, and what premises and rationales underlie
our own teaching and that of others’ (Hubball et al. 2005, p. 60). Expected out-
comes included that faculty members would develop a critically reflective teach-
ing practice; think critically about curriculum and pedagogical issues; and
articulate their own values about teaching and learning. Over 8 months, partici-
pants engaged in activities such as journal reflections on readings, developing a
personal teaching philosophy, and developing a teaching dossier. The authors
used an instrument, the Teaching Perspectives Inventory (Collins and Pratt 2011;
Pratt and Collins 2013), to help participants to look more deeply at the underly-
ing values and assumptions which guided their teaching practice. The Teaching
Perspectives Inventory (TPI) identifies five perspectives or lenses through which
educators view their work. Each perspective brings a blend of beliefs, intentions
and actions, framing views of teaching, learners, learning, content and context.
The authors found that the TPI stimulated greater reflection on teaching prac-
tices, which in turn contributed to changes in participants’ (self-reported) TPI
scores. The TPI emphasizes the plurality of ways in which good teaching can
occur. This is particularly relevant when we think of role-modeling; many differ-
ent approaches to a problem may be modeled.
Barriers to reflection were also identified and included inadequate time for reflection
and unclear expectations and goals for reflection activities. Participants identified the
importance of ‘habitualizing’ reflection and the lack of cultural norms supporting reflec-
tion in academe. The messages of the wider literature resonate strongly with our experi-
ences as teachers and learners in the health professions.
Studies in general education provide many parallels to the studies reported ear-
lier, in which teachers in medicine and the health professions have engaged in criti-
cal reflection on their practice. Readers may find it helpful to consult the summary
of all studies presented in Table 12.1.
12.5 Guidelines for Faculty Development Practice
Promoting faculty development for role-modeling and reflection is a rich area for
faculty development. Taken together, the conceptual underpinnings for each offer us
several implications for practice. These implications, drawn from the literature, are
presented below as principles which may guide the design of faculty development
initiatives.
1. Raising awareness of the impact of role-modeling can improve faculty
members’ awareness of themselves as models. Encourage faculty members
to discuss and share experiences with role-modeling, both as a learner and as a
teacher. This can be accomplished informally, but also in seminars or in interac-
tive discussions. Faculty can benefit from reflecting on how they themselves
have learned from role models, both in the past and currently. Further, helping
faculty members to realize that they are modeling ways of being even when
they are unaware of it can help them to be more deliberate about the behaviors
they wish to model.
2. Attention to improving teaching performance can lead to changes in role-
modeling behavior. Teaching performance is closely related to role-modeling
and to how teachers are viewed as role models. This is especially true of teach-
ers in the health professions where teaching is inseparable from communication
and interactions with patients and other team members. Concentrating on
improving teaching, and awareness of one’s own teaching, can lead to improve-
ments in role-modeling as well.
3. The institution’s role is critically important in creating an environment in
which the best attributes of professional practice can be modeled.
Encourage faculty members to explore the setting and climate of their work-
place, and to reflect on how it supports or hinders their ability to model the
kind of practice they would like. This may also include exploration of the
hidden curriculum and how they may model some of its values unknowingly.
Learners and staff can also contribute to this discussion and to developing
shared approaches.
4. Short, one-time interventions are unlikely to provide the opportunity for
lasting change. Like the learners they work with, faculty members need time
and support to make changes and grow professionally. The most successful
approaches involve stable groups who meet regularly to discuss and share
258
Table 12.1 A summary of selected reports of interventions to improve reflection and role-modeling in faculty members
Authors Year Intervention/Program Length of program Strategy Outcomes
Hubball, Collins & Pratt 2005 Certificate Program 8 months Individual learning plans were Depth of reflection on teaching
on Teaching developed consisting of various increased following the
and Learning in reflective activities based on a program
Higher Education prior learning assessment
Aronson, Chittenden & 2009 Faculty Development 3h Small group seminar consisting of a Faculty members developed a
O’Sullivan Workshop in presentation, an evaluation of better understanding of
Teaching reflective ability of students and reflection as demonstrated by
Reflection residents, a critique of current their ability to create
reflective exercises, and a appropriate exercises focused
discussion around educational on the development of
approaches to promote critical reflective abilities of learners
reflection
Branch, Frankel, Gracey, 2009 Longitudinal Faculty 18 months Combination of experiential learning Positive impact was demonstrated
Haidet, Weissmann, Development of skills and reflective learning to on humanistic teaching skills
Cantey, Mitchell & Program explore attitudes and values and personal and professional
Inui attributes of participants in the
program
Quaintance, Arnold & 2010 Teaching and Dependent on Narrative storytelling and reflection Students were able to identify and
Thompson Modeling of participation through writing internalize concepts of
Professionalism professionalism
Higgins, Bernstein, 2011 Longitudinal Faculty 18 months Combination of small group Participants developed as teachers
Manning, Schneider, Development facilitated experiential learning of and leaders and increased
Kho, Brownfield & skills and role modeling with awareness through apprecia-
Branch reflective learning tive inquiry and critical
K.V. Mann
reflection
12
Suchman, Williamson, 2004 Development of an Individual Appreciative narrative approach and Initial assessment showed an
Litzelman, Frankel, Informal interviews open forum to elicit and organizational identity shift
Mossbarger & Inui, Curriculum occurred over disseminate inspiring narratives towards reinforcing values of
Relationship-Centered and Promotion 3 months about the informal curriculum at the formal curriculum
Care Initiative of Mindfulness its best
Discovery Team
Steinert, Cruess, Cruess 2005 Faculty Development Varied by Used think tanks, workshops, and Self-reported changes in teaching
& Snell Program for participation evaluation and practice, new educational
Teaching and initiatives, and more effective
Evaluation of use of role modeling
Professionalism
Faculty Development to Promote Role-Modeling and Reflective Practice
259
260 K.V. Mann
experience and to engage with new learning. This continuity provides the
opportunity to build an atmosphere of trust among members.
5. Faculty members need time and opportunity to practice new skills and to
receive feedback on their experience. In addition to providing regular meet-
ings, interventions with faculty members should allow time for participants to
test new learning in their practice. This may involve trying a new teaching
approach on one’s own or working with a colleague to observe and provide
feedback to each other. Once there has been an opportunity to practice, reflec-
tion with the group can maximize learning for both the individual and the
group.
6. Teaching practices are improved by reflecting on one’s own teaching and
the values that underlie it. This notion links reflection to improving teach-
ing and role-modeling. Skills in reflection can be learned. Faculty members
need support and structure to understand what reflection involves, and to
understand how they can learn from their own practice, not just to improve
it but to uncover their own expertise. They also need support in learning and
acquiring these skills.
7. Reflecting on both teaching successes and failures can help faculty mem-
bers to improve their teaching. Teachers can learn from both successes and
failures, and incorporate what they learn into their teaching. The importance of
trusted colleagues and an environment that supports learning are paramount for
the development of critical reflexivity.
8. Learning to use reflection in their own practices allows faculty members to
model this for learners and peers. As faculty members become familiar with,
and more confident in, using reflection to enhance their own learning, they can
use these skills with the learners they teach.
9. Various resources are available to support faculty members in involving
learners in reflection. These include models for reflecting and rubrics for eval-
uation. Structured models may provide a scaffold for both teachers and learn-
ers. They also provide a framework for structured feedback to learners.
10. Feedback models can be helpful to support faculty members in assisting
learners to reflect. The ECO model (Sargeant et al. 2011) can be used by fac-
ulty members both to reflect and enhance their own use of feedback and also
when they are working with learners. Similarly, the rubric developed by Wald
et al. (2012) may be helpful.
11. Involving more junior faculty members may lead to long-term benefits.
By having the opportunity to participate in a community of faculty colleagues,
it seems that over time, junior faculty members experience both personal
growth and an increase in the ability to collaboratively create a shared value
system. These values can sustain faculty members and they can support each
other in enacting them.
12. It is important to help faculty members build their self-efficacy in this
area. Self-efficacy is important to faculty both in their own use of reflection in
their teaching and in their work with learners. Experience, practice and feed-
back, as well as observing others, can build self-efficacy.
13. A variety of reflective activities should be used. Faculty members will find
that some activities will suit them better than others. No one activity will work
for all. As they are exposed to a variety of approaches, faculty members will
also have more options to use in their teaching.
14. Reflection will be most effective when it is situated in the faculty member’s
own experience and practice. Reflection should be ongoing, linked to other
activities and always be authentically related to the individual’s teaching, the
context of their work, the setting and the learners they teach.
15. It is critically important to provide a safe place for faculty to reflect, debrief
and discuss their experiences. The importance of safety for faculty members
to develop the skills in reflection and role-modeling cannot be overestimated.
Communities and groups of faculty who have the opportunity to develop as a
group can share experience and develop common values. The development of
shared norms and values can, in turn, support both individual and institutional
transformation.
12.6 Conclusion
The goal of this chapter was to present current thinking about role-modeling and reflec-
tion and to stimulate our collective thinking about how these strategies might be incor-
porated into our faculty development practices to assist both teachers and learners.
Skills in role-modeling and reflection are important for effective teaching and
learning. However, they are not easily acquired in short or one-time exposures
alone, although these activities may be helpful in raising awareness. The literature
suggests instead that such faculty development may be most effective when longi-
tudinal opportunities for faculty members are also provided to enable them to
acquire skills and to use those skills to reflect on their own teaching practice and
experience. Further, this process can be enhanced when these activities occur in the
context of groups which form communities that are supportive and share common
values. The role of the institution in supporting such development emerges clearly.
Although the focus of the chapter has been on role-modeling and reflection in the
context of teaching, the potential importance of these skills crosses all the aspects of
faculty members’ practices, including research and administration. Some suggested
implications for practice have also been presented as principles which may guide
the development of programs which are suited to the needs of our faculty members
and the contexts of our institutions.
Preparing faculty members for role- modeling and reflective practice offers rich
possibilities: for faculty members, it can provide an enhanced awareness of them-
selves as teachers and opportunities for personal and professional development;
learners can benefit from their interactions with faculty members who encourage
them to be reflective in their learning and development, and who use the power and
process of role-modeling effectively; and institutions derive the benefits of the vital-
ity that results from learning and growth among their members.
262 K.V. Mann
12.7 Key Messages
• Role modeling remains a significant influence on learners as they develop their

professional identity.
• Faculty members can be helped to be more effective as role models through
increased awareness of themselves as role models, an understanding of the stan-
dards and values they wish to transmit, and learning to use role modeling delib-
erately in their teaching.
• The influence of the institution is of critical importance in supporting and pro-
moting effective role modeling. The goal is to create an environment that pro-
motes optimal role modeling and student learning.
• Reflection and reflective practice are essential capabilities of competent profes-
sionals. Faculty members need support to develop these skills.
• Ability to reflect critically on one’s experience as a teacher can result in
changed teaching practices. It can also help faculty members to assist learners
to use reflection for learning, and to learn from their experience throughout
their practice.
Acknowledgements Grateful appreciation and thanks are extended to Dr. Anna Macleod for
her feedback on an earlier version of this chapter, and to Dr. Yvonne Steinert, both for the invi-
tation to write this chapter, and secondly, for her patience and thoughtful feedback as the ideas
were developed.
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Chapter 13
Faculty Development for Curriculum
Change: Towards Competency-Based
Teaching and Assessment
Linda Snell
13.1 Introduction
As health care advances and knowledge of effective educational strategies evolves,

curriculum renewal in health professions education is a given. Ensuring that faculty
members can effectively function within a new curriculum implies that faculty
development has a key role to play in curriculum change, at the individual, organi-
zational and systems level. This chapter discusses the relationship between faculty
development and curriculum change, and then uses the example of a move to a
competency-based curriculum to illustrate how faculty development can help to
bring about change at multiple levels.
There is a reciprocal relationship between new curricula and faculty development.
Preparing faculty is a necessary adjunct to facilitate the design, implementation and
evaluation of new curricula. As well, faculty development may drive change to a new
curriculum, through creating a need or fostering a change in attitudes, increasing
‘buy-in’, or building capacity by improving knowledge or enhancing skills in a con-
tent area such that it can be taught better.
13.1.1 What Does Curriculum Change Include?
The term ‘curriculum change’ in this chapter is used to encompass curriculum

renewal as well as the development or implementation of new curricula. Curriculum
change can include the implementation of new curriculum models, the integration
L. Snell, MD, MHPE, FRCPC, FACP (*)

Centre for Medical Education and Department of Medicine,
Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada

266 L. Snell
of new content areas, or explicitly teaching areas that were previously learned
implicitly, situating learning in new contexts or including new faculty members in
teaching. Examples of new curriculum models are competency- or outcomes-based
approaches (Frank et al. 2010b) or technology-enhanced learning. New content
areas might include explicit teaching about patient safety, professionalism, health
advocacy or humanistic values. Examples of new contexts include moving learning
to ambulatory settings, using simulation or developing a distributed education
model. New faculty may include adding community-based supervisors or an inter-
professional team as teachers. To add even more complexity, many of these changes
may be undertaken as concurrent initiatives (Jolly 2002), so that identifying a spe-
cific faculty development need may be complicated.
13.1.2 What Are Faculty Members’ Needs When New

Curricula Are Implemented?
Faculty development activities can assist leaders, curriculum planners and health profes-
sions teachers prepare for change or respond to it effectively. Teachers might have to
learn about new content areas, different roles for teachers or novel strategies for teach-
ing, learning or assessment. Curriculum planners and leaders must become familiar with
new curriculum models, educational planning and strategies to lead change (Jolly 2002;
Steinert 2011b). They may also have to facilitate a change in faculty attitudes, such as
supporting buy-in to a new system, or trying to encourage the ‘unlearning’ of entrenched
teaching methods. Finally, faculty development can enhance educators’ skills so that the
impact of a new curriculum can be evaluated appropriately.
13.2 The Relationship Between Faculty Development

and Curriculum Change
The published literature describing the relationship between faculty development

and curriculum renewal in the health professions is scant. Most articles describe
faculty development programs that support curriculum implementation; only a few
address the use of faculty development to drive curriculum change. In addition,
most of the articles outline activities to assist individual faculty members improve
skills; a minority also discuss the issues relating to changes at the institutional or
systems level (Dath and Iobst 2010; Farmer 2004; Jolly 2002).
13.2.1 New Curriculum Models and Faculty Development
In the past few decades, a number of new curriculum approaches have been intro-
duced into health professions education. These have included problem-based meth-
ods, integrated models, outcomes-based education, spiral curricula, and longitudinal,
13 Faculty Development for Curriculum Change… 267
community- or ambulatory-care-based and disseminated programs. These have

been described briefly by Kusurkar et al. (2012) and Jolly (2002). Two models,
problem-based learning and competency-based education, will be discussed in this
section to illustrate how faculty development can be used to bring about curriculum
change. The former, PBL, is now well established and lessons can be learned from
the process of curriculum change. The latter, CBE, is gaining acceptance and pro-
vides a model for future application.
13.2.1.1 Faculty Development for Problem-Based Curricula
In the late twentieth century, many medical schools followed the recommenda-
tions of the GPEP Report (Physicians for the Twenty-First Century 1984) and other
national reports, and developed new curricula that were more student-centered and
focused on problems. The GPEP report recommended that faculty development be
an integral part of curriculum renewal, and a few papers have reviewed the role of
faculty development in these changes.
Grand’Maison and Des Marchais (1991) described a comprehensive faculty
development approach to support the change to a problem-based learning (PBL)
curriculum in Sherbrooke, Canada. Their faculty development program, which uti-
lized a variety of formats and strategies, included a ‘2-day introductory workshop to
initiate teachers into educational principles and their application in the new pro-
gram, a 1-year basic training program in medical pedagogy requiring 100 h of
participation, a 1-day workshop on PBL and a 3-day training program in PBL tutor-
ing’ (p. 557), followed by an annual ‘refresher’ course. The formats in the shorter
programs included discussions, readings, individual work and assignments and
experiential practice activities. The 1-year program included self-instructional mod-
ules with ‘homework’, regular small group discussions, and the opportunity to
apply what had been learned. The major goals were to change faculty attitudes with
an increased emphasis on the process of learning (as opposed to teaching), to
encourage faculty members to learn the scientific basis of medical education and the
knowledge and skills of teaching and learning, and to apply these to their daily
teaching activities. Because of limited resources and local expertise at the onset, a
systematic approach to development was taken. Outside experts trained a small
group of locally-involved educators, then observed these faculty members as they
provided faculty development activities and gave them constructive feedback. The
local educators eventually implemented the programs independently. Faculty mem-
bers who had a stronger background in education were encouraged to become
‘mentors in the art of faculty development’ and to be responsible for maintaining the
quality of the programs. Those involved in implementing the new curriculum were
invited to become instructors, with the strategic aim of increasing their expertise in
education. There was a high attendance rate and a low attrition rate, perhaps in part
attributable to the mandatory nature of the two introductory activities; that is, all
faculty members wishing to teach were required to attend. The authors concluded
that their faculty development programs, particularly the activities aimed at changing
attitudes, ‘had a significant impact on the successful shift from a traditional to a
268 L. Snell
problem-based, small-group tutorial curriculum’ (p. 561). They also commented

that faculty activities must be continuous and tightly based on needs, and that activi-
ties to change attitudes must be initiated a long time before curriculum change is
started. Developing a cadre of faculty members with broad expertise in education to
act as faculty development instructors and as mentors contributed to the change.
The lessons learned led them to believe ‘that faculty development was… a prereq-
uisite of curriculum change in medical schools’ (p. 561).
Nayer (1995) reviewed faculty development initiatives in a change to problem-
based learning curricula in seven medical schools. In each school, she found that the
teacher (tutor) role in a PBL curriculum was more student-centered, and that this
required a change in the orientation of faculty members. In this context, faculty
development needed to do more than just develop the required skills; rather, it had
to focus on the role of the teacher as well. Nayer also noted that, in the few faculty
development programs that have been evaluated, faculty members changed attitudes
and improved knowledge and gained teaching skills.
Farmer (2004) described a sequence for designing and implementing compre-
hensive faculty development programs for a change to a PBL curriculum. She out-
lined three stages of change: curriculum transition, curriculum implementation and
curriculum advancement. In the first phase, programs presented the new curriculum
approach and developed basic abilities such as PBL tutor skills and skills in case
writing and assessment. Programs for the second phase enhanced teaching and
assessment abilities. The final phase provided advanced training for teaching excel-
lence. Within this three- stage sequence she outlines a number of strategies specifi-
cally addressing change in attitudes or culture. In the first phase, faculty members
were given opportunities to understand the new curriculum approach. In the second,
they were given opportunities for reflection and personal development. This was
facilitated by allowing faculty members access to their teaching evaluations. In the
final phase, teaching excellence was recognized, and as also mentioned by Licari
(2007), appropriate rewards systems were developed. This included institutional
recognition of leadership and scholarship activities associated with curriculum
change. Farmer also points out that faculty development programs can have a posi-
tive effect on organizational culture as well as on individual faculty values.
The papers in this section describe in detail the systematic approaches to faculty
development needed to implement PBL curricula. Overall, factors leading to faculty
improvement in many of these studies included: (1) a multifaceted approach with
varied faculty development strategies including longitudinal or modular programs
starting early in the proposed curriculum change; (2) a mix of theoretical presenta-
tions, group work, practice sessions (microteaching), and experiential sessions such
as role playing; and (3) a phased approach from novice to advanced content.
13.2.1.2 Faculty Development for Competency-Based Curricula
A more recent change in curriculum models has been the adoption of a competency-
based approach. Competency-based education (CBE) has been defined as:
…an approach to preparing physicians for practice that is fundamentally oriented to gradu-
ate outcome abilities and organized around competencies derived from an analysis of soci-
etal and patient needs. It deemphasizes time-based training and promises greater
accountability, flexibility and learner-centeredness (Frank et al. 2010a, p. 636).
In a competency-based curriculum, fundamental competencies, often organized

in a framework, are taught, observed and assessed according to explicit criteria. In
CBE, the outcomes (competencies) are not isolated elements of knowledge or a skill
but rather integrate:
…multiple components … [of] knowledge, skills, values [or] attitudes that are applied in
practice. In CBE, learners assume greater responsibility for their own learning and assess-
ment than in traditional approaches. Since competencies are observable, they can be mea-
sured and assessed and compared to a standard to ensure their acquisition and application.
Competencies can be assembled like building blocks to facilitate progressive development
(Frank et al. 2010b, p. 641).
Moreover, learners are expected to demonstrate their competence along a develop-

mental continuum of milestones, and assessment focuses on criterion-referenced
direct observation.
Dath and Iobst (2010) have commented on the importance of faculty develop-
ment in the transition to competency-based education. At the level of the individual,
teachers working within a CBE paradigm need faculty development to improve
their knowledge of CBE and the competencies being acquired, their facility in
teaching within this model and their ability to use new ways to assess learners. The
authors also noted the need for front-line teachers ‘to understand, accept, teach, and
evaluate domains of practice [i.e. content areas, competencies] beyond medical
expertise’ (p. 685). Medical teachers who were not explicitly taught according to
these competencies during their own training need to learn to teach them to their
learners. At the level of the institution, Dath and Iobst (2010) noted the utility of
faculty development to address resistance to change. At the systems level, faculty
development activities can improve understanding of, and confidence in, CBE
principles, to ‘pave the way’ for new credentialing and accreditation processes. The
authors described an example of system-level engagement, concurrent with the
introduction of the CanMEDS framework in Canada in 1996 (Frank and Danoff
2007), where faculty development was included as one of the requirements of
implementation. Dath and Iobst (2010) also described university-based and national
faculty-oriented initiatives, including workshops and presentations-on-demand,
each supported by a group of specifically trained national clinician educators and
extensive online and print resources. A more formal national ‘train-the-trainer’
workshop series served to educate and promote local ‘champions’ for the various
competencies at each medical school in Canada. As well as providing content about
a specific competency, the series included practice in educational design to help
local champions understand how best to provide faculty development at their own
institutions. The authors conclude that the transition to a CBE approach may be
slow; however, they suggest that an approach to faculty development aimed at insti-
tutions and systems, as well as at individuals, may facilitate the adoption of a
competency-based curriculum. This approach should include a number of methods,
270 L. Snell
using multiple formats and enlisting ‘early adopters’, demonstrating how faculty
members can identify fundamental competencies in their own practice and then
explaining how to teach and assess them.
13.2.2 Addressing Attitudes, Buy-In, Resistance

and Organizational Culture Change
When implementing curriculum change, faculty members may need to become more
enthusiastic about the change or be more motivated to move away from what may be
firmly entrenched teaching or assessment approaches or curriculum models. They
may also fear a ‘loss of control’ or become antagonistic to change (Farmer 2004).
Faculty development activities must therefore not only address skills acquisition
needed for new curricula, but also tackle a change in attitudes and organizational
culture (Carraccio et al. 2002).
Lanphear and Cardiff (1987) noted that curriculum renewal can be threatening to
faculty members, who may resist the change or simply refuse to adopt it. They
described a multistep program to facilitate the change to a longitudinal pathology
curriculum that emphasized problem-solving and independent learning. The pro-
gram included organizational development, instructional development and faculty
development. They suggest that one of the first steps in curriculum change is to
bring faculty members into active participation early in the change process. In their
case, this involved including all stakeholders and constituencies in the decision-
making process about the new curriculum, soliciting objectives from all teachers,
and requiring regular performance reports. These activities gave faculty members a
sense of involvement in decision-making and in the direction and amount of prog-
ress towards the curriculum change. The second step was the institution of training
in the teaching methods required by the new curriculum. In this step, faculty mem-
bers also contributed their own ideas into the curriculum goals and process. The
final step gave faculty members the opportunity to clarify their priorities for teach-
ing and professional roles, and included activities that addressed, for example, per-
sonal growth, conflict resolution and career planning. The institution of these steps
led to a curriculum change solidly anchored in the attitudes and philosophy of the
department, and allowed the faculty to ‘make a success of a new curriculum because
they could claim it as their own’ (p. 491).
Based on these studies, it would appear that one of the early stages of curriculum
change should be to focus on addressing the organizational culture and ensuring that
there is faculty understanding of the need for change. In this context, Zaidi et al.
(2010) found that a facilitator training workshop associated with a move to a
problem-based learning curriculum did not just improve faculty members’ teaching
skills but also stimulated their interest in the curriculum and in a student-centered
approach; it also increased their desire to be facilitators.
Curriculum change and the associated faculty development process must also
‘become a core value of the school’s culture’ (Licari 2007). In addition to the stan-
dard instructional development activities, Licari suggested that the development of
a reward system for faculty members to encourage new curriculum development

and innovation be considered. For example, providing faculty with ‘incentives, time
to plan, credit for development of learning experiences, rewards and recognition for
innovative teaching’ (p. 1510), and even recognition of these activities for promo-
tion and tenure, may serve to foster culture change. As Licari eloquently stated
‘programs need to help faculty members navigate from the current steady state of a
traditional curriculum through the unknown white-water rapids inevitably created
by curriculum change’ (p. 1509).
In this section, we have underscored the role of faculty development programs in
focusing on changing attitudes and organizational values to facilitate the smooth
implementation of new curricula. Effective programs have involved faculty mem-
bers at the onset, initiated faculty development activities early in the change pro-
cess, used multiple strategies to recognize faculty contributions to change, and
addressed culture change at an individual and at an institutional level.
13.2.3 Leading a Curriculum Change
Curriculum renewal implies the need for individuals to lead the change, and faculty
development programs have the potential to prepare current or future leaders to
implement new curricula. A number of authors have noted the need to address lead-
ership skills with specific faculty development activities (Farmer 2004; Jolly 2002;
Steinert 2011a; Swanwick 2008).
In 2002, Jolly, in reviewing the literature on faculty development for curriculum
implementation, identified the need for developing a strong leadership to sustain
and support new curriculum strategies. In the third phase of her faculty development
program, Farmer (2004) also highlights the need to nurture leadership skills. She
suggests that teaching curriculum leaders about Complex Adaptive Systems (CAS)
theory may facilitate change.
Swanwick (2008) notes that the institution of faculty development activities
requires ‘effective and sympathetic leadership from postgraduate training institu-
tions, hospitals and health authorities’ (p. 339). He also comments on the need for
the development of management and leadership skills for those leading educational
change. In Chap. 3, Swanwick and McKimm describe a number of faculty develop-
ment content areas and strategies to enhance leadership skills, many of which are
highly relevant to leading curriculum change.
These concepts are underscored by Steinert (2011b) who has noted that faculty
development can serve to promote organizational change in a number of ways. In
addition to achieving more ‘traditional’ faculty development goals such as imple-
menting the change and enhancing organizational capacities, it can help to build
consensus and generate support and enthusiasm, Similarly, Lanphear and Cardiff
(1987) described specific features and actions of leaders that facilitated a curricu-
lum change. These included explicit support of the change by departmental chairs,
engagement of faculty members in the change process, effective communica-
tion skills, focused appointment of education experts, and effective management of
272 L. Snell
conflict and change. Many of the factors and skills described by Lanphear and
Cardiff (1987) and Steinert (2011b) are ‘learnable’ and could be addressed in a fac-
ulty development program for those leading change.
13.2.4 Enhancing Research Skills Related

to Curriculum Change
In order to fully understand curriculum change, it should be evaluated. Faculty

development activities can also be used to enhance faculty scholars’ education
research skills so that they can evaluate the impact of a new curriculum. Examples
of these skills include applying an educational research design or methodology,
using a valid program evaluation model such as that described by Musick (2006), or
developing needs assessment tools or program evaluation measures to assess pro-
cess or outcomes. Research on curriculum change can enhance our knowledge
about curriculum in general, defining needs, teaching and learning strategies, and
assessment methods. As well, the resulting evaluations of new curricula can guide
decisions about further curriculum change.
13.3 Twenty-First Century Curricula, Competencies

and the Need for Faculty Development
Health professions education curricula have evolved over the past few decades,
with the adoption of outcomes-based approaches to curricula and an increased
emphasis on the use of competency frameworks at all levels of medical education.
Competency-based curriculum approaches have been implemented at both under-
graduate and graduate levels in a number of health professions. This curriculum
approach builds on the evolution of our understanding of competence. In pure
CBE, fundamental competencies are learned outside of a time-based framework.
Assessment focuses on direct observation, using explicit criteria over developmen-
tal stages (Holmboe et al. 2010).
Faculty development is essential to fostering this curriculum change. It can
enhance the acquisition of content for teaching fundamental competencies (e.g.
leadership, health advocacy, professionalism) that may previously have been learned
implicitly by faculty teachers. As well, it can foster the development of potentially
unfamiliar teaching and assessment skills (e.g. explicit role modeling, fostering
reflection, using portfolios, using simulation methods for intrinsic roles).
In the rest of this chapter, the implementation of a competency-based model and
the teaching and assessment of fundamental competencies will be used to illustrate
the importance of faculty development for curriculum change. However, many of
the principles described above apply equally well to other curriculum initiatives.
13.3.1 Contemporary Competency Frameworks

and Content Areas
Examples of contemporary competency frameworks that have been adopted in a

number of constituencies include The Scottish Doctor (Simpson et al. 2002), the US
ACGME Competencies (Swing 2007), the National Undergraduate Framework in
the Netherlands (Laan et al. 2010) and the CanMEDS 2005 Physician Competency
Framework (Frank and Danoff 2007). Other similar frameworks have also been
implemented in nursing, physiotherapy and occupational therapy (Verma et al.
2006). Although each framework is slightly different, the metacompetencies or
‘roles’ in most frameworks include some variation of (clinical) expertise, problem
solving, health advocacy/prevention, communication skills, teamwork/collabora-
tion, leadership and management, teaching skills, life-long learning, critical
appraisal and professionalism (Verma et al. 2009). The competencies other than
clinical expertise have been called the ‘intrinsic roles’ in that they are ‘inherent,
fundamental or essential to the practice of medicine, integrated with each other and
the Medical Expert Role’ (Sherbino et al. 2011, p. 697).
These competency frameworks comprise complex ‘metacompetencies’ that are
divided into component parts, which are learned over time with milestones or mark-
ers along the way. Competencies have been described as multi-dimensional, dynamic,
developmental, and contextual in nature, integrating knowledge, skills and behaviors
in practice (Frank et al. 2010b; Snell and Frank 2010).
One of the most frequently-used approaches is the CanMEDS (Canadian Medical
Education Directions for Specialists) framework, now adopted in over two dozen
jurisdictions worldwide, in medicine at the medical school and residency level, as
well as in nursing, occupational therapy, physical therapy, medical radiation tech-
nology, social work, psychology, midwifery and other health professions (Royal
College of Physicians and Surgeons of Canada, Ottawa: unpublished data, 2013).
Some of these programs have adopted pure competency-based models, such as the
University of Toronto Orthopedics residency (Wadey et al. 2009) and the Cleveland
Clinic undergraduate medical program (Dannefer and Henson 2007). The CanMEDS
framework is perhaps successful because it has educational utility and was derived
from a systematic needs assessment that included the perspectives of the public on
what they hoped their physicians would model (Frank and Danoff 2007).
13.3.2 Innovative Approaches for Teaching and Assessing

Fundamental Competencies
Although these fundamental competencies have been recognized for years as essen-
tial areas for learners in all health professions education contexts, they have usually
been acquired tacitly through work-based learning and have not been assessed
specifically. In fact, only recently have they started to be taught explicitly and
274 L. Snell
assessed formally. With a move to competency-based education, this will become

even more formalized, with the content better defined and a need for objective
assessment of actual performance, milestones and outcomes.
CBE provides a clear description of intended outcomes rather than suggesting
particular learning strategies or formats. However, many of the competencies, par-
ticularly the intrinsic ones beyond medical expertise (e.g. communication skills,
teamwork, leadership skills, health advocacy, professionalism, as described in
Sherbino et al. 2011), place an emphasis on skills, behaviors and attitude change
rather than solely on knowledge acquisition. These competencies are often not
effectively acquired using traditional teaching strategies such as didactic methods
alone. As well, work-based learning alone is not considered to be adequate for the
acquisition of these abilities. A change in approach to learning is implicit in a
change to a competency-based curriculum. There will need to be increased attention
to student-centeredness and flexibility, for example by providing outcomes (either
milestones or abilities of graduates), and then allowing the learner to select from a
number of routes (learning strategies) to acquire a competency. As well, there
should be alignment of learning activities with assessment and a more active engage-
ment of teachers in assessment by direct observation. Finally, there is a spiral devel-
opment of concepts, knowledge, and skills, delineated by milestones along the way
to full acquisition of competence (Harris et al. 2010). As can be imagined, this
philosophical approach may not be familiar to most faculty members, who will need
to understand, accept and be comfortable with this new paradigm.
To address this change, a number of emerging or innovative educational approaches
have evolved, each thought to be effective for learning or assessing one or more of
the fundamental competencies. These include, for example, teaching techniques to
promote reflection, explicit role modeling (Cruess et al. 2008), simulation methods,
team-based learning, and OSTEs (objective structured teaching exercises) (Boillat
et al. 2012). Newer formative and summative assessment methods include the mini-
CEX, work-based assessment methods such as direct observation and formative feed-
back, multisource feedback and the use of portfolios (Holmboe et al. 2010; Iobst et al.
2010). As well, many faculty members or clinical supervisors may not be familiar
with some of the content of these competencies, which they may have learned implic-
itly, and as a result they may not have a ‘vocabulary’ or framework to teach them.
They may also not be comfortable with using the range of teaching or assessment
approaches described here. More importantly, some faculty members may not ‘buy-in’
to either the competency framework or even to the need to teach the competencies
explicitly (Snell and Frank 2010).
13.3.3 Strategies for Faculty Development in CBE
For those moving towards a CBE approach, or implementing explicit teaching of

fundamental competencies beyond that of medical expertise, it has been proposed
that many of the challenges to meeting expectations of a competency-based
Table 13.1 Effective faculty development formats and strategies for a move to competency-based
education
Formats
Workshops and other small group activities
Short courses
Longitudinal programs
Self-instructional modules, including on-line formats
Lectures and other didactic activities
Strategies
Simulation methods, such as OSTEs
Peer mentoring
Experiential learning
Role-play
Practical sessions, such as microteaching (practice with observation and immediate feedback)
Reflective exercises
curriculum can be addressed with faculty development (Holmboe and Snell 2011).
Faculty development may serve a number of roles. It facilitates the design of novel
curricula in which to learn desired competencies. As well, faculty development
programs can teach teachers and supervisors about the content of the competencies
and how to use teaching and assessment approaches effectively. At an institution or
systems level, faculty development activities can encourage buy-in, develop faculty
development leaders, evaluate the success of new curricula, and promote further
curriculum change.
Faculty development can address both the competency (the content) and the edu-
cational methods (the process) (Dath and Iobst 2010; Scheele et al. 2008). For instance,
commonly-used faculty development strategies such as workshops, short courses
and experiential activities like OSTEs (Objective Structured Teaching Activities;
Boillat et al. 2012) can combine teaching of both. This has some advantages, as many
teachers may not attend a pure ‘content’-based faculty development session (saying,
for example, ‘I already know about teamwork’), yet they will attend a combined ses-
sion (such as one on ‘faculty development for teaching and assessing collaborator
skills’). An example is the CanMEDS Train-the-Trainer series (e.g. Cruess et al.
2009; Snell et al. 2010), 2- to 3-day workshops which teach advanced content about
a single CanMEDS competency (such as Health Advocate). At the same time, these
workshops provide skills in faculty development, such as using the education cycle,
workshop planning and implementation, and program evaluation. Other faculty
development strategies and formats discussed elsewhere in this volume include on-line
learning, role modeling, mentoring, and peer coaching. These have not been discussed
much in the literature as it pertains to faculty development for CBE, but many strate-
gies could reasonably be used to teach faculty members, as listed in Table 13.1.
Given that most competencies are not acquired by learners at a single moment
but developed over time, it makes sense to consider a progressive/longitudinal and
integrated faculty development approach for teachers (Steinert 2011b). This has
276 L. Snell
systems and policy implications, as a change to a competency-based curriculum,

with new roles for teachers and students and greater involvement of faculty, implies
a significant investment in faculty development (Taber et al. 2010).
13.4 A Proposed Model
Throughout this chapter, three elements of faculty development for curriculum

change have been discussed: the ‘content’ (i.e. what the learner – and sometimes the
teacher – has to learn; the ‘process’ (i.e. how the student learns and is assessed on
the content); and the faculty development formats and strategies (i.e. how to teach
the teachers the content and process). One could think of these three elements on
three axes, each in a different direction, forming a cube, as in Fig. 13.1.
Two examples of this model are given. In the first example, shown in Fig. 13.2, a
student is learning competencies within the CanMEDS competency framework, so
the ‘content’ includes the seven CanMEDS Roles. The clinical student can learn
these competencies in a number of ways (i.e. the ‘process’), through observing role
models, reflection or discussion of case vignettes; he or she can also learn these
competencies both in the workplace and using simulation approaches. For the spe-
cific competency of communication skills, the student can attend mandatory activi-
ties in a simulation-based environment, with practice communicating in varied
simulation scenarios. The student is debriefed following the scenario and reflects on
the skills learned. Faculty members design the scenarios and act as debriefers. For
teachers new to simulation scenario design, an effective form of faculty develop-
ment would be peer mentoring. In this case, an experienced designer would assist a
new teacher to develop communication scenarios at the appropriate level.
In the second example, pictured in Fig. 13.3, residents are being assessed on the
ACGME competencies (the ‘content’). A number of new or evolving potential
Content
Fig. 13.1 Three-dimensional

model relating the Content
(WHAT trainees learn or are
assessed on), Process (HOW
trainees learn/are assessed),
and faculty development
at
m
Format or strategy (HOW

r
Fo
faculty members learn

Process
Content or Process)
Medical Expert
Communicator
Content
Collaborator
Manager
Health Advocate
Scholar
at
Professional W
rm
C ork
Fo
Process Pe our sh
sim er se op
ul me on e on s
Work-based
Simulation
Group discussion
Case vignettes
Role-modeling
Reflection
Lectures
at nt n m
io or co a
ns in u ll
g ra gr
on gi ou
de ng p t
sig ref ea
ni lec chi
ng tio ng
n
Fig. 13.2 Example of model using the CanMEDS competency framework and common learning
strategies at the student level
Patient care
Medical knowledge
Content
Interpersonal &
communication skills
Practice-based learning
Professionalism
at
Systems-based practice D
m
M ebr
r
Fo
Co ent iefi
Process W ur orin ng
or se g tra
ks o o in
Global rating
Oral exam
Portfolio
3608 feedback
Simulation
Portfolios
Written exams
ho n n u in
p MC si g
on Q ng
fe w po
ed rit rt
ba ing fol
ck io
s
Fig. 13.3 Example of model using the ACGME competency framework and common assessment
strategies at the resident level
assessment methods (i.e. the ‘process’) are used. The resident may be required to
keep a portfolio to demonstrate achievement of competence in Practice-Based
Learning. Faculty members may need instruction in the use of portfolios as an
assessment tool. This might be done through mentoring or through a workshop on
encouraging reflection using portfolios.
278 L. Snell
This model should not be thought of as static. Competencies are learned and
assessed within an institution or system, where new teaching strategies and assess-
ment tools are implemented and the curricula in which these competencies are
learned evolve. There are also a number of other factors or variables that are too
complex to depict in a static diagram. For example the ‘size’ of the small cubes
within the big cube may vary depending on the emphasis of the content within the
curriculum, the frequency with which the teaching or assessment method is used, or
the acceptability of the faculty development method.. Another variable is the ‘level’
of the faculty development initiatives, and whether they are aimed at novice or
advanced teachers.
From a practical perspective, this model can be used as a ‘blueprint’ by a faculty
developer who wants to ensure that their faculty can teach and assess each compe-
tency. The specific competency and the desired teaching or assessment processes
are identified. A faculty development strategy is chosen to match these. On the other
hand, a new teaching or assessment strategy which might be applicable to more than
one competency can be taught. During the faculty development activity, examples
can be drawn from relevant ‘matching’ competencies.
13.5 A Case Study
In this section, the fundamental competency of professionalism is examined as a

case study. The goal is to illustrate best practices for providing faculty development
both to enhance teaching and assessment and to promote curriculum change. In the
essential area of professionalism, a learner must acquire core knowledge, apply this
knowledge in progressively more realistic contexts, and develop and express behav-
iors that reflect professional practice (Steinert et al. 2007). Faculty members who
teach professionalism must be able to explicitly ‘articulate its core concepts and
demonstrate appropriate behaviors. This requires that faculty development should
start with [learning] a cognitive base that includes the definition of professionalism,
its historical roots, its relationship to the ever-changing social contract between
medicine and society, and the obligations necessary to sustain professional status.
‘New’ teaching strategies for professionalism may include activities that will pro-
mote self-reflection, awareness and change in the learner. Finally, professionalism
must be evaluated in a valid and reliable fashion’ (Steinert et al. 2005, p. 128), and
faculty members must learn new assessment methods.
13.5.1 Teaching and Assessing Professionalism

at McGill University
The increasing emphasis on professionalism in medicine motivated the Faculty of

Medicine at McGill University to introduce formal teaching about the competency of
professionalism at both the undergraduate and residency level. This teaching starts on
the first day of medical school and is built sequentially through the undergraduate and
postgraduate program, reinforcing the same concepts and allowing application to the
appropriate level and context of the learner as their professional identity is formed.
Although the teaching strategies include didactic methods to transmit core
knowledge, most of the learning occurs in small groups or in the clinical context
and workplace, and much of it is longitudinal in nature as professional identity is
formed over time. Learning occurs in multiple settings: in classrooms, using sim-
ulation, integrated within various preclinical and clinical experiences, and during
resident workplace learning. A flagship course in the undergraduate medical pro-
gram is the ‘Physician Apprenticeship’ where groups of six students meet regu-
larly with the same faculty member, a practicing physician, over the entire 4 years
of the undergraduate curriculum (Steinert et al. 2010). All individuals who come
into contact with students need to use the same definitions and vocabulary and be
aware that they are role models. The ‘importance of residents in the learning expe-
rience of medical students led to the recognition that further education of resi-
dents as role models was required’ (Steinert et al. 2007, p. 1063). A faculty-wide
half day on professionalism is held annually for all 2nd-year residents, to rein-
force the concepts of professionalism and to emphasize their role as models of
professional behavior. In all these learning activities, the same cognitive base is
taught and the same ‘vocabulary’ is built.
The assessment of professionalism is equally important. As a result, the prin-
ciples and attributes of professionalism that are taught are also assessed, both in
the learners and in the faculty and resident teachers (Todhunter et al. 2011).
More recently, the MMI (multiple-mini-interview) method used for student
selection has included assessing for professional attributes and behaviors in
entering students.
The goal overall is to lead to a ‘culture change’, with faculty members not
just teaching and assessing professionalism, but also demonstrating exemplary
professionalism.
13.5.2 Faculty Development for Professionalism

at the Teacher Level
From the outset of the curriculum change, an iterative process of faculty develop-
ment activities (e.g. working groups, workshops, medical education rounds and
skill building sessions) was aimed at the faculty members in general and at teachers
with specific roles, as described by Steinert et al. (2005, 2007). This allowed for
input from the faculty and buy-in, as well as building faculty capacity for teaching
and assessing professionalism. For example, a series of faculty development work-
shops that mirrored the students’ work was provided to prepare and support the
Physician Apprenticeship faculty preceptors (Steinert et al. 2010). For any inter-
ested faculty member, activities to increase knowledge, provide a common vocabu-
lary and improve specific skills (e.g. role modeling, feedback) were provided. The
concurrent student learning and faculty development programs are linked and have
280 L. Snell
Table 13.2 Faculty development for the competency of Professionalism, at the individual learner
and teacher levela
Faculty
Faculty knowledge, development
Learner knowledge Learning Assessment skills & attitudes activities &
and skills strategies strategies needed strategies
Core knowledge of Lecture Written exams Professionalism Working groups &
professionalism Small group principles; core workshops on
discussion knowledge, core knowledge
‘vocabulary’ Workshops on small
group
facilitation
Application in Case vignettes OSCE Facilitation skills Workshops on small
progressively discussed for small groups group facilita-
realistic in groups. Simulation tion using
contexts Simulated debriefing vignettes
patients OSCE case Courses on
development debriefing
Course on OSCE
development
Development of Experiential Direct Observation and Feedback workshop
professional (work- observation/ feedback skills Workshops on
behaviors and based) feedback Facilitating reflection, use of
demonstration learning Portfolios reflection narrative
in practice Reflection Role modeling Role modeling
Role models workshop
a
This table shows the link between what the learners must learn, what the teachers must teach and
assess, and how faculty development can foster this
included activities as outlined in Table 13.2. In this table the content for the student
or resident can be learned and assessed using different strategies. The faculty must
possess knowledge or skills to do this, and there are specific faculty development
strategies and activities that can facilitate this.
13.5.3 Faculty Development at the Systems Level
Selected faculty members involved in leading curriculum change or evaluating its

success also needed skills in these areas. As a result, a 4-day leadership develop-
ment program was developed and activities to develop program evaluation and edu-
cational research skills were offered. Residency program directors participated in
focused activities aimed at improving their skills in recognizing all fundamental
competencies, designing relevant curricula, and implementing appropriate assess-
ment methods. The faculty leaders were very supportive of both the curriculum
change and the faculty development program. Table 13.3 depicts the link between
the organization or system goals, the changes needed in faculty to achieve these
goals, and the faculty development activities that facilitated this.
Table 13.3 Faculty development for the competency of professionalism, at the institution and
systems level
Faculty knowledge, Faculty development
Institutional goal skills & attitudes needed activities & strategies
Selection of professional MMI construction MMI station development
traits in entering training
trainees using multiple
mini-interviews (MMI)
Ensuring faculty buy-in, Ensuring faculty buy-in and ‘Think tanks’ on teaching &
motivation, consensus motivation assessing professionalism
and knowledge Ensuring consensus on content, Invitational workshops on
teaching & assessment teaching & on assessing
strategies; stimulating professionalism
discussion about feasibility
Developing a group of skilled, Faculty-wide workshops on
knowledgeable faculty teaching & on assessing
members professionalism
Provide skills to program Knowledge about core Focused day-long workshops on
directors competencies teaching and assessing core
Curriculum models competencies, curriculum
Assessment tools development, developing and
using new assessment tools
Evaluation of curriculum Education research skills Peer mentoring and capacity
change & faculty building sessions for
development initiatives education research and
program evaluation methods
Developing leaders for Leadership skills, change Faculty leadership development
change management skills program
13.5.4 Results of the Faculty Development Program
The evaluation of the various faculty development components showed that the fac-
ulty members were:
… able to expand their teaching of professionalism, in part because they had become more
knowledgeable about the cognitive base underlying professionalism, strategies for teaching
this subject matter, and methods of evaluation. Secondly, the initiative allowed the medical
school to agree on the cognitive base of professionalism, the attributes and characteristics
of a professional, and the behaviors to be encouraged in students, residents and faculty
(Steinert et al. 2005, p. 134).
It also led to the development of better methods of evaluating professional behavior.

Finally, the initiative showed that faculty development can be a powerful tool in
initiating and setting the direction for curriculum change. This initiative raised
awareness, channeled the faculty’s efforts and stimulated desire for curriculum
change and reform. ‘Many of the educational initiatives currently underway would
probably not have occurred as rapidly, or in their current form, without both the
stimulus and the direction of this program’ (Steinert et al. 2005, pp. 134–135). The
specific faculty development program for the Physician Apprenticeship preceptors:
282 L. Snell
… increased teachers’ perceptions of connection (and reconnection) to teaching, medical

education, core professional values, and colleagues. It also demonstrated the benefits of a
longitudinal faculty development course, rooted in both situated and work-based learning,
which mirrored the students’ experiences and helped to promote a community of practice
(Steinert et al. 2010, p. 1248).
13.6 Conclusion
In this chapter, we have highlighted the link between faculty development and cur-
riculum change and used a case study to illustrate a number of ‘best practices’. As
we noted, there is a reciprocal relationship between curriculum change and faculty
development. Faculty development can be used as a tool to engage the faculty in
curriculum change and promote capacity building. Curriculum change can, and
probably should, be a ‘bottom-up’ as well as a ‘top-down’ process. Some aspects of
curriculum change might be viewed as more ‘difficult’ to implement (e.g. imple-
menting teaching about health advocacy frequently provokes resistance to change).
Engaging faculty members early in the change process is essential to promote buy-
in; it can also assist in developing applicable tools for teaching and assessing learn-
ers and in educating faculty about their use. Faculty development is important for
attitude change and consensus-building around change. Second, programs should
address faculty needs; in a curriculum change, these needs may include education
about unfamiliar content and curriculum models as well as about teaching and
assessment methods. Third, skill building must go beyond teaching and assessment:
leadership, change management and education scholarship must also be addressed.
Support from leaders is important, but developing new leaders with the skills to lead
change is equally so. Finally, faculty development in the context of curriculum
change can have effects on the organization or system. The case study is an example
of faculty development leading to change as well as supporting it. It illustrates what
Steinert et al. (2007) noted; in the context of curriculum change or renewal, faculty
development ‘can help to build consensus, generate support and enthusiasm, and
implement a change initiative; it can also help to change the culture within the insti-
tution by altering the formal, informal, and hidden curricula’ (p. 1057). In fact, as
Jolly has stated: ‘Modifying a curriculum is likely to be difficult. Without faculty
development, it may well be impossible’ (p. 945).
13.7 Key Messages
• There is a reciprocal relationship between curriculum change and faculty devel-

opment. Faculty development is a tool to both engage the faculty in curriculum
change and to promote capacity building.
• Faculty members should be engaged early in the curriculum change process to
promote buy-in, to develop tools for teaching and assessment of learners, and to
educate faculty about their use.
• Faculty development programs should address content that may be unfamiliar to

faculty members. It can also assist faculty understand and use new curriculum
approaches.
• Skill building should also address leadership abilities, change management and
education scholarship.
• Faculty development is important for attitude change and consensus-building
around change.
• Faculty development in the context of curriculum change can have effects on the
organization or system.
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Chapter 14
Faculty Development for Interprofessional
Education and Practice
Liz Anderson, Sarah Hean, Cath O’Halloran, Richard Pitt,

and Marilyn Hammick
14.1 Introduction
Interprofessional education occurs when students from two or more professions learn
about, from and with each other to enable effective collaboration and improve health out-
comes (WHO 2010, p. 7).
Interprofessional education (IPE) is a response to specific changes within

health and social care delivery in the twenty first century, aimed at facilitating the
delivery of integrated services and patient-focused care. IPE is shaped by a com-
mitment to safe, patient-centered collaborative practice by national governments
worldwide, including the United Kingdom (Department of Health 2000), Canada
L. Anderson, Ph.D. (*)

Department of Medical and Social Care Education, University of Leicester, Leicester, UK
S. Hean, Ph.D.
In-2-Theory: Interprofessional Theory and Scholarship Network, School of Health and Social
Care, Bournemouth University, Bournemouth, Dorset, UK
C. O’Halloran, Ph.D., M.Sc.
Department of Health Sciences, School of Human and Health Sciences,
University of Huddersfield, Queensgate, Huddersfield, UK
R. Pitt, M.Phil.
Interprofessional Learning, Law and Ethics Interest Group for Health and Social Care,
School of Nursing, Midwifery and Physiotherapy, Queens Medical Centre Campus,
University of Nottingham, Nottingham, UK
M. Hammick, M.Sc., Ed.D.
The Best Evidence Medical Education Collaboration, Dundee, Scotland, UK

288 L. Anderson et al.
(Health Canada 2001), Australia (Australian Council for Safety and Quality in
Health Care 2005) and the United States of America (Cerra and Brandt 2011), and
global workforce policy (WHO 2010).
In this chapter, we will look at how faculty development can prepare faculty to
deliver a workable curriculum1 for the local context and in the process advance
faculty members’ skills to teach, implement and offer IPE that assures student
engagement. In addition, we explore how IPE has the potential to involve practitio-
ners in deeper reflection and analysis of their collaborative working. This, in turn,
enhances patient care. Our examples are mainly drawn from undergraduate curricu-
lum development, but they apply equally to post-graduate, classroom and practice-
based IPE. We acknowledge the challenges educators face in the development and
delivery of effective IPE, outlining how these can be overcome. Using a theoretical
curriculum model, we show how these challenges can be managed and how we can
bring IPE practitioners together as a community of practice.
14.2 The Challenges of Developing and Delivering

Interprofessional Education
We have identified five challenges associated with the development and delivery
of an interprofessional curriculum. Our position is that faculty development is
essential to address these challenges, establish interprofessional learning (IPL)
throughout a professional curriculum and promote effective interprofessional
practice (IPP).
Challenge 1: Crossing professional boundaries
Curriculum development and other educational activities within a single discipline
are complex and nonlinear endeavors. This complexity can be articulated at a pro-
fessional/school level through the use of Engeström’s activity theory (2001), and
diagrammatically as a triangle representing a single activity system (Fig. 14.1). The
diagram summarizes the many factors within the profession/school that surround
and mediate curriculum development. These phenomena include the tools that may
mediate this activity (e.g. means of assessment), the rules or social norms that may
govern how the profession and its training is managed, as well as the range of indi-
viduals (e.g. teachers, students, administrators) who may be involved and the man-
ner in which different roles are allocated amongst them.
This complexity increases when faculty from different activity systems or disci-
plines collaborate to develop an interprofessional curriculum, as shown in Fig. 14.1.
To work effectively together, faculty members must learn to understand each other’s
activity system and work together to create new shared understandings and ways of
working. Without an understanding and empathy for the activity system of the other,
1
We use curriculum to mean the content and processes of a learning opportunity; this might be a
lengthy undergraduate programme or short continuing professional development workshop.
14 Faculty Development for Interprofessional Education and Practice 289
Fig. 14.1 Education as an activity system: Interprofessional integration. The diagram is adapted
from Engeström (2001) and shows the activity systems of a nursing and medical school coming
together to form an Interprofessional Education Curriculum. The thick black line across each activ-
ity system represents a contradiction within each system (the requirement by the regulator to
deliver IPE) that is resolved if the two systems interact successfully. If unresolved, different cul-
tures, priorities and expectations prevail
contradictions within their shared activity remain unidentified and unresolved. This
allows the different expectations, priorities and cultures of each system to remain
unexplored, and for poor intergroup attitudes and a lack of cooperation to grow
(Hean et al. 2012a).
Challenge 2: Integrating interprofessional education into each profession’s
existing curricula
If the IPE curriculum remains separate to existing curricula it can become an add-on
activity; subsequently, students can lose motivation and faculty members can priori-
tize other subjects. The challenge is the integration and alignment of the IPE cur-
riculum so students and faculty members appreciate its fit with profession-specific
curricula, its contribution to student learning, and its role as a valid part of the edu-
cational experience.
Challenge 3: Paying attention to the theoretical rigor and the evidence base for IPE
Interprofessional education has been accused of lacking sound theoretical underpin-
nings (Reeves and Hean 2013). The design and evaluation of IPE curricula are said
to be superficial, descriptive and lacking in rigor. There has been limited understand-
ing of the outcomes or processes at work within IPE (Hean et al. 2009). A growing
number of interprofessional educators, evaluators and practitioners now identify and

apply theories from sociology, psychology and education in their work (Hean et al.
2012b). Striving to understand and apply theory needs encouragement, with faculty
supported in work that pays attention (and gives time) to the development of theoreti-
cally sound and evidence-based IPE.
Challenge 4: Managing the changeable and unpredictable nature of interprofes-
sional education development and delivery
Aligning uniprofessional and IPE elements of a curriculum needs a flexible and
adaptable team, able to collaborate and continually learn about, from and with each
other. Faculty members need to be comfortable with the concept of expansive learn-
ing and be able to cope with uncertainty and change (Engeström 2001).
Challenge 5: Recognizing that interprofessional learning is complex and different
IPE produces diverse learning groups. The students vary not only through their
personal traits but through adherence to values which have shaped their career
choice and become further molded as they take on a professional identity during
training (Anderson et al. 2009). One role for faculty development includes criti-
cal reflective work to appreciate the unique properties of these mixed student
groups and to equip educators with the skills to support students to learn about,
from and with each other. Faculty development should aim to support everyone
involved in the design and delivery of IPE curriculum as they re-analyze their
personal teaching repertoires and become competent in managing interprofes-
sional learning groups.
14.3 The Interprofessional Education Curriculum:

Modeling Its Complexity
We have borrowed Coles and Grant’s (1985) curriculum model to identify the
IPE faculty constituency and unpack the development needs associated with the
roles different faculty members have in establishing and assuring a credible IPE
curriculum.
The curriculum model (Fig. 14.2) comprises three components – the curriculum-
on-paper, the curriculum-in-action, and the curriculum experienced by the learners.
There is always some incoherence between these components; not everything in the
curriculum-on-paper will be translated into action by those responsible for curricu-
lum delivery, and learners, with their unique knowledge and skills, will experience
different versions of the curriculum. The model recognizes the dynamic nature of a
curriculum and can usefully guide faculty development through attention to the
need to maximize, as much as possible, component coherence. It is particularly use-
ful in health professions learning, where courses include practice experiences, often
including unplanned, opportunistic learning.
The IPE curriculum is not only influenced by the contributions and interplay of its
three different components but additionally by the different professions working in IPE
and the diversity of the IPL students. In the following sections, we discuss faculty
Fig. 14.2 Model of

curriculum design (adapted
from Coles and Grant 1985).
Written for curriculum Curriculum-on-
evaluation purposes, we have Paper (A)
taken the original concepts
from Coles and Grant’s paper
(1985) of the curriculum as
three distinct overlapping
circles; the curriculum-on-
paper (A), the curriculum-in-
action (B), and the curriculum Curriculum
Curriculum-in-
experienced by the students Experienced
Action (B)
(C). We have not addressed by Learners
those parts of the circles (C)
which overlap
development initiatives for faculty members responsible for maximizing the coherence
of the three components of the IPE curriculum and thus, for ensuring effective IPL.
14.4 The Interprofessional Faculty
Faculty development initiatives need to be available to all involved in the planning

and delivery of the IPE curriculum, and the design of the initiatives needs to reflect
the different roles for faculty members. This is a priority for those in roles that are
essential to the success of an IPE curriculum which we will define and explore in
detail: namely, the IPE Champion, the IPE Professional Leads and IPE Facilitators.
Table 14.1, shows there are many other individuals involved in IPE curricula whose
contribution to IPE will be enhanced by interprofessional faculty development.
The local IPE Champion can be defined as the leader and ambassador for both
the strategic and operational aspects of the curriculum with management and
research responsibilities (Barker et al. 2005; Oandasan and Reeves 2005). Their
major task is to maintain strong partnerships across professions, organizations and
institutions (Bjørke and Haavie 2006; Gilbert 2005). Mostly there is one IPE
Champion, a sole voice who is responsible for the early vision for IPE and for initi-
ating the local IPE curriculum. In addition, each profession may appoint an IPE
Professional Lead, with in-depth understanding about their profession-specific cur-
riculum, to work alongside the champion.
Those involved in the IPE curriculum-in-action are IPE Facilitators. The title
reflects the mode of interprofessional learning where the educator assists the prog-
ress of learning, paving the way for students to construct meaning through debate,
discussion and shared reflection (Reeves et al. 2011). IPE Facilitators are usually
university academics or practitioners who teach in practice (also known as precep-
tors, mentors, clinical or practice teachers). They may also be patients/service users
and students with a teaching role (McKeown et al. 2010; Selby et al. 2011).
Table 14.1 Faculty members involved in an interprofessional education curriculum

Curriculum areas Faculty members involved
The curriculum-on-paper External experts involved in curriculum approval (e.g. senior
clinicians, managers or representatives from licensing bodies)
Deans, Heads of School
Faculty committee decision-making members
IPE champion(s)
IPE leads (profession-specific)
Students involved in curriculum development
Patient/service user reference groups
Administrators
The curriculum-in-action IPE champion(s)
IPE leads
Facilitators from academia and practice
Administrators
The curriculum experienced External reference group (e.g. external examiners, external
by learners advisors to the research group)
IPE lead researcher(s)
Evaluators responsible for IPE quality control mechanisms
Student feedback groups
University assessment committee members
Administrators
14.5 The Purpose of Interprofessional Faculty Development

Initiatives
The purpose of interprofessional faculty development is to align more closely the

different IPE curriculum components (e.g. written, in-action and experienced).
Outcomes should assure a vibrant community of highly competent teachers who
advance their practice and student learning through evidenced-based teaching. To
reach such goals, faculty development must address the five challenges we outlined
for developing an IPE curriculum. We continue by exploring the ‘when’, ‘where’,
‘what’ and ‘how’ of initiatives designed to achieve this.
14.5.1 Faculty Development and the Interprofessional

Education Curriculum-on-Paper
Faculty development events that bring together members of different professions to

work together on curriculum development provide opportunities to model interpro-
fessional learning. They promote group work and the formation of a new community of
practice. The function of team building cannot be understated (Steinert 2005). Initially
we suggest organizing ‘away days’ or ‘time-out’ events for faculty members; the aim
here is to encourage ownership of the curriculum-on-paper. The environment for

these events needs to be versatile, enabling interactive debate and discussion towards
consensus agreements. A series of events may be necessary to address some or all of
the aims of this faculty development, as detailed below.
14.5.1.1 Gain an Understanding of the Education Context of the Other

Professions Involved in Developing the IPE Curriculum
(Challenge 1)
Early activities should include opportunities for interaction and sharing of pro-
fessional programs and underpinning education values. This can be achieved
through group work that enables participants to find out about each other, their
courses, and their interest in IPE development. The end-point of these activities
would be the sharing of course documentation, professional body standards, and
other relevant materials, as a starting point for identifying the common ground
for IPE development and preliminary agreement about the local IPE curriculum
strategy.
14.5.1.2 Confirm Common Ground in Professional Curricula Where IPE

Could Be Developed (Challenge 2)
Patient safety is an example of a topic that provides common ground for the
design of IPE. The seminal document within the USA on patient safety, To Err
is Human (Kohn et al. 2000), mirrored in the UK by the Department of Health’s
An Organisation with a Memory (Donaldson 2000), emphasizes the importance
of patient-centered team-working in practice. The World Health Organization
(WHO) has a comprehensive guide to including patient safety in health profes-
sions curricula with methods for teaching and assessing patient safety interpro-
fessionally (WHO 2011).
14.5.1.3 Write Interprofessional Learning Outcomes (Challenges 2 and 3)
The goal here is for participants to experiment with writing interprofessional learn-
ing outcomes. This means translating the broader philosophical issues discussed in
earlier sessions into learning outcomes that are coherent with the IPE curriculum
rationale and resonate with curriculum documentation conventions in the academic
institutions involved. Intended learning outcomes have been described and include:
patient-centered team-working, the different roles and responsibilities of health and
social care professionals, interprofessional communication, interprofessional reflec-
tion, patient safety and human behavior, and ethical aspects of shared practice
(Thistlethwaite and Moran 2010).
14.5.1.4 Design Theoretically Sound and Evidence Informed

Interprofessional Learning Activities (Challenge 3)
Faculty development should expose participants to the wide range of theories that
have been applied in IPE and encourage them to use these to design effective IPL.
We recommend that this event draws on the emerging research literature which can
provide pre-reading material for the session. Syntheses of useful theories for IPE
are available (Colyer et al. 2005; Hean et al. 2009, 2012b) to encourage debate that
focuses on theories that reflect, explain or hypothesize the means to promote social
learning (learning about, from and with each other) which is achieved in groups and
mediated by social actors. These theoretical frameworks underpin the guidance to
curriculum developers as shown in Table 14.2.
14.5.1.5 Select Appropriate Methods for Assessing IPL

(Challenge 1, 3 and 4)
This involves sharing the assessment regimes for each profession and (finally) agreeing
upon an interprofessional assessment strategy. The following are areas to consider:
• Decide if the assessment will measure learning in action (e.g. how students
behave during interprofessional learning) or the attainment of learning outcomes
(knowledge recall). There has been a recent growth in the use of competence
frameworks to assess the knowledge, skills and attitudinal components of IPL
(Reeves 2012; Wilhelmsson et al. 2012). Consider also capability frameworks
(Gordon and Walsh 2005).
• An assessment strategy where interpretation offers some flexibility because it
can be used for the IPE assessment while satisfying profession-specific require-
ments. For example, a case study report or essay following patient-centered,
practice-based IPE could both fulfill the professional requirements and the
agreed local IPE assessment strategy.
• A trajectory of assessments to show progression over time, for example, a
Professional Portfolio. A progressive accumulation of learning can show student
development along the continuum from novice to expert. Also, the use of a
Professional Portfolio is now popular across the professions gaining increased
importance in medicine (Buckley et al. 2009). As there is overlap between the
aspects of learning for professionalism and interprofessionalism, a Professional
Portfolio can combine both of these assessments (McNair 2005).
• The value of practical examinations to reveal student performance. Today, in
health and social care, it is common to combine performance examinations with
written examinations. Miller has drawn attention to the need to assess student
knowledge (‘Knows’), competence (‘Knows how’), how this knowledge is
applied (‘Shows how’), and the more challenging aspect of what students do with
this learning when in practice (‘Does’) (Miller 1990).
Table 14.2 Guidance for curriculum developers (Adapted from O’Halloran et al. 2006)
Questions to be asked of all IPL activities
Will the activity provide the students with a productive learning experience? Is it relevant
and will it allow students to meet the learning outcomes?
Is it sufficiently challenging? (e.g. Is it based on realistic cases from practice; is it at the correct
academic level?)
Is there adequate support in place? (e.g. Are appropriate learning or technical resources available;
will access to a facilitator be needed?)
Will students have control over their own work? If the activity is overly prescribed, the group
will have no freedom to decide how to tackle the task
Does it require students to formulate questions and seek the help of other group members?
Does the group have to produce something (e.g. a report, a presentation, public information)?
Does it only require students to act as representatives of their profession in a way that is
appropriate to their stage in their program? (e.g. Final-year students can be expected to
provide an informed professional perspective on a practice problem, but first-year students
could be asked to research which professions would be involved.)
Will the activity generate genuine interdependence? Do the students have to depend on
each other to complete the exercise successfully?
Does it allow division of work between members of the group? When the work is divided are
there enough tasks and roles to ensure everyone has an essential contribution to make?
Will it allow group members to contribute unique skills that will enable the group to achieve
goals that the individuals otherwise could not? These may be professional (e.g. negotiation
skills, data analysis) or non-professional (e.g. artistic ability, IT skills)
Will it require students to share resources such as information, meanings, concepts and
conclusions?
Does the assessment reinforce the inter-dependence? Are the students assessed as individuals or
as a group? Is everyone in the group subject to the same assessment? Are the consequences of
passing or failing the same for each profession in the group?
Will the activity foster differentiation and mutual inter-group differentiation? Will the
activity allow students to explore the differences as well as the similarities in the
professions they represent?
Will each profession be able to contribute something special to the exercise?
Will the contributions to be made by each profession encourage the students to acknowledge and
value the strengths of other professions?
Will the activity allow equal contribution? Will the activity allow all members of the team
to invest in the success of the project?
Will it allow the group to generate shared goals? The patient is the reason why health and social
care professions work together and so activities based on practice scenarios, clinical cases,
service improvement, patient safety or public health challenges are helpful
Will all members have equal status? Activities must not favor one professional group over
another
It is wise to seek students’ views on assessment and encourage their involvement

in the assessment process, for example, on the use of peer assessment. Remember
to also ask for patient/service user views on work-based assessments of interpro-
fessional behaviors within practice settings (Frankel et al. 2007; Freeman and
McKenzie 2002).
14.5.1.6 Ensure Curriculum Alignment and Integration Within Core

Profession-Specific Curricula (Challenge 2, 3 and 4)
Finally, the group needs to agree how to align and integrate IPE throughout profes-
sion specific curricula (Biggs and Tang 2007; Stone 2010). This requires debate on
whether IPE is to be placed within modules at set times, versus approaches where
IPE is included as small group activities that can be easily run at different times. We
suggest avoiding too much rigidity and focusing on a pathway of learning that starts
with theory and knowledge and progresses to application for understanding in prac-
tice. Experiential learning to appreciate the complexity of effective team-based col-
laborative practice, based in practice, should be included as soon as students are
familiar with learning alongside other student professions.
To achieve this understanding, faculty development activities should include
mapping exercises to ensure that all faculty members can articulate how the IPE
curriculum-on-paper has been (vertically and horizontally) aligned and integrated
for coherence within the core profession-specific curriculum of participating pro-
fessions. Engeström’s activity theory is a useful way of looking at alignment and
unpacking the interplay of systems, and can lead to a pictorial understanding of
alignment (Engeström 2001). Figure 14.3 shows the result of a faculty development
activity that looked at how IPL informs uniprofessional learning and vice-versa.
The IPE curriculum-on-paper may be subject to formal approval, and for faculty
members involved in approval processes we suggest a seminar to assist their under-
standing of these challenges. Do try to include (or invite) a diverse audience includ-
ing academics or senior clinicians involved in university course approval, professional
and regulatory body representatives, and senior academics (e.g. Deans with resource
allocation responsibility). More specifically, this type of seminar should aim to:
1. Explain the policy drivers for IPE relevant to the approving institution(s).
2. Discuss options for the alignment of learning intentions and how this might
appear in course documentation.
3. Explain the importance of stakeholder involvement and what to look for in
course documentation.
4. Discuss the importance of leadership and how to recognize whether this has been
considered by those developing the curriculum.
5. Explain the resource implications of undertaking IPE and questions the panel
should ask about funding, faculty capacity and capability.
14.5.2 Faculty Development and the Interprofessional

Education Curriculum-in-Action
We move on to consider faculty development for translating aspirations into reality,

to the ‘IPE curriculum-in-action’ overseen by the IPE Champion and the IPE Leads.
The IPE curriculum-in-action is what faculty members involved in assigning
resources and teaching IPE ‘do’ with the IPE curriculum-on-paper. This includes
Fig. 14.3 Alignment of the

IPE curriculum within the Health and social care professions participating
core profession-specific in Interprofessional Education (IPE)
curriculum. The cylinder
represents the core
profession-specific
curriculum with
interprofessional curriculum
running through as a theme
of learning, here with three
distinct learning episodes. IPE learning events
at the beginning of a
The arrows from the IPE curriculum
alignment
events link to uniprofessional
learning as students, helped
by faculty members, integrate
and align their learning
within their professional IPE learning events
training program in the middle of a cur-
riculum alignment
IPE learning events

towards the end of a
alignment curriculum
Ongoing post-registration IPE
ensuring that sufficient time is available in the timetable, deciding whether student
learning groups meet physically in classrooms or in practice, virtually or both, the
size and professional mix of the learning groups, the number of appropriately
trained facilitators needed, what learning tasks are developed, and the administration
of the learning events. The translation of the curriculum aspirations heavily depends
upon faculty support for the IPE Champion, IPE Leads and the IPE Facilitators.
14.5.2.1 Faculty Development to Lead and Teach on Interprofessional

Education Events
The IPE Champion requires a unique skill set (Table 14.3) and we suggest that this
person attends leadership and change management courses and is supported to work
with national and international IPE organizations. (See Chap. 3 for more information
Table 14.3 Unpacking the skill set of the interprofessional education champion
Aptitudes that IPE champions should seek through faculty development
Core aptitudes
Credibility: From both the local and national IPE community which is underpinned by
educational research and androgogy which aspires others to follow
Capability: To lead and initiate the necessary steps for faculty development and to work
alongside relevant colleagues to steer the emerging joint vision
Authority: To use wisely within the IPE Community of Practice. This authority is not just that
bestowed from Heads of Faculty for chairing meetings but earned through scholarship and
professional behavior
Other aptitudes
Problem solver: Able to tackle the key obstacles in a collegial way which assures solutions
Communicator: To work closely with others using excellent communication strategies which
aim to assure the delivery of the local IPE aspirations, while ensuring to listen to all
viewpoints, to seek compromise. And to remain non-judgmental
Scholar: Through the application and alignment of theoretical thinking to curriculum design,
development and research/evaluation
Political: To be aware of linked systems and issues which could undermine IPE and to assure
solutions to sustain IPE when challenged. Seeks relevant external reference group support in
these endeavors
Reflective: Able to see things from many viewpoints and especially using second order
interprofessional reflection (Wackerhausen 2009)
Economical: Aware of financial pressures and resource issues seeking internal and external
funding where necessary
about faculty development and leadership opportunities). This would include attending
local and international conferences, for example, the conference series All Together
Better Health (ATBH VI, on-going) and Collaboration Across Borders (CAB IV, on-
going). Skill development can also be enhanced through mentoring opportunities from
within the IPE national and international community of practice. With the support and
benefits of their own professional development, the IPE Champion can subsequently
lead the development of IPE Professional Leads and IPE Facilitators.
Developing skilled IPE Facilitators is an important faculty development
role. IPE facilitation is a complex skill; it cannot be assumed that an experienced
educator, from practice or academia, will seamlessly become a skilled IPE
Facilitator (Anderson and Thorpe 2010; Anderson et al. 2011; Hammick 1998;
Howkins and Bray 2008). Our experience is that IPE facilitators need preparation
and development for their role. We offer a model to guide the faculty developer to
achieve the combination of skills required (outlined in Fig. 14.4).
Educators usually develop an understanding of the interprofessional course
content quickly. Skilled IPE facilitation means recognizing the primacy of learning
rather than teaching and the ability to appreciate and reflect from multiple profes-
sional perspectives (Wackerhausen 2009). It also demands the desire to facilitate
through understanding and managing the complexity of interprofessional group
dynamics in a learning context. Faculty development should assist faculty members
to achieve an in-depth understanding of these elements of mixed profession group
teaching relevant to IPE. As previously acknowledged, interprofessional student
Fig. 14.4 Developing interprofessional education facilitators. An IPE facilitator must combine
being an Expert (a full understanding of the aspects of teaching for learning to become a pedagogue)
with competent Teaching Abilities (facilitation skills for managing small mixed-professional
IPE students groups underpinned with interprofessional values) for the management of effective
learning
groups are more diverse than many other learning groups, different not just by
age, gender or academic profile, but in respect of their reasons for choosing their
profession and over time through the process of taking on a professional identity
(Anderson et al. 2009). It follows that there can be tensions that need to be managed
as the different individuals come together to learn together, for example, when a
student from one profession thinks the approach from another profession is wrong,
or where a student feels the medical student is dominant, taking on the leadership
role unnecessarily. IPE Facilitators can be helped in this regard through appreciation
of the psychological and sociological principles of team working and learning,
which we will explore further in Sect. 14.5.3.
IPE facilitation development may include regular in-house teaching events or certifi-
cated programs. Examples of successful local programs are available (Deutschlander
and Suter 2011; Freeman et al. 2010; Freeth et al. 2005; Howkins and Bray 2008).
Successful faculty development programs develop a range of teaching competencies
and bring together mixed professional academic and practice faculty working in
small groups to mirror the student IPE experience (Anderson et al. 2009). In this way,
expert stances are shared between practice and academia, and facilitation skill sets are
exchanged. See Table 14.4 for a possible framework for facilitator faculty develop-
ment. This could be set up as a credited course or a series of certificated workshops.
The framework offers an assessment process to assure competent IPE Facilitators
who are confident to work in pairs, to team teach, and to support student interprofes-
sional learning. IPE Facilitators who are skeptics should be offered opportunities
to observe the teaching in action, working with positive role models as this can
positively change attitudes to favor IPE (Anderson et al. 2011).
14.5.2.2 Developing a Community of Practice
Putting the curriculum into action demands more than IPE champions and skilled
facilitators. It needs a community with a common interest in the development,
delivery and evaluation of IPE. Through their practice as facilitators, curriculum
developers, IPE champions or researchers, faculty members face complex challenges
and often, great uncertainty. Forming a recognized Community of Practice
(CoP) that adopts the principles presented by Wenger et al. (2002) is a valuable way
for colleagues from different professions to learn to deliver collaboratively a
successful IPE curriculum. Table 14.5 includes more details of how to do this.
A Community of Practice is particularly important in the delivery of practice-
based IPE where it has been shown to enable professional exchanges and enhance
service delivery (Lennox and Anderson 2012). Sustaining practice-based IPE is
dependent upon strong networks (Armitage et al. 2009). Note also that the IPE CoP
should, where possible, include patients/service users and students whose needs for
support may be time consuming, demanding similar processes of befriending, and
development as outlined above (Anderson and Ford 2012; Furness et al. 2012).
14.5.3 Faculty Development and the Experienced

Interprofessional Curriculum
We mostly learn about the IPE curriculum experienced by learners or, put another
way, the students’ lived experience of IPE, through evaluations and/or research
conducted for faculty committees. These data may identify issues where faculty
Table 14.4 A faculty development framework for preparing IPE facilitatorsa
Competencies for IPE
facilitation (Freeth et al. How to assess IPE facilitators’ competence
2005, p. 106) Proposed faculty development activities (Anderson et al. 2009)
A commitment to IPE and • Knowledge exchange: Ask the group to map the national (a) Informal feedback
IPP and international IPE policy requirements (e.g. on patient safety) The IPE Champion/IPE Lead asks questions and
and link research evidence on poor team working and collaborative seeks clarification for understanding from
practice to outcomes attendees
(b) Formative
• Showcase the literature on how team working enhances patient care Faculty members are helped to practice and work
through problems receiving feedback from
both peers and the session leaders
(c) Summative
The attending faculty members seeking to
become IPE Facilitators complete an IPE
Teaching Portfolio, containing:
(i) Theory applied to IPE events in which
they participate (e.g. why this design?)
Credibility in relation to the • Explore collaborative practice in modern health and social care (ii) Reflections on how the teaching event
particular focus of the • Ask faculty members to share their experience and expertise (e.g. within was facilitated (e.g. Could they have
IPE to which the mental health, child and elderly care, acute adult hospital care, public acted differently to support student
educator contributes health and other sectors) learning, were there problems? What
could have been done differently and
14 Faculty Development for Interprofessional Education and Practice
• Faculty members with expertise in research and education (non-clinical

why?)
staff) can share their expert stances (e.g. application of theory to practice
in education and health and social care delivery, educational research (iii) A reflection on observer feedback to
approaches suitable to evaluate IPE) include a personal critical analysis on
their performance
Positive role modeling • IPE Champion/IPE Leads who run the sessions should role model
what is required. In this way, the leads should team-teach
and come from different professional backgrounds
• Place participants in small and interprofessional working groups.
Discuss group tensions throughout
301
(continued)
302
Competencies for IPE

facilitation (Freeth et al. How to assess IPE facilitators’ competence
2005, p. 106) Proposed faculty development activities (Anderson et al. 2009)
An in-depth understanding • Relate adult learning theories to IPE
of interactive learning • Ask groups to design IPE using interactive teaching methods
methods and confidence • Explore psychological and sociological theories of power and difference
in application (e.g. stereotypes)
A knowledge of group • Consider how to set ground rules at the start of IPL
dynamics • Ask participants to practice managing poorly functioning groups by
working through real examples from IPE events. Ensure facilitators
understand how to remain non-judgmental and to motivate group work
and encourage student group discussions
Valuing diversity • Share medical and social models of health
and unique contributions • Share the value base of the professions
• Discuss patient/service user-centered care

Balancing the needs of • Set up debates and discussions on corrupting factors in team working,
individuals and groups leadership battles, etc
• Explore Belbin’s (1993) model of group roles
Inner conviction and good • De-brief on how those leading the session role model IPE facilitation.
humor in the face of Share examples within the group
difficulties • Explore the use of humor to dissipate group tension
a
The competencies for IPE facilitation are adopted from the literature as shown
L. Anderson et al.
Table 14.5 Developing an interprofessional community of practice (CoP)
Principles of designing a community of practice
(from Wenger et al. 2002) Strategies for application
Treat the development and delivery of an IPE Allow facilitators, curriculum developers, IPE champions and researchers, practitioners from
committee as an evolutionary process different professions, faculties and institutions to share their interests. The IPE agenda evolves
from the CoP participants
Create an open dialogue between people inside Enable a dialogue between the members of the CoP themselves and those outside (e.g. students,
and outside of the CoP academics from other disciplines-education, psychology, and external reference groups such as:
the UK Centre for Interprofessional Education (CAIPE); Canadian Interprofessional Health
Collaborative (CIHC); Australasian Interprofessional Practice and Education Network
(AIPPEN); American Interprofessional Health Collaborative (AIHC)
Invite different levels of participation There are three levels of participation in a CoP. The core group, the active membership and
peripheral membership. The core group forms the strategic and operational committees, those
engaged in IPE while the peripheral members may in the future take on this role if they are
helped to perceive the benefits. Although active participation is encouraged, it should not be
forced. Different faculty members may play different roles at different stages of development.
Faculty members may begin as facilitators when they first enter the community but progress to
greater involvement as curriculum designers and eventually IPE champions as their skills and
confidence develop
Focus on value Involvement in the CoP must have an active value for its members who can perceive benefits
(Anderson et al. 2011)
Develop both public and private community A CoP is about building strong individual relationships between its members. Public spaces may
spaces include seminars, workshops, facebook pages, blogs and discussion forums open to all faculties
14 Faculty Development for Interprofessional Education and Practice
to attend and discuss. Private spaces are more protected and include confidential spaces such as
emails between selected individuals or special interest groups engaged in more discrete or
focused activity
Combine familiarity and excitement The CoP should mix a set of activities to generate comfort and familiarity, while novel activities
such as away days need to be included to maintain vibrancy
Create a rhythm for the community A regular pattern of activity should be established in the IPE CoP. This could include a schedule of
working meetings, a seminar program to promote sharing of ideas, teleconferences focused on
particular projects, with a central tenet that during these activities participants learn about, from
303
and with each other

development has worked and also where it is failing to achieve its goals. This should
lead to an assessment of what further faculty development is needed and/or may
help identify small issues for immediate short-term attention.
Student assessment outcomes can similarly alert faculty to concerns that warrant
a review of faculty development. The faculty development leadership team needs to
ensure on-going faculty meetings to work through each issue. Involvement of a
student consultative group and/or researcher(s) able to analyze and collate random
samples of uniprofessional student focus group material will ensure clarity of the
priority of student concerns. Faculty away days provide opportunities for IPE
Champion(s)/Leads from participating professions to have protected time to re-
explore and review the IPE strategy, leading to a redesigned curriculum-on-paper
and in-action that takes account of student experiences of IPL.
We have already highlighted how learning within IPE sessions is different for
every learner because of what each of them brings to the learning context. Our
experience, supported by the literature (Anderson and Thorpe 2010; Carpenter and
Hewstone 1996; Hean et al. 2006), is that there are some common issues within
interprofessional learning groups. These include what students feel during the IPE
experience, such as negative stereotyping, and may depend on how well students are
prepared for the difference of IPL to uniprofessional learning and the perceived
relevance of the session and how it relates to practice (Freeth et al. 2005). Table 14.6
offers some ideas for faculty development relating to these issues.
The underpinning differences between student groups can be easily understood
by considering social capital theory described as ‘an unceasing effort of sociability,
a continuous series of exchanges in which recognition is endlessly affirmed and
reaffirmed’ (Bourdieu 1997, pp. 51–52). The learning, skills and trust of other profes-
sional groups created within this exchange is cumulative in nature, constituting social
capital, and encourages the learner to reinvest and build future collaborations when
joining interprofessional teams in practice. The advantage gained through this social
network may be afforded to some but denied to others. Similarly, not all professionals
come to the IPE learning group on a level playing field. Students may bring in social
capital (and other forms of capital such as human capital) from their professional
groups (or other networks) that afford them greater status, skills and/or experiences.
This enables them to take advantage of the knowledge transfer that happens in the
IPE group to a greater degree than other learners denied these networks.
Student engagement by faculty members should be encouraged with greater
understanding of the local possibilities and constraints for IPE. Students can become
peer-teachers and support the development of the IPE curriculum where a collegiate
approach is taken.
14.6 Conclusion
There is growing evidence of the value of interprofessional faculty development

(Simmons et al. 2011). Preparing tomorrow’s workforce for interprofessional practice
requires IPE to be carefully woven into health and social care professional education
Table 14.6 Listening to the students’ experiences of interprofessional education: messages for
faculty development
Issues which might hinder
student learning Proposed faculty development activities
Students arrive unprepared Design written materials (handbooks) and verbal materials (virtual
for the IPE activity or actual presentations) for preparing students for IPE. These
could be shared within the IPE faculty community using blogs
and wikis (e-technology). Design other educational tools
(e.g. short films) to help orientate students see: http://youtu.be/
Fh7tIr4Tl1o
The TIGER Open educational resources have materials for
re-purposing to help students to get the most out of group
learning (TIGER 2012)
Ensure student preparation for IPE is part of the IPE Facilitator
training. Ensure IPE facilitators have the skills to engage all
students at the beginning of any event using relevant ice
breakers and developing ground rules
The IPE Champion may need to convene a meeting with all IPE
Leads to ensure the same approach is followed for student
preparation by all schools
Students fail to learn IPE Champion and IPE Leads will need to revisit the location and
because of the location reflect on student insights. Change venues where they are not
and the environment conducive for IPE
Develop partnerships with students so that they better understand
why certain environments are chosen for IPE and seek their help
to get the environment right. This may mean students represen-
tatives at IPE faculty curriculum meetings
Re-assess all materials that inform students about the ‘place’ for
IPE and prepare design materials to help orientate students to
the location
Agree upon a neutral learning environment where an emphasis is
placed on equality between participants
IPE Champion and IPE Leads work to develop relevant clinical
sites for IPE in practice
Students are overwhelmed Reflect on the content of IPE facilitation to ensure IPE Facilitators
by the status, power and can recognize these issues and deal with them in a collegial way
territory of some or one during the sessions. This may include engaging students in
of the participating debate on power and territory in health and social care practice
student professions Run events with facilitators to enhance their understanding of these
issues from a theoretical perspective using, for example, social
capital theory (Bourdieu 1997)
Students fail to recognize The IPE Champion and Leads should review the curriculum map
the learning content for each school(s) to ensure the content of IPE has relevance for
as it does not apply all students participating in the IPE curriculum
to their future work Liaise with clinical practitioners to ensure participating students are
(e.g. authenticity aware of how the IPE is appropriate for their learning
of the event) requirements
Run a student focus group to seek their views on orientation for,
and engagement in, IPE
curricula. This, in turn, is dependent upon effective faculty development for all
faculty members involved.
In this chapter, we have suggested how to best achieve faculty development
across the diverse faculty groups involved in IPE, planning and delivery. Our aim
has been to highlight effective ways to move the three IPE curriculum components,
the curriculum-on-paper, the curriculum-in-action and the curriculum experienced
by the learner, into closer harmony. A future challenge for faculty development is to
ensure that faculty members are able to correctly direct the pace and direction of
movement of each component. The question of what should move where will only
be answered when all three are based on sound theory, shaped by evidence, and
faculty members can apply this understanding to their teaching.
For long lasting acceptance of the curriculum-on-paper there is a need for opportu-
nities for faculty from the different professions to learn to continue to work together. In
this way, the separate professional education activity systems embed an IPE curriculum
that is likely to endure. Sustainability is also enhanced through the development of a
Community of Practice. Here, a learning environment built on strong interpersonal
relationships between faculty, alongside students and patients/service users, supports
its members through the complexities of IPE development, delivery and review.
The IPE curriculum needs to maintain credibility and nowhere is this more so
than within practice. The current trend is to develop practice-based IPL that is
focused on learning within already effective team-based care (e.g. rehabilitation,
cancer care, mental health, further enriching faculty and benefitting patients)
(Kinnair et al. 2012). This enables students to see interprofessional practice (IPP) at
its best. Other clinical settings where teams are more fluid and practice is fraught
with challenges are marginalized. They miss the potential to transform their practice
and improve health and social care outcomes. These practice settings present new
challenges for faculty members developing the interprofessional curriculum-on-
paper and for faculty development initiatives aimed at supporting their work.
A successful curriculum-in-action requires the development of leaders and team
members who understand how to best deliver the curriculum-on-paper. Here,
faculty development aims to develop in faculty members the same interprofessional
competencies set for students: team working skills, an understanding of other
faculty roles and responsibilities, the ability to communicate across professional,
faculty and institutional barriers, and dealing with uncertainty. These are always
likely to feature in interprofessional faculty development initiatives, but in the
future we will need facilitators who are in tune with twenty-first century learning.
This means greater use of information technology and social media, and recognizing
the role of individual learning. We will need facilitators who can empower and
support students as they translate the curriculum-on-paper into their own curriculum-
in-action, especially in practice settings. ‘In situ’ faculty development, as suggested
by Silver and Leslie (2009), may well suit emergent IPE practitioners already
used to interprofessional learning and keen to guide practice-based interprofessional
learning in their work settings.
The curriculum experienced by learners offers important clues to tailoring
faculty development following implementation of the planned IPE curriculum.
But, in writing this chapter, we have realized the lack of material from the learner
experienced curriculum available to guide faculty development initiatives. In the
future, we would hope for enhanced use of program evaluations and robust research
to identify key mechanisms for bringing the experience of interprofessional
learning closer to the curriculum-on-paper, and for ensuring that this is driven by
student learning needs.
The curriculum model used in this chapter offers a theoretical basis for research
into the mechanisms needed for effective and sustainable interprofessional faculty
development. In turn, this will lead to an evidence base for faculty development
for IPE and IPP. There is an on-going need to refresh interprofessional faculty
development as emerging practitioners who have experienced IPL in pre-registration
programs and continued professional development courses shape and naturally
develop IPE opportunities within practice. We suggest that future faculty development
needs to be continually shaped by the views of patients, service users and students,
the fresh insights offered by developments in the theory of interprofessional learning
and practice, and the growing evidence base of IPE and IPP.
14.7 Key Messages
• Faculty development for interprofessional education involves building strong

partnerships with diverse stakeholders, including students, clinicians and colleagues
from external organizations.
• Interprofessional faculty development aims to enable faculty members to understand
the work and values of colleagues from other professions and institutions.
• As interprofessional education becomes a key part of professional curricula, faculty
development has a role in helping faculty adapt and extend their teaching skills
repertoire.
• Interprofessional faculty development is an opportunity for faculty to experience
and understand the processes of interprofessional learning and practice.
• Well planned interprofessional faculty development has the potential to enrich
and enhance all teaching, learning and research activities across university and
related practice settings.
Acknowledgements The authors wish to thank Dr. Deborah Craddock (formerly of the University
of Southampton) for her contribution to the early ideas of this chapter.
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Chapter 15
International Faculty Development
Partnerships
Stacey Friedman, Francois Cilliers, Ara Tekian, and John Norcini
15.1 Introduction
International faculty development partnerships are relationships that form for

mutual benefit and seek to achieve shared, and sometimes complex, goals such as
improved health care. They are motivated by a desire to achieve specific goals more
effectively than any partner could independently (Kolars et al. 2012; Leffers and
Mitchell 2011). They are also a response to the globalization of health professions
education, research, and practice (Marchal and Kegels 2003). Globalization includes
conceptualizing health professions education in global terms, with cross-border
integration and exchange of ideas and resources (Hodges et al. 2009). International
faculty development partnerships have variously been called collaborations, networks,
coalitions, alliances, consortia, task forces, joint-working, and twinning (Dowling
et al. 2004). The term partnership will be used for the purposes of this chapter.
S. Friedman, Ph.D. (*)

Foundation for Advancement of International Medical
Education and Research (FAIMER), Philadelphia, PA, USA
F. Cilliers, M.B., Ch.B., M.Phil., Ph.D.
Education Development Unit, Faculty of Health Sciences,
University of Cape Town, Cape Town, South Africa
A. Tekian, Ph.D., MHPE
Department of Medical Education, College of Medicine,
University of Illinois at Chicago, Chicago, IL, USA
J. Norcini, Ph.D.
Foundation for Advancement of International Medical
Education and Research (FAIMER), Philadelphia, PA, USA

312 S. Friedman et al.
For institutions that participate, partnerships may build global awareness of the
institution, improve student recruitment and faculty retention, and provide a resource
for students, faculty members, and alumni (Kanter 2010). Well-functioning partner-
ships allow faculty to be exposed to different methods of teaching and learning,
expanded opportunities for research, and clinical contexts, materials, and methods
that they may not encounter locally (McAuliffe and Cohen 2005). Moreover, they
allow faculty to expand their networks of collaborators and the communities of schol-
arship in which they work. There are similar advantages for students in the schools
that are involved in faculty development partnerships, realized either indirectly via
faculty exposure or directly where student exchanges are part of the faculty devel-
opment partnership, allowing students to experience different patient populations,
develop cultural sensitivities, and learn about other healthcare systems.
International faculty development partnerships arise in response to a range of
needs and opportunities, but they all seek to enhance the quality and relevance
of education as a means of achieving their goals. One of the biggest needs some
faculty development partnerships seek to contribute toward addressing is that of
inadequate quality, quantity, and/or distribution of health care workers in both high
and low income countries (Norcini and Banda 2011; WHO 2008). One dimension
of this need is the production of enough health workers with basic and advanced
qualifications that are relevant to the needs of the community (Scheffler et al. 2009).
Another dimension is the ability to offer faculty members adequate and appropriate
opportunities for professional growth in their own institutions and a satisfactory
local environment in which to function (Marchal and Kegels 2003). Professional
and personal factors that may influence faculty decisions to relocate to a different
institution, country, or region include remuneration, access to equipment and advanced
technology, career and training opportunities, skills development, professional
network creation, opportunities for career advancement, work environment, opportu-
nity for experience in a different environment, regional politics of health care, desire
to improve medicine in region, social conditions, personal safety, degree of personal
freedom, and family issues (Burch et al. 2011; Burdick et al. 2006).
As illustrated by the examples in this chapter, international faculty development
partnerships differ (and evolve over time) in structures and purposes, and in the
corresponding degree of organizational independence (Gajda 2004). Organizational
independence can be conceptualized along a continuum from cooperation (where
fully independent organizations share information) to coordination (where indepen-
dent organizations align activities or co-sponsor events) to collaboration (where
organizations give up some independence to achieve mutual goals).
Partnerships also vary in terms of partner resources and needs. The nature of
partner contributions and benefits differ in part depending on partner resources and
needs. For partnerships between relatively well-resourced and resource-limited
institutions, the well-resourced may in part be motivated by altruism, as well as the
potential for enhanced reputation, influence, and broadened perspectives and
knowledge. The ideal partnership would be one in which there were equal, if distinct,
benefits to each partner involved. Einterz et al. (2007) argue that equity, rather than
equality, should be a characteristic of productive relationships, given that ‘medical
15 International Faculty Development Partnerships 313
systems in the developed and developing world are inherently unequal’ (Einterz et al.
2007, p. 813). Partnerships are supported by mutual contributions and benefits. This
entails empowerment of all partners and a focus on fostering institutional strength.
In this chapter we will describe: (1) individual, institutional, system, societal,
and relationship benefits of international faculty development partnerships; (2) ways
in which international partnerships to date have been structured, of which we will
provide examples; and (3) factors that support the quality and strength of partner
relationships.
15.2 What Are the Benefits of International Faculty

Development Partnerships?
There are inevitably multiple stakeholders in international faculty development

partnerships, each operating within a different context and each with unique needs
and strengths. Stakeholders include individuals, their institutions, and the societies
and systems – including national healthcare and education systems – in which these
institutions are situated (see Fig. 15.1). Organizations providing funding for
partnership programs may also have an interest in partnership outcomes.
Each category of stakeholder (individuals, institutions, systems) derives different
benefits from partnerships, as shown in Table 15.1. In addition, there are benefits
distinctly related to the relationships between stakeholders. Achievement of any
of the benefits will depend on well-functioning relationships, and so these are
shown as central in Fig. 15.1. Faculty development evaluation has often focused
Fig. 15.1 Components

of international faculty
development partnerships
Table 15.1 Benefits of international faculty development partnerships

A. Individual benefits
New/expanded learning opportunities for faculty and students, resulting in knowledge/skill/
attitude/behavior changes
Broadened perspectives on health professions education (learning about healthcare and education
practices and values in different countries and cultures)
Increased faculty preparedness for teaching, leadership, and other roles (broadly, or in educa-
tional areas)
B. Institutional benefits
Enhanced institutional reputation (by being seen as innovative, involved in global health)
Financial/resource benefits; strengthened institutional financial status; funding (resource sharing
between partner institutions, resources from third parties external to partner institutions)
Development of sustainable capacity for ongoing faculty development
Education innovations or improvements
C. System and societal benefits
Strengthened education system (broadly, or in specific specialty areas)
Strengthened health care (broadly, or for specific health issues)
Enrichment of international practice of medicine and health professions education as well as health
sciences and health professions education knowledge
Movement toward consideration of global standards/competencies as applicable
D. Relationship benefits
Development of, or improvements in, relationships between faculty members (through
development of and participation in programs)
Development of an international community of health professions educators
on individual-level outcomes; however, there is increasing recognition of the need

to examine ‘relationship’ aspects of faculty development (Asthana et al. 2002;
El Ansari et al. 2001; Halliday et al. 2004; O’Sullivan and Irby 2011).
15.2.1 Individual Benefits
Potential benefits to those involved in any faculty development program will vary
with the nature of the program being offered, and such benefits have been extensively
treated in other chapters in this book. However, some benefits are particular to indi-
vidual faculty members participating in an international program. Exposure to fac-
ulty and ideas from other countries, as well as to health care and culture in new
contexts, can be motivating to faculty (Kanter 2010). Participation in partnerships
can contribute to faculty and student growth by enhancing their knowledge about
illness and wellness in different cultures and can thereby enrich their practice of both
health professions education and health care (Brook et al. 2010; Kanter 2010).
Benefits might also include enhanced work satisfaction accrued from participating in
innovations in health professions education in low resource settings (Kolars et al.
2012). Greater professional recognition and advancement may also accrue to
individuals for involvement in such partnerships (Tekian and Dwyer 1998).
15.2.2 Institutional Benefits
Most faculty development initiatives are intended to increase capacity and improve
the quality of education at the participating institutions. These benefits should
in turn extend to student learning and health care. Ideally, these benefits should be
such that they are sustained beyond the duration of the faculty development
partnership. The design of the initiative would be one crucial factor among several
in determining whether any benefit accrues beyond participating individuals (Grossman
and Salas 2011; Holton et al. 2003).
Involvement in partnerships can result in resource sharing or development by
partners. These resources could be materials or access to facilities or exposure to a
disease profile not common to one or the other institution. Involvement in partner-
ships can also generate access to funding that allows the development of capacity
that would not otherwise be possible in resource-constrained environments (Kanter
2010; Kolars et al. 2012). Institutions involved may benefit from funding of external
agencies (such as grant funding) that is channeled through their institutions.
This funding may augment departmental and/or institutional resources by buying
out faculty time for their involvement in the partnership.
When the faculty development partnership is between institutions from high and
low income countries, the value proposition for partners from high income nations
may be in part altruistic (Kolars et al. 2012). Helping to improve the quality of
health professions education or health in resource constrained settings can enhance
the reputation of institutions from high income countries (Kanter 2010).
Moreover, the reputation of all partners can be enhanced through collaboration
and development of innovations (Kanter 2010). Involvement in international
collaborations can gain credibility for partners with influential role players like
legislators and national, regional, and international funding agencies (Conaboy
et al. 2005; Tekian and Dwyer 1998). Over the longer term, benefits such as these
could strengthen institutions by allowing them to attract better faculty and students
(Kanter 2010).
15.2.3 System and Societal Benefits
The ultimate goal of many international faculty development partnerships is

strengthening health care in their countries, typically by way of strengthening educa-
tional systems (Kanter 2010). The focus of international partnerships may be on a
major illness, an area of specialty training, or more general areas of education.
Faculty development that enhances education in partners’ countries may contribute
to the retention of health workers, especially where health care worker migration
is an issue (Burch et al. 2011; Clinton et al. 2010). Stemming this migration, both
between countries and from underserved (often rural) areas within countries, poten-
tially reduces the costs of meeting the health needs of a nation (Kanter 2010).
Relatively small faculty development initiatives cannot hope to address major

societal issues such as the small number of universities graduating health profes-
sionals and the small number of graduates they deliver. However, issues like faculty
preparedness to teach, curriculum development skills, the ability to network with
other health professions educators, and preparation to assume leadership and
management roles in the health care system (Kolars et al. 2012) can be addressed
by such initiatives.
Faculty development partners from high income countries may benefit to some
degree by contributing to the realization of humanitarian goals like improving
the quality of health professions education around the world (Guo et al. 2009),
enhancing health in a district or nation where resources are limited, and helping
solve pressing health problems by improving the quality and relevance of the educa-
tion of health professionals (Kanter 2010; Kolars et al. 2012). Strengthening health
care and enhancing health in lower income countries may have benefits that extend
to all partners. For instance, this could contribute to decreasing the spread of illness
from one country to another (Kanter 2010). As importantly, much can be learned
from the solutions to challenges encountered in low resource environments. Finally,
mutual engagement across cultural and resourcing divides can build knowledge
about the practice of medicine and of health professions education that can enrich
these practices internationally.
15.2.4 Relationship Benefits
It may sound obvious to say that partnerships are about relationships, but in fact
there are distinct benefits related to a partnership comprised of well-functioning
relationships. Partnerships can build teams and strengthen networks (Kolars et al.
2012). Lessons learned about facilitators and challenges of relationship sustainability
and success can be applied to strengthen and expand international partnerships
(Tekian and Dwyer 1998). Extended partnerships can contribute to the development
and strengthening of international communities of health professions educators.
15.3 Examples of International Faculty Development

Partnership Programs
Each international faculty development partnership has arisen from a unique set of
perceived needs and available resources. This section will briefly describe some
partnership programs. It is important to note that one partnership may yield multiple
programs. Likewise, faculty development may be one component of an interna-
tional collaboration (e.g. a collaboration to start a new medical school that includes
faculty development as one component). Programs in this section have been selected
on the basis that faculty development through sustained institutional partnerships is
a substantive component of the overall program. Not included here are international
and regional conferences, consortia, committees, and task forces such as those
supported by the Association for Medical Education in Europe (AMEE), the World
Health Organization (WHO), and the World Federation for Medical Education
(WFME), all of which have broader health professions education oversight and
improvement goals (e.g. Conaboy et al. 2005). Examples were also selected based
on the availability of information about the program.
The following sections offer a few examples of varied partnership program structures
that include coordinating organizations with multi-institution participation; health
professions education degree- and diploma-conferring institutions; and two-institution
partnerships. They are not intended as an exhaustive listing of partnerships. Each
program’s ‘desired benefits’ are those identified in the literature, and may not include
all levels of benefits described in the previous section of this chapter.
15.3.1 Coordinating Organization with Multi-institution

Participation
International partnership programs that involve a central coordinating organization

with multi-institution participation are capable of global reach. The following two
examples illustrate this geographic breadth.
One example of a program run by a coordinating organization is The Harvard
Macy Institute: Program for Educators in Health Professions (http://www.
harvardmacy.org; Armstrong et al. 2003; Armstrong and Barsion 2006; Armstrong
2007). Program faculty come from a range of institutions and countries. Some
program alumni are involved as faculty. International participants are healthcare
professionals with a role as educators. The program was established with a grant
from the Josiah Macy Jr. Foundation, and additional funding comes from tuition
fees paid by participants. Additional support comes from faculty and staff time from
Harvard and other institutions.
The program consists of two residential sessions about 4 months apart. There are
five curricular themes: learning and teaching, curriculum, evaluation, leadership,
and information technology. Participants undertake an educational project (e.g.
revision of curriculum or implementation of a faculty development program in the
participant’s home institution). The informal curriculum is noted to be as important
as the formal curriculum (i.e. largely ad hoc interpersonal interactions between and
among students and faculty are as important to the achievement of program goals as
the formally stated and intended curriculum).
Desired benefits of the program include enhancing the professional development
of health professionals as educators, supporting institutional changes via changes
in participant teaching behaviors and professional activities, and developing
communities of practice across disciplines and institutions. Evidence of goal
achievement includes participants’ (learners’) report of:
• Increased awareness and use of a greater array of teaching methods; increased

knowledge about and comfort with active learning.
• Increased enthusiasm for and commitment to medical education as a primary
career direction and stronger identity and confidence as a medical educator.
• New understanding of, and appreciation for, ways in which medical education is
implemented in institutions nationally and globally (i.e. broadened perspectives).
• Evidence of organizational change via participant behaviors (e.g. additional
projects, joining educational committees, educational grant applications).
• Creation/expansion of a global network of resources and connections, including
support from like-minded colleagues.
The Foundation for Advancement of International Medical Education and
Research (FAIMER): FAIMER Institute and FAIMER Regional Institutes are
also examples of programs with a coordinating organization (http://www.faimer.
org; Burdick et al. 2006, 2007, 2010, 2011, 2012; Norcini et al. 2005). The FAIMER
Institute program has on-site sessions based in the USA with international participants;
FAIMER Regional Institutes have on-site sessions and participants based in their
regions (including programs based in India, Brazil, China, and South Africa). The
core program faculty and leadership include FAIMER personnel, alumni of the fel-
lowships (including local alumni for the Regional Institutes), and other international
faculty. Health professions educators apply in a competitive process to participate
in the fellowship programs, with evidence of institutional support as part of the
application process. FAIMER provides partial funding and in-kind support for
the fellowships. Regional Institutes provide in-kind support. The Brazil program
is largely funded by the Brazil Ministry of Health. Fellows and their institutions
share costs of the program, with each program working on a slightly different cost
sharing model. Fellows and alumni are occasionally funded to attend national and
international health professions education conferences, based upon advancing
collaborative projects.
The FAIMER programs are 2-year fellowships, with two residential sessions (at
the start of each year) interspersed with an 11-month intersession of learning at a
distance. An educational innovation project is central as an opportunity for hands-
on application of fellowship learning and work towards institutional or regional
change in health professions education. Community building occurs via extensive
interaction during residential sessions, overlap of the on-site sessions of year 1 and
2 fellows, and continued engagement with program alumni.
Desired benefits of the programs include strengthening fellows’ skills in
health professions education methods, leadership, management, research, and
scholarship. At the institutional level, there is the desire to improve health pro-
fessions education in the fellows’ home institutions and countries/regions, stimu-
late growth in the field of health professions education, and improve opportunities
for professional advancement. The programs also aim to build a transnational
community of practice by creating a critical mass of health professions educators
and facilitating interaction, resource sharing, and collaboration. Evidence of goal
achievement includes the following:
• Fellows have reported applying knowledge and skills gained from the fellowship
experience in their home institutions, including achievement of a range of project
outcomes.
• The majority of fellows have reported that their educational innovation projects
have been incorporated into the curriculum or institutional policy, and/or
replicated in their institution or another setting.
• Follow-up data indicate that fellowship program alumni have health professions
education career paths, produce education scholarship, engage in collaborative
projects, and serve as resource experts in health professions education.
• Fellows have reported a community of practice characterized by support, shared
learning and problem solving, and a network of expanded breadth in terms of
geographic diversity and expertise.
As the above examples illustrate, the coordinating organization model of interna-
tional faculty development programs is distinguished by not only geographic breadth
of reach but also a desire to build international communities of practice. This latter
distinction also may involve on-going relationships with program graduates.
15.3.2 Health Professions Education Degree-

and Diploma-Conferring Institutions
International partnerships for health professions education degree/diploma programs

(Tekian and Harris 2012) vary in the roles of each partner institution (including
degree conferral), and plans for long-term sustainability (e.g. joint degree program
versus capacity building for program administered by one partner institution). Two
examples are offered here in order to illustrate this variation.
The Joint Master of Health Professions Education (JMHPE) Maastricht
University – Suez Canal University (http://www.maastrichtuniversity.nl/web/
show/id=449891/langid=42; http://www.themedfomscu.org; Mohamed et al. 2012)
involves core program faculty and leadership from both Maastricht and Suez Canal
Universities. Global faculty are chosen from program graduates. Participants are
graduates of any health professions education institution (e.g. medicine, nursing,
dentistry, pharmacy, health sciences, physiotherapy, and speech therapy). Participants
include presidents of universities, deans and vice deans of health professions educa-
tion institutions and full professors.
The program is a 1 year (9 blocks) Master program, conducted entirely via distance
learning. By the end of the program a master degree is jointly granted, and the
certificate is co-signed by both Maastricht and Suez Canal Universities.
There is WHO sponsorship for the program. Most participants are either self-
funded and pay the full tuition fees, or get partial fellowship funding from the WHO
and pay part of the fee. A few participants get a full fellowship from the WHO that
covers all program expenses including the full tuition fees and travel costs to attend
their graduation. Some participants share costs of the program with their institutions.
JMHPE Management provides limited full/partial funding for joining the program.
Desired benefits of the programs include equipping participants with the knowledge
and skills required for a career in health professions education and research, and
developing critical masses of graduates who can actively participate in the enhancement
of medical education in their home institutions. Evidence of goal achievement
includes the following:
• Program graduates and participants (learners) report that the program supports
increased knowledge of health professions education as well as enhanced capacity
building and career development at the national, regional, and international levels.
• The Medical Education Department of Suez Canal University was awarded a
Leadership and Management Award in 2010 by Management Sciences for Health,
an international non-profit organization working with individuals, communities
and institutions in developing nations to build stronger health systems, improve
health services, and respond to priority health problems.
Another example of a degree- or diploma-conferring partnership is the University
of Illinois at Chicago (UIC) and KLE University in Belgaum, India – Diploma
and Masters in Health Professions Education (MScHPE) program (http://www.
kleuniversity.edu.in/udeph/index.html; A. Tekian, personal communication, August
22, 2012). The core teaching faculty for this program come from UIC and are
full-time professors. There are other local faculty as well who were trained at UIC.
All the participants come from India. Priority is given to KLE University faculty
members; however, a few health professionals from neighboring provinces are
accepted as well. All participants are health professionals, with the majority from
medicine, dentistry, and nursing.
This is a 2-year program, with mandatory week-long courses offered at regular
intervals. All course material is developed at UIC taking into consideration the Indian
context of education and culture. Completion of the program requires a capstone. The
primary advisor is from UIC and the thesis committee consists of three faculty mem-
bers. All capstone projects are presented at an Annual Conference in health professions
education held in Belgaum. Diplomas and degrees are offered by KLE University.
The program is funded by KLE University and is housed at the University
Department of Education for Health Professionals (UDEHP). UDEHP provides
in-kind support for the daily operation of the program, including coordination of
communication, educational resources such as handouts, and the physical facility.
KLE University provides lodging accommodations located on campus for all inter-
national teaching faculty. Tuition fees are subsidized and participants are supported
by their institutions, or pay themselves.
Desired benefits of the program include acquisition and improvement in knowledge
and proficiency in essential skills in medical education, including teaching and
learning, curriculum development, scholarship, and leadership. It is also hoped that
program participants will act as change agents and resources within their colleges
and departments, promote collaboration institution wide, and help to create an
educational climate within the institution that fosters excellence in education and
scholarship. On a systems level, it is hoped that the program will strengthen the edu-
cational system nation-wide by fostering dissemination of educational innovations
within the country’s higher education system, within institutions associated with
the Ministries of Health and Education, and through professional societies. The
program also aims to support relationships among participants in order to create a
community of practice among health professionals who exchange ideas and share
resources; to create working relationships and collaborations among institutions to
share data and conduct inter-institutional scholarship; and to prepare and submit
multi-institutional grant proposals to fund research. Evidence of goal achievement
includes the following:
• Participants of the program have been involved in introducing education changes
at their institutions (primarily KLE) and have published and presented education
scholarship. For example, the concept of competency-based curriculum has been
introduced for the first time in the College of Dentistry.
• Faculty development activities in medical education are organized and conducted
by the participants of the program. UDEHP and a few participants of the program
organized the first medical education conference in Belgaum in 2012.
• A select number of participants have been asked to serve as educational consultants
to committees that guide national policies.
• Networking among the participants has initiated multi-institutional projects
attracting research funding.
The examples above illustrate different models for partnership capacity building –
i.e. creation of a joint degree program (Suez-Maastricht) versus enhancing capacity
of one partner institution to independently offer degree/diploma conferral (KLE-
UIC). There are also differences in whether the degree/diploma program is focused
on faculty from one of the partner institutions (e.g. KLE University) or whether it is
geared to more broad dissemination (e.g. Suez–Maastricht, which also uses distance
learning to broaden its reach).
15.3.3 Two-Institution Partnerships
There are several documented examples of partnerships between two institutions in

different countries. These programs vary in their structures and goals, including
faculty development as part of a larger initiative such as development of a new resi-
dency program (e.g. Alem et al. 2010), bilateral exchange of faculty and students
(e.g. Wong and Agisheva 2004, 2007), and long-term institutional partnerships
(twinning, e.g. Lacey-Haun and Whitehead 2009; Tache et al. 2008). The following
offers some examples, not an exhaustive survey, of programs based on the Indiana-
Moi twinning partnership. This partnership includes multiple components, and has
evolved and grown over the course of about 20 years.
The Indiana University – Moi University (IU-Moi) Partnership (Einterz et al.
2007) involves collaboration between virtually all disciplines at both schools and
relationships at both individual and department levels.
Desired benefits of the partnership include achieving mutual, equitable benefits

for both partner institutions and their individual participants; developing leaders in
healthcare for the United States and Kenya; and fostering the values of the medical
profession and promoting health through collaboration and education.
One program based on the Indiana-Moi partnership is the Academic Research
Ethics Partnership (AREP). AREP has developed two Master’s degree programs,
one at Indiana University-Purdue University Indianapolis (IUPUI) and one at Moi
University. These programs have common components, joint advisory committees,
and a practicum experience partly taken at the counterpart university. Each AREP
partner convenes an annual Teaching Skills in International Research Ethics
(TaSkR) workshop to provide training to approximately 50 faculty and students
each year. AREP is funded by a $940,000 4-year grant from the Fogarty International
Center at the National Institutes of Health.
A second program based on the Indiana-Moi partnership is the Academic Model
for the Prevention and Treatment of HIV/AIDS (AMPATH). AMPATH partners
include Moi University, Moi Teaching and Referral Hospital, and a consortium
of North American academic health centers led by Indiana University, working in
partnership with the Government of Kenya. AMPATH has established a compre-
hensive HIV-care system that serves over 40,000 patients and their communities.
AMPATH has been supported by grants from multiple sources, including the United
States Agency for International Development, President’s Emergency Plan for HIV/
AIDS Relief, U.S. Centers for Disease Control and Prevention, Maternal to Child
Transmission Plus Initiative, Gates Foundation, and other private philanthropy.
Evidence of goal achievement includes establishment of initiatives such as AREP
and AMPATH, and the achievements of these programs including the opportunities
and services offered to faculty, students, and patients.
Partnerships such as the above example are distinguished by having multiple
components (e.g. student and faculty exchanges, faculty development, joint programs),
evolution over time in response to partner needs (e.g. focusing on HIV pandemic)
and collaboration with additional partners (medical institutions and hospitals,
government institutions, communities, funders) to achieve specific goals.
15.4 Descriptors of International Faculty

Development Partnerships
The previous examples illustrate some of the variations in international faculty

development partnerships. The descriptors in Table 15.2 attempt to more systemati-
cally illustrate potential variations in partnership programs. Generally there is a
collaborative relationship (i.e. partners giving up some independence) between two
or more institutions at the core of program delivery. However, there are often other
cooperative and coordinating relationships – either with additional institutions or
between the partner institutions but for other purposes. For example, the Foundation
for Advancement of International Medical Education and Research (FAIMER)
Table 15.2 Descriptors of international faculty development programs

Descriptor Explanation
Degree of organizational
While partnerships generally involve collaboration (where organiza-
independence tions give up some independence to achieve mutual goals), they
may also involve cooperation (where fully independent organiza-
tions share information) and coordination (where independent
organizations align activities or co-sponsor events)
Partners and their Backgrounds and selection of faculty development program faculty
roles and participants (e.g. geographic representation, participation of
program alumni as faculty for the program, program faculty, and
participants internal/external to partner institutions)
Desired benefits/goals Purpose, change or goal that program seeks to achieve (see Table 15.1)
Programs and processes Timing of program (longitudinal ongoing, at regular intervals, at
varying intervals depending on need). This refers to the timing of
faculty development programs; partnerships would by definition be
long-term
Credentialing (source of any degree/diploma conferral – e.g. ‘home’
institution confers degree with technical/resource support from
external institution; degree conferred by external institution)
Process and content (e.g. curricular themes; education methods)
Resourcing Funding and other resources from external third party, one/some/all
partners, program participants
programs involve collaboration with the institutions hosting and providing in-kind
resources for regional faculty development programs as well as cooperative
relationships with the institutions from which participants come. The Indiana-Moi
partnership has also led to the development of a consortium of North American
academic health centers led by Indiana University, working in partnership with the
Government of Kenya.
Thus, partnerships can be conceptualized as a set of relationships that evolve
over time in structure, purpose, and degree of independence in order to meet changing
needs and respond to emerging opportunities.
15.5 Factors That Facilitate Successful Partnerships
While there is a need for more research on success factors for international faculty
development partnerships (El Ansari et al. 2001; Glendinning 2002; Halliday et al.
2004; O’Sullivan and Irby 2011), existing literature on successful partnerships,
including international collaborations in medical education, point to relevant factors
for international faculty development partnerships (Kolars et al. 2012; Tekian and
Dwyer 1998).
‘Success’ is defined by both the process and outcomes of the partnership.
Indicators of process success include high engagement and commitment of the partners,
agreement about the purpose and need for the partnership, high levels of trust and
respect, supportive surrounding environments (financial climate, institutional and
Fig. 15.2 Factors facilitating successful international faculty development partnerships
legal structures, broader inter-organizational relationship), adequate monitoring and

evaluation of the partnership, and active and effective leadership and management
(Dowling et al. 2004).
Process success can further be divided into success with partnership formation
and success with sustaining partnerships over time (Leffers and Mitchell 2011).
Outcome success indicators relate to achievement of the individual, institutional,
system, and relationship benefits described earlier in this chapter. These may include
positive changes in the partner institutions (e.g. quality of teaching) as well as the
community being served (e.g. competence of graduates, health of community).
Outcome success is dependent upon process success in forming and sustaining the
partnership.
Figure 15.2 represents our synthesis and adaptation of ideas from the multiple sources
cited in this chapter regarding definitions and facilitators of partnership success.
15.5.1 Partnership Formation
Three key elements in the establishment of partnerships are the respective partners;
certain human, financial, and material resources; and a process of engagement (Leffers
and Mitchell 2011). Recognition and acceptance of the need for partnership, frequent
and two-way communication, mutual goal setting, adequate resources (including not
only tangible assets but also time, expertise, trust, and understanding of each other),
knowledge and information sharing, and cultural competence are cited as factors sup-
porting the establishment of partnership relationships (Asthana et al. 2002; Gajda
2004; Kolars et al. 2012; Leffers and Mitchell 2011; Tekian and Dwyer 1998).
Incorporating these factors into a partnership requires mindful planning. For
example, there is a need to recognize and minimize organizational barriers that
may impede sharing information between institutions (e.g. policies restricting
information sharing). Mutual goal setting is important to ensure that all partners
benefit; it also helps to avoid the potential fostering of dependency of one partner on
the other (Kolars et al. 2012).
Cultural competence includes being open to and valuing differences, with cultural
differences arising also from differences in organizational cultures (Asthana et al.
2002). Addressing language differences may be part of this (Wong and Agisheva
2007), along with cultural awareness, knowledge, and skills (Tekian and Dwyer
1998; Campinha-Bacote 2002). The bridging of cultures also extends to educational
cultures (Wong and Agisheva 2007). Faculty in one setting may not be accustomed
to being subjected to teaching strategies in the course of faculty development
activities that are commonplace in another setting.
In a comparison of international partnerships to establish Masters programs in
Health Professions Education (MHPE) in China and Egypt, Tekian and Dwyer
(1998) highlight the importance of effective communication and the challenges
of language differences. This includes potential difficulty with faculty members
communicating with each other and with students (in the absence of translators),
and limited use of literature in languages where faculty and students have limited
fluency. Cultural awareness, understanding of accepted values, political climate, and
the socioeconomic status of the country are important when developing international
faculty development partnerships. Thus, partners need to work toward understanding
each other’s contexts, needs, resources, and priorities, and using this awareness as a
basis for developing the partnership agenda.
Strategies to achieve cultural competence may include seeking culturally-friendly
teaching and assessment tools, resisting stereo-types, discussing features of culture
with others, reviewing the literature on identity, and participating in professional
development that addresses cultural competence (Willis 1999). Careful preparation,
including molding and tailoring a program to local needs and adapting and
supplementing the content with examples and case studies appropriate to local
environments, is also imperative to success (Tekian and Dwyer 1998).
Cultural perspectives, personal attributes, personal expectations, and knowledge
of the partner country all play a role in the development of the partner relationship.
Careful selection of faculty who are willing to teach in a different culture improves
the productivity and contribution of the faculty. Additionally, sufficient time should
be devoted for preparing faculty interested in undertaking international assignments
in order to minimize cultural misunderstandings and increase tolerance to seeing the
world through multiple lenses (Tekian and Dwyer 1998).
Citing various papers, Leffers and Mitchell (2011, p. 99) highlight the role of
various attributes for effective partnerships, including the following: ‘agreement to
partner; collegial relationships that include reciprocity, communication, mutual

support, mutual trust, respect, equality and conflict management; interdependency
that involves sharing, cooperation, and synergy between professionals; frequent
feedback; and power and leadership that is consensual and egalitarian’.
Effective communication, shared decision making, and negotiation are important
skills for effective collaboration (Kolars et al. 2012; Leffers and Mitchell 2011; Tekian
and Dwyer 1998). This is aided by face-to-face meetings between collaborators
(Kolars et al. 2012). Establishing mutually-agreed goals is part of the on-going process
of exchange. Implicit in this process is the development of a shared set of values.
Setting a clear agenda for both what constitute appropriate goals and how those
goals will be measured may help ensure an effective partnership. One way of achieving
this is devising and undertaking a needs assessment process together (Guo et al.
2009). One collective of partnerships between North America and sub-Saharan
African institutions devised ten learning questions to inform their discussions and a
framework of desired evidence at the outset (Kolars et al. 2012). Taking this a step
further, robust approaches need to be developed to assess potential benefits and risks
so that parties engaging in a collaboration are both informed about and optimally
able to address relevant issues (Kanter 2010).
15.5.2 Partnership Sustainability
As discussed in the beginning of this chapter, partnership structures and goals may
evolve over time. Mutual support and encouragement are important at all stages of
partnerships. Partners contributing energy at different stages of the process can be
important for sustainability, as are mutual benefits. Altruism alone is not a sufficient
condition for maintaining a partnership (Einterz et al. 2007).
Active and effective leadership and management and shared project ownership
have been noted to support sustainability of partnerships (Asthana et al. 2002;
Leffers and Mitchell 2011). For relationships to be sustainable, there is a need to
transcend dependence on specific individuals (since the specific individuals involved
are likely to change over time). Institutionalizing networks so that relationships and
values are part of the structure and process of how the partnership operates may
support this (Asthana et al. 2002). Evaluation of partnerships may also provide
information and accountability that is useful for improving and sustaining the
partnership (Asthana et al. 2002).
Establishing linkages with other organizations engaged in related work may
strengthen the success and sustainability of partnerships (Asthana et al. 2002). Large
collaborations may be effectively established by first establishing relationships
at personal, departmental, and institutional levels, before involving universities,
government ministries, and central governments (Einterz et al. 2007).
Attention to sustainability is in itself of great importance so that partners focus
on institutional strengthening rather than transitory relationships and benefits (Kolars
et al. 2012). This sort of capacity building may entail attention to champions,
leadership, expertise structures, policies, procedures, and resources (Leffers and
Mitchell 2011). Depending on the ultimate partnership goals, success over time
may involve transfer of program ownership from joint to one partner, once sufficient
capacity exists. There has also been a call for government and philanthropic funders
to direct support to the establishment of long-term institutional partnerships so as to
increase the likelihood of impact on building developing countries’ health systems
(Einterz et al. 2007).
15.6 Conclusion
International faculty development partnerships are often comprised of a set of

relationships that evolve over time in structure, purpose, and degree of indepen-
dence in order to meet changing needs and respond to emerging opportunities.
The potential benefits of these partnerships, and means to achieve benefits, are
varied. General factors that support successful partnership formation include fre-
quent two-way communication, mutual goal setting, setting a clear agenda, ade-
quate resources, and cultural competence. Partnership sustainability is supported
by realization of mutual benefits, effective leadership and management, shared
project ownership, establishment of linkages with other organizations, and insti-
tutional strengthening and capacity building.
15.7 Key Messages
• Building relationships is crucial for productive, sustained international faculty

development partnerships.
• Well-functioning partnerships allow faculty exposure to methods, materials,
opportunities, contexts, and contacts/networks that they may not encounter locally.
• Cultural bridging, effective and frequent communication, and mutual goal
setting are important to partnership success.
• Success in partnerships is defined by both process and outcomes success, and
rests on attention to and planning for not only partnership formation but also
sustainability.
• International faculty development partnerships vary in their structures and purposes,
with both potentially evolving over time in response to partner needs and goals.
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Chapter 16
Starting a Faculty Development Program
Ivan Silver
16.1 Introduction
Faculty development programs in medical and other health professions schools,

specialty societies, and colleges have grown steadily over the past 20 years (Al-Wardy
2008; McLeod and Steinert 2010). This surge in growth has been precipitated by the
acknowledgement that support for faculty in their roles as teachers, educators,
researchers and administrators is essential for a vibrant academic community and
culture (Steinert et al. 2006).
For the purposes of this chapter, faculty development is defined as:
The broad range of activities that institutions use to renew or assist faculty members in their
multiple roles. Faculty development activities include programs to enhance teaching and
education, research and scholarly activity, academic leadership and management, and faculty
affairs, including faculty recruitment, advancement, retention, and vitality. The intent of these
activities is to assist faculty members in their roles as teachers, educators, leaders, adminis-
trators and researchers (1st International Conference on Faculty Development in the Health
Professions 2011).
Faculty development programs have also grown in complexity in response to

recent trends and changes in health professions education. Some of these key trends
include the professionalism of health professions education, competency-based edu-
cation, technology-enhanced learning, social accountability, increasingly sophisti-
cated and standardized selection of students and assessment processes, work-based
learning, academic leadership development, interprofessional education, the use of
simulation, patient safety and quality improvement, transitions curricula, and continuing
I. Silver, MD, M.Ed., FRCP(C) (*)

Department of Psychiatry, Centre for Addiction and Mental Health,
Faculty of Medicine, University of Toronto, Toronto, ON, Canada

332 I. Silver
personal and professional development for certification purposes (Association of

Faculties of Medicine of Canada 2010, 2012; General Medical Council 2009;
Medical Deans Australia and New Zealand 2009; Patricio and Harden 2010). These
trends are also shaping the form in which faculty development is being offered.
Starting a faculty development program can be challenging for health professions
educators and administrators. The purpose of this chapter is to outline an approach
for starting a faculty development program—whether it is initiating a single hospital
department-based program addressing a focused faculty development issue, building
a program in a hospital, specialty society or college, or starting a program that
is faculty-wide, national or international. Guided by change theory and other
theoretical approaches and related models and guidelines that can inform faculty
development, we will describe the developmental steps required (Steinert et al.
2005; Steinert and Mann 2006; Wilkerson 1984).
16.2 Initial Steps in Designing a Faculty

Development Program
16.2.1 Accept the Challenge
Being asked or taking the initiative to start a faculty development program in an

organization is the very first step. The leader needs to be convinced that there is a
strong institutional willingness and support to engage in these activities, that there
are colleagues who will work with the leader, and that the program will have some
resources attached to it. When organizations don’t fully understand what might
be needed for a faculty development program to succeed, the proposed leader of the
program needs to take the time to meet with those she/he reports to, in order to
secure the necessary resources. It is very possible to start a program successfully
with modest resources, combined with strong institutional willingness for its
success. For example, one of the most compelling ways to begin a program is to
simply gather interested faculty and staff together to talk about teaching, career
development or leadership (D’Eon et al. 2000). While this isn’t a common institu-
tional practice, don’t be surprised to hear participants say, ‘I don’t understand why
we haven’t done this before. When are we meeting again?’
16.2.2 Understand the Institutional and Organizational

Culture
Understanding the institutional and organizational culture allows the faculty

development program to be responsive to the organization’s needs. This subject is
crucial, since successful faculty development programs are situated contextually
within organizations. See Chap. 6 for a further discussion of this topic.
16 Starting a Faculty Development Program 333
Ideally, the faculty development leader is integrated into the organization’s

education leadership. In a small program, where the leader of faculty development
may be the only faculty developer, this can take the form of representation on the
faculty or society education or academic planning committee. In a larger faculty
development program, this can take the form of mutual committee membership
(i.e. representation of faculty developers on key curriculum committees and
representation of university or society leadership on faculty development planning
committees). Integrating the leaders of faculty development into the key decision-
making bodies of an organization ensures alignment of the needs of the organization
with program planning.
Curricular reform is an ideal time to situate or initiate a new faculty development
program because there are more opportunities for new relationships, exchanges and
collaborations to develop; funding for resources is also more often available (Rubeck
and Witzke 1998). Health professions education is increasingly interprofessional,
and this is reflected in several new faculty development programs (Brashers et al.
2012; Moaveni et al. 2008; Silver and Leslie 2009; Steinert 2005). Faculty development
leaders need to address whether a program is oriented to single disciplines, interpro-
fessional audiences or combinations of the two. Having permanent representatives
from various health professions on faculty development planning committees can
help faculty developers and educators anticipate and integrate new and cutting
edge curricular innovations into the faculty development curricula and promote
interprofessional education.
16.2.3 Develop a Change Strategy
Whether faculty developers or educational leaders are considering initiating a

single faculty development program within a department or a system-wide pro-
gram at a medical school, speciality society or college, it is easy to be intimidated
by the challenge. Where do we start? Whom do we involve? How do we get our
colleagues to be so excited about the change that they line up to help us succeed?
Change strategies originating out of the leadership and change management
literature can be very helpful. John Kotter (1996) describes a cogent eight-step
process that can be directly applied to the context of a faculty development
program. More specifically, Kotter emphasizes issues like creating a sense of
urgency at a program’s initiation, forming a powerful coalition of partners and
collaborators, creating a vision for change that is well communicated, removing
institutional obstacles, creating early wins for the program, consolidating gains
and producing more change, and anchoring the change in institutional culture.
Because this model can help to propel the initiation of a faculty development program,
the reader is directed to Kotter and other change strategists for more information
(Rogers 2003; Morrison 1998).
334 I. Silver
16.2.4 Form a Planning Committee
Gathering a group of like-minded individuals around the planning committee

table is essential, whether the program is small or large. For smaller programs and
initiatives, having members of the target audience and key stakeholders around the
table is essential. For a larger program or centre, it is helpful to consider including
representatives of the key curricular committees, leaders and change agents within
the organization, as well as teachers, researchers and administrators who are opinion
leaders. This committee can evolve into an ongoing management committee for the
program as it develops and grows.
Faculty development programs at large medical schools might want to consider
forming an additional governance committee made up of representatives of higher
leadership within the organization, or if there are partner organizations involved,
representatives from the various organizations. Examples of higher leadership
include deans, vice-deans and associate deans, hospital chiefs (in education and faculty
affairs), and department heads at medical schools. In specialty societies, they would
include members of the organization’s executive team, their lay advisory group,
and key academic opinion leaders within the society. Medical schools and specialty
societies should consider the inclusion of policy representatives from provincial
or state associations to ensure alignment with human resource needs in the state or
province. The purpose of a governance committee is to ensure alignment with the
strategic plans of the host organization(s) and to ensure continuous infrastructure
and funding support going forward.
Larger schools or programs may consider hiring an external change management
consultant to assist with the planning and change process, since a consultant can
be especially impartial during interviews and focus groups with stakeholders and
participants, and can provide seasoned facilitation of the start-up process.
16.2.5 Conduct an Environmental Scan

of Existing Programs
A literature search to find programs and education contexts similar to what we

intend to build can be very helpful. Reviewing best practices in faculty development,
such as systematic reviews and outcome studies, can establish which best practices
should be incorporated into the program (Steinert et al. 2006). Website reviews
are also helpful as many schools, specialty societies, and colleges highlight their
faculty development programs online. Educators and administrators may make
direct contact with other organizations to clarify details of their programs. This
contact with the broader faculty development community can be a valuable part of
relationship building.
16.2.6 Design and Execute a Needs Assessment
A needs assessment can establish the directions a program can take and elaborate
the specific context and potential influence of the institution’s stakeholders and
potential participants. Case, Buhl and Lindquist (in Lindquist 1979) suggest some
questions that institutions can utilize for a needs assessment:
• Will the institution’s authorities champion a faculty development program?
• Who could influence the level of acceptance of the program?
• What resources related to faculty development are currently available?
• What has taken place already in faculty development in the institution? How was
it received?
• Are the institution’s goals and strategies known? Acted upon? Shared by all
participants?
• What norms exist that might influence faculty participation?
Looking at subjective individual needs will help define the goals, identify
the content and preferred learning methods, assure relevance, assess interest, and
identify preferred timetables of activities. Common methods of conducting this
assessment include surveys and individual interviews or focus groups with key
informants, frontline teachers, researchers, administrators, students and patients
(Blouin and Van Melle 2006). Objective data can be derived from student ratings of
their teachers and supervisors, observing teaching in action, an accreditation report,
or the faculty development literature. Needs assessment data may reveal unexpected
observations that can help shape a program; for example, junior faculty will not
perceive learning needs for academic development that more seasoned faculty may,
and vice versa. Needs assessment data can also help translate goals into objectives
for the program (Steinert et al. 2006).
16.2.7 Establish the Mission, Vision and Values

of the Program
Establishing the mission, vision and values statements will bring the education
community together for a common task. It is not unusual for these statements to take
several months to write; it is a function of the process that advisory and organizing
committees take to focus the program and establish the partnerships and culture that
will characterize it. From personal experience, establishing the values statements
can be the most meaningful of all the tasks undertaken by those establishing a new
program in faculty development.
A vision statement describes what the program aspires to, what it wants to be,
and its intended scope of influence:
Foundation for Advancement of International Medical Education and Research (FAIMER)
Faculty Development Program: To create and enhance educational resources for those
336 I. Silver
who teach physicians committed to improving and maintaining the health of the
communities they serve (Foundation for Advancement of International Medical Education
and Research 2012).
A mission statement states the purpose of the program and what it will do in the
field, for example:
McGill University, Department of Family Medicine Faculty Development Office: The division
of Faculty Development is committed to helping Family Medicine faculty, both in the
University and in the community, improve their comfort and competence in the following
areas: Teaching and learning, understanding research and stimulating interest, and research
methods training (McGill University Department of Family Medicine 2011).
Harvard University, Office of Faculty Development at Boston Children’s Hospital (BCH):
To facilitate the career advancement and satisfaction of Harvard Medical School (HMS)
faculty at Boston Children’s Hospital, fostering careers of all junior faculty, and increasing
leadership opportunities for women and minorities (Boston Children’s Hospital 2013).
Although it is rare for faculty development programs to have a specific values

statement (i.e. we could not find another example of a specific values statement
online, outside of our university), writing them can set the tone for a program at its
inception. Bringing together the relevant stakeholders to do this can be an invigorating
and inspiring experience. A values statement captures the culture the organization
aspires to, for example:
University of Toronto, Centre for Faculty Development at St. Michael’s Hospital: As leaders
who are committed to excellence and the well-being of faculty, students and their patients,
we embrace the following core values (Centre for Faculty Development n.d.):
• Learner centeredness.
• Inter-professional collaboration.
• Critical inquiry and scholarship.
• Innovation and creativity.
• Accessibility.
• Social accountability.
16.2.8 Describe the Purpose, Goals and Objectives

of the Program
The purpose, goals and objectives should reflect institutional, departmental and
individual issues. They are often derived from the results of a needs assessment
(Wilkerson 1984). Crafting these statements carefully will be time well spent because
they will influence the target audiences, the choice of program, the content and the
formats of the faculty development program (Steinert and Mann 2006).
16.2.9 Create a Short List of Strategic Deliverables
Using the results of the needs assessment and the deliberations of the planning
committee, two to three key strategic initiatives should be identified for delivery in the
first year. More deliverables can be articulated and scheduled over a 3-year period,
depending on the size of the program and available resources. When working
groups are used, it is best to vet these initiatives first with the stakeholders who were
previously consulted during the needs assessment. This will help ensure alignment
of these initiatives with the vested interests and priorities of education leaders,
curriculum committees and host institutions.
Clearly outlining each initiative’s goals, objectives and implementation plan will
make it clear to the institution’s leaders where the faculty development program
is going. In larger programs, working groups can be formed from interested
stakeholders to flesh out the details of the program content, to identify how the
program will be delivered and evaluated, and to determine the resources that might
be needed over the 3-year period. The planning process is in itself a form of faculty
development, as it helps to socialize a larger group of teachers, educators and
researchers into a learning community. It also provides the leads of the working
groups with leadership opportunities.
16.3 Establishing the Faculty Development Curriculum,

Design and Method of Delivery
Having established the strategic needs of the organization or program, begin to

develop faculty development curricula and identify how they will be designed and
delivered. Nearly all programs worldwide have a strong focus on improving teaching
effectiveness (Steinert 2000; Steinert and Mann 2006). A faculty development
curriculum is often directed by the curriculum renewal process and by evolving
trends in health professions education. Leadership and management programs are
increasingly popular, especially with medical education associations, international
foundations and medical schools (Gruppen et al. 2003; Lieff 2010; Swanwick and
McKimm 2010). Organizational development is an equally important issue because
it plays a critical part in creating an institutional culture that supports teaching excellence,
education scholarship, innovation and leadership (Steinert and Mann 2006).
Changes in organizational systems are often necessary to provide these supports.
For example, unless a medical school has aligned its policies on promotion to support
promotion on the basis of teaching and education scholarship, faculty development
programs will have difficulty recruiting participants, because the new skill sets learned
by faculty members may not be rewarded. Career development, including orientation
programs for junior faculty, specialized programs for mid-career and late career fac-
ulty, and programs with a special focus such as women and minority faculty, is seen
as an essential component of support programs (Rust et al. 2006; Spickard et al. 2002).
Program developers need to choose the appropriate education formats to deliver
faculty development curricula. Steinert (2010) has provided an excellent framework
to guide the choice of these activities, ranging from formal to informal, and from
individual to group. This framework includes workshops and seminars, mentoring,
fellowships, longitudinal programs, online learning, peer coaching, peer and student
338 I. Silver
feedback, work-based learning and communities of practice. Each of these formats

has a rich literature that supports its efficacy (Fidler et al. 2007; Gruppen et al. 2006;
Hatem et al. 2009; Lieff 2009; Pattison et al. 2012; Pololi et al. 2002; Steinert and
McLeod 2006; Takagishi and Dabrow 2011; Thorndyke et al. 2008). Other formats
could also be considered (depending on access to resources), including the use of
co-teaching, simulation, and theatre techniques (Krautscheid et al. 2008; Kumagai
et al. 2007; Orlander et al. 2000).
To get started, it may be more feasible to start small with a menu of activities that
includes both formal and informal activities, such as workshops, rounds, seminars,
co-teaching, mentoring, using peer and student feedback, and individual and group
methods of work-based learning. Later, creating online learning, simulation, fellow-
ships, longitudinal programs, and communities of practice can be added. Kotter’s
(1996) suggestion, of going for ‘early wins’, is relevant and practical in this context.
Choosing an activity or a series of activities that will please or meet an urgent
faculty development need in the organization can kick-start a program and create a
‘buzz’ about it. This could take the form of monthly grand rounds in education,
a new academic leadership program for a speciality society or a journal club on
supervision for postgraduate teachers.
16.3.1 Consider Theoretical Approaches and Related

Models, Principles and Guidelines That Inform
Faculty Development
No single comprehensive education theory explains how faculty develop academic

skills, but several theories, guidelines, models and principles can help inform the
planning of a faculty development program (Steinert 2011). The following is a summary
of key approaches and their implications for initiating a new program.
16.3.1.1 Andragogy
Malcolm Knowles (1984) introduced the term ‘andragogy’ to describe key principles
on how adults learn. These learner-centered principles have strongly influenced
health professions education for almost three decades and provide a solid foundation
for initiating a faculty development program:
• Setting a cooperative learning climate where learners feel safe.
• Creating mechanisms for mutual planning of curricula (by teachers and students).
• Arranging for a diagnosis of learner needs and interests.
• Enabling the formulation of learning objectives based on the diagnosed needs
and interests.
• Designing sequential activities for achieving objectives.
• Executing the design by selecting methods, materials and resources.
• Evaluating the quality of the learning experience by having learners critically
reflect on their learning.
16.3.1.2 Self-Directed Learning
Self-directed learning is a method of organizing teaching and learning so that learners

are empowered to accept personal responsibility for their learning. Learners are
provided a menu of learning formats to choose from and are encouraged to be
autonomous. This approach to learning helps guide faculty development program
leaders to structure learning in a manner that gives much of the responsibility to
faculty learners. For example, to encourage faculty to be self-directed in their learning,
it is suggested that learners have opportunities to critically appraise new information,
to ask questions, to identify their own learning gaps by comparing these to education
best-practice benchmarks, and to critically reflect on how and what they have learned
(Lunyk-Child et al. 2001; Mamary and Charles 2003; Silén and Uhlin 2008). There
are elaborate collaborative faculty development programs designed with this
self-directed learning in mind (Sanders et al. 1997). Please see Chap. 11 on online
faculty development for more examples.
16.3.1.3 Self-Efficacy
Self-efficacy theory was articulated by Albert Bandura (1986). His work in this area
focused on how an individual’s self-assessment of their ability is central to how
they behave. It is very specific to a domain or specific tasks. Self-efficacy is the
individual’s perception of their ability to execute a certain task (or tasks) that
predicts the level of the goals, the effort and the persistence they will demonstrate.
Essentially, perceived success can raise our self-efficacy, while failures (especially
if they are early in the learning process) can lower self-efficacy. Bandura wrote that
these self-judgments are based on a combination of factors (in decreasing order
of influence): the person’s experience with the task; observational learning; verbal
persuasion; and the individuals’ physiological state. Self-efficacy is not a fixed
perception; it can be changed through education and learning experiences. For
example, when thinking about observational learning, this theory predicts that if
we set up our faculty development programs so faculty members can be observed
being successful with unfamiliar tasks, other faculty are more likely to feel that they
can perform the tasks well too. Giving faculty members an opportunity to practice
new skills, receive feedback and achieve some success can also be a powerful way
in which to build a sense of self-efficacy.
16.3.1.4 Expectancy-Value Theory
Related to self-efficacy theory is a framework called expectancy-value theory

(Fishbein and Ajzen 1975). According to this theory, a learner’s motivation is
determined by how much they value a goal and whether they expect to succeed with
a task or activity. Heckhausen (1991) defined several types of expectancies that
learners can have, including the subjective probability of obtaining a particular out-
come with an activity, and the subjective probability of an outcome being associated
340 I. Silver
with a specific consequence. These dynamics can often be at play in faculty

development. For example, if clinical teachers anticipate that faculty development
will enhance their professional development, and if they believe that these activities
are relevant to them, they may be more likely to attend workshops and seminars on
teaching improvement. In addition, the value they place on self-improvement and in
their teaching activities may be self-motivating (Steinert 2010).
This theory has great potential to help faculty developers understand what
motivates faculty to attend sessions. Educators need to understand why well-rated
teachers or excellent administrators habitually attend faculty development work-
shops, while faculty who might really need the faculty development do not attend.
Seasoned faculty developers have also observed that it is sometimes difficult for
faculty to move out of the safety of their own department, unit or area of speciality
to attend workshops with faculty members from different specialities or health
professions. These faculty members may not place much intrinsic value on interpro-
fessional learning, or expect that it will not go well. However, it has been observed
that expectancies and values can change after a single, well-taught interdisciplinary
workshop (Pandachuck et al. 2004).
16.3.1.5 Constructivist Theory
Within a constructivist framework, learning involves the active construction of

learning and mental processes (Fosnot 1996). Several theories of learning are
constructivist. Within a faculty development context, this theory would predict that
it is important to understand faculty’s preconceptions and to build knowledge based
on what has been learned already. It is also important to understand that individual
faculty members will have different experiences, knowledge and values, and as a
result, they may construct their understanding of their teaching, research and
leadership behaviors in different ways. Faculty developers need to understand the
specific contexts in which faculty members teach, conduct their research, and
work in their organizations in order to construct learning sessions that are optimally
relevant and useful.
Teachers and administrators will also change their behavior based on the learning
that occurs in their teaching and organization’s environments. Teaching more effectively
results from gaining practical knowledge and skills from the teaching experience
itself (i.e. constructing meaning and building on prior knowledge). Reconstructing
actual teaching or administrative experiences during faculty development sessions,
or reviewing videotapes of previous teaching sessions, are applications of construc-
tivist theory in practice (Skeff et al. 1986).
16.3.1.6 Social-Cultural Theories
Social learning theories focus on how learning occurs with, and from, others and
from the environment. These theories generally have two perspectives: the first
deals with the learning that happens within an individual; the second focuses on the
learning that happens through interactions with other individuals. Social-cultural
theories belong to the second perspective.
Within the social-cultural learning framework, learning is thought of as socializa-
tion into a new knowledge community (Wilkerson and Irby 1998). In a faculty
development context, knowledge is socially constructed through interaction with a
peer group of faculty. Learning occurs through contact with faculty members who
are role model teachers and educators, and via arranged peer-coaching learning
opportunities. Learners are immersed in a community where teaching and learning
is explored, beliefs are discussed, and roles are identified. This is one of the most
important and effective methodologies in faculty development (Steinert et al. 2006).
Two learning constructs are derived from social-cultural theory: communities of
practice and situated learning (Lave and Wenger 1991).
D’Eon has described teaching as a social practice that is purposive, rational and
situated within a community (D’Eon et al. 2000). Communities of practice have
been defined as a ‘persistent, sustained, social network of individuals who share
and develop an overlapping knowledge base, set of beliefs, values, history and
experiences focused on a common practice and/or mutual enterprise’ (Barab et al.
2002, p. 7). Faculty developers have an important role in socializing faculty and
staff into communities of practice based on their mutual interests. Moreover, these
communities of practice can provide an important foundation for influencing the
greater community of teachers, administrators or researchers in an organization
(Vescio et al. 2008).
Situated learning is based on the notion that learning is situated in authentic
contexts (Miller et al. 2010). When learning normally occurs, it is embedded within
activities, context and culture. This theory highlights the fact that knowledge needs
to be presented in authentic contexts—settings and situations where this knowledge
would be applied. In a faculty development context, case-based learning, role-playing
and the use of simulation are teaching modalities that support this theory.
16.3.1.7 Reflective Practice
Donald Schön (1987) argued that formal learning theories were not adequate to
explain the everyday messy problems of practice. He labeled professionals’ automatic
ways of responding to clinical situations in areas of superior competence as ‘zones
of mastery’ or ‘knowing in action’. When a clinician experiences a surprise situation
in their practice, they ‘reflect[s]-in-action’ while the patient might still be in their office.
The clinician would problem solve within the situation and make the best-educated
formulation of the problem and come to a decision. Schön (1987) perceived
this situation as an experiment based on the clinician’s best hypothesis. Later in the
day, the clinician might ‘reflect-on-action’ about what had happened. As a result,
the clinician might consult other colleagues, a text, or the Internet to further
understand the ‘surprising’ situation. Moreover, as a result of the ‘reflection-on-
action,’ the clinician would learn something new, and this would become a new part
of their zone of mastery.
342 I. Silver
Applied to a faculty development context, this model for learning would

predict that the encouragement of mindfulness toward metacognitions, connected
to teaching surprises and challenges, would be a helpful way to access narratives
for sharing between teachers. In a teaching context, faculty developers could
reconstruct these situations with other faculty members through role-playing and by
assisting faculty to move along the continuum from reflection-in-action, to experi-
mentation, to reflection-on-action.
16.3.2 Develop an Evaluation Plan to Measure Program

Impact and Outcomes
Establishing an evaluation strategy at the outset is important to build an accountability

framework for the program. This will be viewed favorably by the funders of the
program and will provide opportunities for education scholarship and research.
There have been a number of evaluation models used in faculty development,
including simple methods such as post-activity self-report evaluations, student
evaluations of teachers, retrospective pre/post assessments, perceived competence
in teaching methods, and commitment to change strategies (Bandiera et al. 2005;
Boerboom et al. 2009; McLeod et al. 2008; Myhre and Lockyer 2010; Pandachuck
et al. 2004). Something as simple as a well-designed participant satisfaction rating
scale continues to remain an important component of faculty development evaluation;
if programs are well-rated, participants will tell their colleagues about it. These instru-
ments also provide valuable feedback to program planners regarding the teaching
and learning strategies and the relevance of the program (Steinert and Mann 2006).
More comprehensive and systems-based evaluation strategies have been applied
to faculty development programs including an outcomes logic model, the Kirkpatrick
framework, objective structured teaching evaluations (OSTEs), faculty achievement
tracking tools, curriculum vitae analyses, and qualitative evaluation methods
(Armstrong and Barsion 2006; Knight et al. 2007; Morzinski and Schubot 2000;
Pettus et al. 2009; Wamsley et al. 2005). Evaluating the impact of faculty development
is important on many levels: accountability to the funders, growing the program,
and marketing the program to potential participants. Whether or not a program becomes
a permanent feature at a school or institution ultimately depends on its demonstrated
value and a positive answer to the question “Does it work?”
16.3.3 Establish a Program of Scholarship

in Faculty Development
Even as a program is just getting established, it is prudent to be thinking of the pro-

gram’s potential for scholarship and research. Starting a program is a unique
opportunity to create a scholarly community in faculty development and to charge
those involved with academic goals and aspirations. Good principles to guide
the process include focusing scholarship on the programs that will be delivered,
engaging education researchers early in the program planning stage, and focusing
scholarship in areas that are aligned with education goals and objectives of the funding
organization. (See Chaps. 17 and 18 for a further discussion of this topic.)
16.3.4 Develop a Plan for Sustainability
Thinking of how to sustain a program is an important consideration at the inception

of a faculty development program. One consideration is to look at advocacy for
policy changes within a university or at a government level that will help sustain the
program. For example, at a university, developing promotion policies that are
aligned with leadership or scholarship training programs in education are important.
Education scholarship including excellence in teaching will need to be included
as key criteria for promotion if faculty development programs are focused on
developing teachers, scholars and leaders. Developing policies that mandate faculty
development for all faculty members as part of their performance review can help
sustain a program. At a government level, advocating for funding for the support
of academic leadership development and health professions education grants to
support innovation in faculty development are important interventions.
Even at the start-up of a program, it is important to begin to consider the identi-
fication of future leaders in faculty development and how to enable their personal
growth and development as the program grows. When resources are available,
hiring an associate director for the program early on can quickly broaden the scope
of the program and address the importance of succession planning.
16.3.5 Secure Infrastructure Funding and Staffing
Faculty development program planners need to take into consideration the budget
available to produce a program of activities. At a medical school level, the school
may fund these programs as part of its core budget, although this may vary consider-
ably between schools. Starting a program may well begin with very modest financial
support. Hospital or university department-specific programs and specialty societies
or colleges may also allocate funds for faculty development. Many medical
schools expect a faculty development office or centre to be partially self-sufficient
financially. Program leaders need to assess the culture of their organization to
understand the faculty’s tolerance for paying for faculty development. It is not
uncommon for departments or hospitals to financially sponsor faculty members
who are participating in longitudinal programs such as fellowships and Teaching/
Education Scholars Programs.
344 I. Silver
Education leadership programs developed by colleges or large medical

associations are often financed on a cost-recovery basis. For larger programs, it is
advisable to establish a formal business plan that can project the growing needs
of the program forward for several years. This process can formalize the necessary
accountability that organizations will expect when funding a new faculty
development program.
There are few guidelines available to recommend the necessary start-up staff
needed to run these programs. At one academic teaching hospital, the initial
infrastructure of the office for faculty development includes one full-time equivalent
(FTE) director and a 1.0 FTE administrative assistant serving approximately 900
faculty (Emans et al. 2008). A Master Teacher Program in a large medical school’s
department of medicine has a 0.6 FTE director and a 0.2 FTE administrative assis-
tant serving 1,160 faculty members (D. Panisko, personal communication, August
2012). When resources are scarce, it is also possible to do faculty development on
a ‘shoestring’ budget (Palloff and Pratt 2011). For example, students or residents
who are technologically savvy may be highly motivated to assist faculty with this
aspect of their professional development. Education specialists from the Education
or Informatics Faculties may be very interested in collaborating with the Faculty
of Health Sciences by providing single faculty development sessions at minimal
cost. Encouraging experienced teachers, administrators and researchers to assist
novice faculty either formally or informally can be organized with minimal admin-
istrative assistance.
16.3.6 Market the Program
Marketing and branding a faculty development program can be very useful in the
start-up phase. Creating a faculty development website is an essential marketing
tool. It can advertise the program calendar, highlight the staff and faculty who
administer and teach the program, and provide additional education resources.
Creating a unique logo for the program can be an effective community-building
exercise. The use of social media—from blogs to wikis to tweets—has become a
new means by which faculty development programs can communicate, collaborate
and teach.
16.4 Conclusion
Starting a faculty development program can be an exciting, even exhilarating, time

in a health professional’s career. It’s a time of relationship- and network-building,
risk-taking, experimentation and creativity. Once started, there are many issues and
challenges that faculty development leaders will face, including engaging staff
and administrators in faculty development, addressing the fact that leading a faculty
development program often needs to be balanced with clinical work, fitting students
and trainees in with the productivity demands of service, balancing formal vs. informal
learning opportunities, resolving ongoing funding challenges, and of course, ensuring
the sustainability of the program.
Having an organized approach based on theoretical assumptions, trends in health
professions education, principles, goals and objectives, and a change and design
strategy, will help overcome the many challenges that are part of the journey of getting
a program off the ground. This chapter has outlined a number of layered approaches
that educators, administrators and faculty developers can use to frame a plan of
action. Starting a faculty development program provides a unique opportunity to
influence the next generation of health professions teachers, administrators and
researchers. Starting and leading a program can be one of the most gratifying
academic activities in a career. We invite future faculty developers to take up the
challenge today, to continue to build capacity in the field and to join our growing
international community.
Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the
impossible.
—Saint Francis of Assisi
16.5 Key Messages
• Consider implementing a comprehensive faculty development program that will

serve the multiple needs of teachers, educators, researchers and administrators.
• Theoretical approaches, and related models, principles and guidelines can inform
the strategies used to plan, develop, implement and evaluate a faculty develop-
ment program.
• Align the faculty development program with the strategic goals, objectives and
culture of the institution that the program is serving.
• Create vision, mission and values statements for the program.
• If participating in the program creates a sense of community, enables faculty mem-
bers to be promoted, is accessible and enjoyable, the program will be successful.
Acknowledgments I would like to thank Ms. Jacquelyn Waller-Vintar and Ms. Stevie Howell for
their excellent editorial assistance.
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Part V
Research and Scholarship in Faculty
Development
Chapter 17
Faculty Development Research: The ‘State
of the Art’ and Future Trends
John Spencer
17.1 Introduction
We all know that faculty development works. Of course it does. It stands to reason
that teachers will teach more effectively, researchers will research more produc-
tively, and leaders will lead more effectively if they are presented with models of
good practice and provided with opportunities for action and reflection, together
with guidance and feedback. Why else would we put all that effort into the faculty
development enterprise if we didn’t think it was effective? Evaluations, on the
whole, confirm our presuppositions, justify our efforts and use of resources, and
further encourage us. The gains go beyond an individual’s personal and professional
development, with potential benefits for colleagues and organizations. The received
wisdom, to quote two major authors in the field, is quite simply that ‘faculty devel-
opment targeted to the several roles of faculty members is the key to academic vital-
ity’ (Wilkerson and Irby 1998, p. 394).
That wisdom is now enshrined in both educational policy and practice. For
example, in the United Kingdom, recent recommendations on undergraduate medi-
cal education from the profession’s governing body, the General Medical Council,
state that ‘everyone involved in educating medical students will be appropriately
selected, trained, supported and appraised’ (GMC 2009a, p. 69). Moreover, medical
schools’ compliance with this will be monitored. This reflects the requirement that
all doctors who are involved in teaching must ‘develop the skills and practices of a
competent teacher’ as part of their personal and professional development (GMC
2009b, p. 14). In North America, medical school faculty are required by the Liaison
Committee on Medical Education (2012) to be able to teach effectively, and the
recently revised Maintenance of Certification Program in Canada recognizes faculty
J. Spencer, FRCGP (*)

Primary Care and Clinical Education, School of Medical Sciences Education Development,
Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

354 J. Spencer
development as an important element in maintaining professional standards (Royal

College of Physicians and Surgeons of Canada 2011, p. 7). The wisdom is clearly
ever-present.
Yet, although we have a sense of what works, in spite of a considerable literature
describing and evaluating faculty development, both in health professions education
and in the broader field of higher education, we have relatively little understanding
about how, why and in what circumstances. This chapter will firstly review what we
know about what works in faculty development, with reference to recently pub-
lished systematic reviews. It will then discuss aspects of the ‘state of the art’ of
research and scholarship in the field, highlighting some important challenges facing
scholars. These include the similarities and differences between evaluation and
research, evaluation of complex interventions, and the utility of particular outcome
measures, notably Kirkpatrick’s framework and self-report, placed in the broader
context of concerns about the quality of medical education research. The chapter
will conclude with some recommendations about future research in faculty
development.
17.2 What Do We Know About What Works in Faculty

Development?
In this section the findings of four systematic reviews will be discussed, focusing
both on the impact and outcomes of faculty development, and on what methods are
effective.
17.2.1 What Are the Impacts and Outcomes of Faculty

Development?
The most recent systematic review of the faculty development literature in medical
education was published in 2012 and looked at the development of leadership skills
(Steinert et al. 2012). The review focused on ‘the effects of faculty development
interventions designed to improve leadership abilities on the knowledge, attitudes
and skills of faculty members in medicine, and the institutions in which they work’
(p. 485). The reviewers addressed three distinct categories of intervention: those
with their main focus on leadership; those including leadership as a component of a
more comprehensive development program; and those including leadership within
a program focusing on academic career development. All study designs reporting
findings beyond participant satisfaction were included.
A modified version of Kirkpatrick’s framework (Table 17.1) was used to evaluate
the impact of studies (the utility of Kirkpatrick’s framework will be discussed in
Sect. 17.4), as well as global judgments about strength of findings and the quality of
17 Faculty Development Research: The ‘State of the Art’ and Future Trends 355
Table 17.1 Kirkpatrick’s modified evaluation framework

Level 1 Reaction Participants’ views about the learning experience, its
organization, presentation, content, methods, and
quality of instruction
Level 2a Learning – change in attitudes Changes in attitudes or perceptions among
participant groups towards teaching and learning
Level 2b Learning – modification of Knowledge; acquisition of concepts, procedures and
knowledge or skills principles
Skills: acquisition of thinking/problem-solving,
psychomotor and social skills
Level 3 Behavior – change in behavior Evidence of transfer of learning to the workplace or
willingness of learners to apply new knowledge
and skills
Level 4a Results – change in the system Wider changes in the organization, attributable to
or organizational practice the intervention
Level 4b Results – change among Improvement in learners’ perceptions, approaches to
participants’ learners study, or performance as a direct result of the
or colleagues faculty development intervention
After Steinert et al. (2006)
the research. Findings were grouped by type of intervention (e.g. workshop, longi-
tudinal fellowship).
Forty eight papers described 41 studies of 35 specific interventions. Most tar-
geted clinical faculty and used a range of formats including workshops, short
courses and fellowships. The findings can be considered under three headings:
impact of interventions, key features of (apparently) successful programs, and the
quality of the research methods used.
In terms of outcomes and impact, the reviewers identified the following:
• High levels of participant satisfaction (Level 1 – see Table 17.1) – both in terms
of practical relevance and usefulness, and for both personal and professional
development.
• Changes in attitudes towards leadership as well as the organization (Level 2a) –
such as increased awareness of institutional goals or of participants’ own
strengths and weaknesses, intentions to change, and increased confidence in
undertaking leadership roles.
• Gains in knowledge and skills (Level 2b) – such as knowledge about leadership
concepts and understanding change management principles.
• Changes in behavior, both self-reported and observed (Levels 3a and 3b respec-
tively) – including application of new knowledge, change in leadership styles,
adoption of new roles and responsibilities, and creation of new collaborations.
• Changes in the organization (Level 4a) – although these aspects were not often
investigated, reported changes included implementation of specific innovations,
increased emphasis on scholarship, development of new programs, and estab-
lishment of new networks.
356 J. Spencer
The review built on earlier work focused on interventions intended to improve

teaching effectiveness (Steinert et al. 2006). Fifty three papers were critiqued and,
as with the leadership review, a wide variety of interventions described. A range of
changes were reported in attitudes (in this case towards both teaching and towards
faculty development), acquisition of new knowledge and skills (for example, knowl-
edge about educational theory, or developing specific teaching ‘micro-skills’ such
as questioning skills), changes in behavior (reported both by participants and their
learners), and changes in organizational practice and student learning, although
these were rarely reported.
These two reviews showed remarkably similar findings in terms of both the vari-
ety of interventions used, and their impacts. There were concerns, however, about
many aspects of research quality and thus the strength of the findings and what
conclusions could confidently be drawn from them. These issues will be discussed
in detail in Sect. 17.3 and recommendations will be made at the end of the chapter.
Nonetheless, it is apparent that faculty development does ‘work’ and at many levels,
although these reviews could only speculate as to how and why.
Stes et al. (2010) in the Netherlands undertook a systematic review of the broader
higher education literature (i.e. not confined to medical education), focusing on
what the authors termed ‘instructional development’, defined as ‘any initiative spe-
cifically planned to enhance course design so that student learning is supported’
(Stes et al. 2010, p. 25). They critiqued five previous reviews, covering literature
from the mid-1960s, including Steinert et al. (2006), noting the consistency of
observations about the variable quality of research and the often inconclusive
results. They set out to address several unanswered questions, including whether
interventions extending over time were more effective than ‘one-time’ events, and
whether course-like instructional development had better outcomes than alterna-
tives such as peer teaching and action research projects. Like Steinert et al. (2006,
2012), they used a modified version of Kirkpatrick’s framework, excluding papers
that solely used participant satisfaction as an outcome. However, rather than analyze
by format of intervention, in addition to clustering studies by level of outcome, they
analyzed according to research design (quantitative, qualitative or mixed
approaches). Thirty-six papers were reviewed, the majority of which assessed
impact on participants. Changes were noted at several levels: participants’ attitudes
(e.g. towards teaching, increased confidence), conceptions of teaching (e.g. about
student-centered approaches), knowledge (e.g. about the role of technology in the
classroom), skills (e.g. use of that technology) and behavior (e.g. adopting more
student-centered, and/or use of innovative approaches). Few studies explored
impacts on learners, but relevant outcomes included positive changes in study
approaches (notably, increased collaboration) and specific learning outcomes.
Finally, although less often measured, some changes at the institutional level were
noted, including increased networking, spin-off activities and dissemination of
ideas. There was also a suggestion that interventions extending over time were asso-
ciated with more positive outcomes than one-off events, as were alternative or
hybrid formats (e.g. peer coaching, or formal course plus coaching and project
work, respectively) compared to more traditional approaches such as workshops.
At the time of writing, the most recently published systematic appraisal of the
faculty development literature, from Australia, is what the authors termed a concep-
tual review (Amundsen and Wilson 2012). They wondered whether previous
reviewers had been asking the right questions in addressing issues of cause and
effect (i.e. ‘What works?’). Driven by the questions ‘How are educational develop-
ment practices designed?’ and ‘What is the thinking underpinning such design?’ the
authors developed a framework based on the core characteristics of the initiatives.
These included the stated intentions or goals, the processes and activities used to
attain the goals, and the evidence collected to demonstrate attainment. Their frame-
work comprised six categories of practice, and papers were analyzed according to
their main focus.
The six categories (or ‘conceptual clusters’) were:
• Skills focus – acquisition or enhancement of observable teaching skills and tech-
niques, the aim being to support change in specific behaviors.
• Method focus – mastery of a particular teaching method e.g. problem-based
learning, both to use the method and to understand underlying concepts.
• Institutional focus – coordinated institutional plans to support teaching improve-
ment and/or successful diffusion of ideas.
• Reflection focus – changes in individual teachers’ conceptions of teaching and
learning through support for individual reflection.
• Disciplinary focus – developing pedagogical knowledge based on the assump-
tion that teaching varies between disciplines because the knowledge base is
different.
• Action research focus – individuals or groups of faculty pursuing topics of inter-
est to them.
The authors argued that the merit of this approach was that it focused on under-
standing the ‘process’ as opposed to analyzing results against pre-defined outcomes,
as with previous reviews. In addition, they reflected on the assumptions that faculty
developers make about the orientations of programs at three levels: institutional,
intellectual and contextual. Institutional orientation refers to whether programs are
‘centralized’ (i.e. led by faculty developers based in an institution delivering work-
shops and other programs to participants who usually leave their own workplace to
attend), ‘decentralized’ (i.e. based in the workplace with faculty developers taking
on a more facilitative role), or a combination. Intellectual positioning refers to the
intended learning, for example whether it is focused on specific content or on
processes such as reflection that facilitate continuing professional development.
Finally, contextual orientation refers to whether activities are focused on improving
individuals’ teaching practice, or whether they are intended to engage faculty in
‘teaching enhancement as a socially situated practice’ (Amundsen and Wilson 2012,
p. 109). The authors discuss how informal learning experiences may have a more
profound influence than organized and didactic interventions, and, related to this,
contend that so-called ‘event-based’ initiatives need to complement not displace
situated social learning.
358 J. Spencer
Table 17.2 Key features of effective faculty development interventions

Key features
Well designed, needs-based interventions
Use of a range of instructional methods within a program – e.g. small group discussions,
simulation, role play, interactive exercises
Experiential learning and reflective practice – e.g. being able to apply new learning in practice,
and having opportunities to reflect on personal goals and learning
Provision of feedback – e.g. feedback about teaching skills
Project work – both individual and group projects
Fostering effective peer relationships – including collegial support and development of communi-
ties of practice
Mentorship – including innovative approaches such as peer-mentoring and co-mentoring
Interventions that extend over time – e.g. fellowships
Institutional support – identified as critical to success of many programs, including funding,
protecting participants’ time and involving senior faculty
After Amundsen and Wilson (2012), Steinert et al. (2006, 2012), and Stes et al. (2010)
This review is perhaps of more interest to scholars and researchers than faculty
developers per se in offering a different way of conceptualizing and categorizing
initiatives. In particular, echoing Steinert et al. (2006), the authors noted how rarely
the context in which faculty members teach and educational development takes
place is acknowledged by researchers. In their words, ‘At this point in time we know
more about how to design educational initiatives to improve individual teaching
practice but less about how this learning is actualized and embedded in the aca-
demic workplace’ (Amundsen and Wilson 2012, p. 111).
In summary, the four reviews (three of them systematic, one a conceptual review,
and two discipline-specific) broadly agree about the impacts of faculty development
in respect to changes in participants’ attitudes, knowledge, skills and behavior,
developments at the institutional level, and impact on student learning. The fact that
similar conclusions were drawn despite the different ways authors organized and
analyzed the data (i.e. by format, outcome, study design and/or type of practice)
strengthens the veracity of the findings. In addition, similar concerns were voiced in
all reviews about the variable quality of the research, and recommendations were
made about further research, both of which will be discussed later in the chapter.
17.2.2 What Works in Faculty Development?
All the reviews highlighted key features of effective faculty development interven-
tions that appeared to contribute to positive outcomes. These were remarkably con-
sistent across the reviews and are summarized in Table 17.2.
Many of these features concur with the literature on continuing education, spe-
cifically that effective interventions ideally should involve needs assessments, use
interactive techniques with opportunities to put new learning into practice,
incorporate appropriately sequenced and multi-faceted activities, and facilitate

reflection (Mazmanian and Davis 2002). When studies were grounded in a theoreti-
cal framework (approximately 50 % of papers), it was most often in relation to a
small number of theories that have currency in health professions education, includ-
ing adult learning, socio-cultural theories and experiential learning.
17.3 What Do We Know About the Quality of the Research

into Faculty Development?
This section addresses the quality of research highlighted in the four reviews dis-
cussed above. Appraisal of methodological quality and rigor of the studies in all
reviews showed consistent findings.
In the leadership review (Steinert et al. 2012) the majority of studies were quan-
titative, all of which had a quasi-experimental design. There were also five qualita-
tive studies and 12 using a mixed-methods approach. Global judgments of the
quality of research and strength of findings were made using a Likert scale of 1–5;
for study quality, 1 = low, 5 = high; for strength of findings, anchor statements were
also provided, with 1 = ‘No clear conclusions can be drawn. Not significant’ through
to 5 = ‘Results are unequivocal’. Mean quality ratings for the three categories of
study were around 2.8 (range 1–5) and strength of findings around 3.0 (range 1–4).
A number of methodological issues were highlighted. Most studies were descrip-
tive and involved single groups (i.e. there were no comparison groups, rendering
generalization difficult). A wide range of data collection methods and instruments
were used. However, these were often ‘home grown’, developed specifically for the
study, and validation procedures and/or their psychometric properties were rarely
described. The majority of studies used only post-intervention measures, as opposed
to using a pre-test/post-test approach, relied on participants’ self-report (the limita-
tions of which will be discussed below), and data were often captured some consid-
erable time after the intervention. In terms of research methods, rigorous qualitative
approaches were infrequently used. Finally, although most articles defined specific
objectives and adequately cited relevant literature, fewer were grounded in a theo-
retical or conceptual framework.
In the earlier BEME review of teaching effectiveness (Steinert et al. 2006), study
designs were similarly predominately quasi-experimental (47/53) with just 6 ran-
domized controlled trials. The mean global rating for quality of studies was 3.14
(range 1–5), and for strength of findings, the mean rating was around 3.0 (range
1–4). Stes et al.’s findings (2010) resonated with those of previous reviewers, in
particular the fact that the majority of studies were based on self-report and used
data collection instruments that were mainly self-constructed, with psychometric
data infrequently provided. Further, few studies were comparative, and descriptions
of the interventions were usually poor.
360 J. Spencer
In summary, all four reviews identified broadly similar problems in terms of

issues such as study design, methods, data instruments and outcome measures.
Recommendations were made about how to improve the quality of research and
these will be synthesized and summarized at the end of the chapter.
17.4 The Broader Context of Medical Education Research
The observations about the quality of the faculty development literature reflect simi-
lar concerns in relation to medical education research in general. For example,
Todres et al. (2007) reviewed 387 papers published during 2004 and 2005 in two
leading general medical journals (BMJ & The Lancet) and two major medical edu-
cation journals (Medical Education & Medical Teacher). They felt that most of the
studies lacked rigor, the majority being cross-sectional surveys; less than 10 % were
longitudinal or before-and-after studies. Ten were randomized controlled trials
(RCTs), although most of them would have failed to meet accepted criteria for pub-
lication of trials in the clinical arena (e.g. lack of a clear hypothesis; absence of a
power calculation). Their review undoubtedly made a helpful contribution to the
debate, but was criticized because of the seemingly positivist stance the authors
adopted in their critique of methodologies and reflections on the nature of ‘rigor’
and evidence (Dornan et al. 2008; Rapid Responses, BMJ 2007).
Approaching the problem from another angle, Albert et al. (2007) interviewed 23
‘influential figures’ from the medical education research community, exploring
three themes: strengths and weaknesses of current research; the role of research in
medical education; and the usefulness of theory in knowledge development. The
majority of respondents felt the overall quality of research remained poor, despite
some progress. Several reasons were identified. Studies were often repetitions of
other work because researchers appeared to have limited knowledge of the literature
in the field, and were thus unable to fully contextualize their study. There was lim-
ited use of theory, with analysis often restricted to a descriptive level, hampering the
creation of an integrated body of new knowledge. Related to this, some respondents
also expressed concern that research was often subordinated to the demands of
administrators and educators, which in their opinion limited development of works
of a theoretical nature; as one interviewee put it ‘…if there is no theory permitting
understanding of fundamental processes, how is it possible to predict and control
for the effectiveness of interventions?’ (Albert et al. 2007, p. 109). Research was
often opportunistic, reactive to curricular demands and carried out on a small scale,
and, in the words of one respondent, failed to address ‘the truly big questions.’
Several influencing factors were identified, including: the contention that clinical
educators (which, for the purposes of this chapter, one could arguably read ‘faculty
developers’) have a predominantly pragmatic orientation towards and a limited
interest in the theoretical dimensions of research – ‘what they want are results’; and
the dominance of the ‘biomedical’ model, which influences the research process at
every level from availability of funding to publication policy. In an accompanying
editorial, Norman, argued that theory was often used to justify an approach, rather
than as a source of testable hypotheses, with the result that ‘theories remain inert
and contribute nothing to growth of knowledge’. He also emphasized the crucial
role that expert peer review has to play in the quality assurance of published
research. In his words ‘I believe that the expert, thoughtful, reviewer, who is pre-
pared to put the time into a serious review, is a tremendous force for change, almost
like having a free mentor on demand’ (Norman 2007, p. 4).
Cook et al. (2007) undertook a systematic review of experimental studies pub-
lished during 2003 and 2004 in four leading medical education journals (Academic
Medicine, Advances in Health Sciences Education, Medical Education and Teaching
and Learning in Medicine) and two US generalist journals (Journal of General
Internal Medicine and American Journal of Surgery). The quality of reporting of the
majority of the 105 studies reviewed was poor. Important elements were often miss-
ing including: a critical literature review (i.e. one that identified the research gap and
how the study would contribute new knowledge); a conceptual framework (the
absence of which, they argued, potentially limits selection of variables, meaningful
interpretation of results, and either refinement of existing theories or development
of new ones); an explicit statement about study design; description of a comparison
or control group; and information about ethical approval.
Although they did not specifically evaluate study quality, they speculated that
poor quality reporting ‘may reflect sub-optimal research designs and methods, and
a lack of attention to human subject rights’ (Cook et al. 2007, p. 743). Like Norman
(2007), they suggested that peer review and editorial policy ‘have the best chances
of improving reporting quality’ (Cook et al. 2007, p. 738).
17.4.1 Problems of Experimental Research in Medical

Education
Cook and Beckman followed up their earlier review with a paper in which they
further discussed some of the problems of experimental research in medical educa-
tion (Cook and Beckman 2010). These included:
• Limitations of randomization – arguing that randomization is not a panacea since
it controls for only a subset of variables.
• Pre-tests weakening study design – challenging received wisdom that ‘pre-test/
post-test’ is the gold standard; indeed they call it ‘a myth’, but listed the circum-
stances in which pre-tests should be used, for example when the pre-test is part
of the intervention, or when sample size is small.
• Limitations of ‘no intervention’ or placebo-controlled studies – such so-called
‘justification studies’, focused on what works, do not always advance our under-
standing, in comparison to ‘clarification studies’ which ask ‘how and why does
this work?’ (Cook et al. 2008; Cook 2012).
362 J. Spencer
• Multi-factorial interventions are ‘hopelessly confounded’ and may have

limited potential application in new settings – see Sect. 17.5.2 on complex
interventions.
• Interventions themselves are often not well described, a deficiency noted by all
previous reviewers.
Some of these issues will be revisited in Sect. 17.6.
17.5 What Challenges Might Researchers in Faculty

Development Face?
This section discusses some of the potential challenges faced by researchers and
scholars in faculty development. These particular areas have been chosen since, in
the author’s experience, as a researcher and former editor, they commonly challenge
researchers, whether from a philosophical or practical perspective. The challenges
are: recognizing the differences and similarities between evaluation and research;
evaluating complex interventions; and problems with measuring outcomes. For fur-
ther discussion about the limitations of positivism in researching faculty develop-
ment, along with a description of alternative research paradigms and several novel
research methods, see Chap. 18 by O’Sullivan and Irby.
17.5.1 Evaluation or Research?
This section will firstly define evaluation and consider its purposes; similarities and
differences between evaluation and research will then be discussed; finally, key fea-
tures of effective evaluation will be highlighted.
17.5.1.1 What Is Evaluation?
Evaluation, defined as ‘the systematic acquisition and assessment of information to

provide useful feedback about some object’ (Trochim 2006, p. 1), plays a central
role in education. The majority of faculty developers would consider it inconceiv-
able to run a program without some sort of evaluation, indeed they are usually
required to evaluate as part of quality improvement. Although the generic goal of
evaluation is to provide ‘useful feedback’, it can operate at many levels (e.g. the
institution, the program, the faculty developers or the participants). Moreover, its
purposes fall into three general categories: for accountability; to generate new
insights and understanding; and to support and guide development (Goldie 2006). It
can be formative or summative. The former, also known as ‘process evaluation’,
asks the question ‘how are we doing?’, and may be an on-going enterprise; whereas
the latter, also known as ‘outcomes’ or ‘impact’ evaluation, asks ‘how did we do?’
and is usually undertaken at the end. In terms of focus, evaluation may be targeted
at one or more levels, including policy, institution, curriculum, teaching, learning or
assessment. Potential stakeholders might thus include policymakers, regulators,
funders, curriculum designers, managers, teachers and learners (and in health care
settings, patients), and evaluators may therefore need to tackle difficult and conflict-
ing issues. To quote one author, evaluation ‘may encompass competing criteria and
purposes, and is situated in potentially sensitive political and ethical contexts’
(Silver 2004, p. 2). Careful consideration of purpose, focus, level and stakeholders’
needs will determine the questions to be asked and thus the data to be collected and
methods used. For example a formative evaluation focused on learner experience
might seek feedback about aspects of the course from both learners and teachers
(i.e. in the context of this chapter, faculty developers) using survey methods or inter-
views and focus groups, whereas a summative evaluation at institutional level might
wish to look at aspects of curriculum governance through documentary analysis.
17.5.1.2 What Are the Similarities and Differences Between Evaluation

and Research?
The question often arises as to the difference(s) between evaluation and research.
This is of more than passing interest, since data collected for evaluation purposes
are often used as the basis of a study that may eventually be submitted for publica-
tion, with the aim of adding to the knowledge base. The main difference between
the two, arguably, lies in their respective aims. On the whole, research aims to gen-
erate new knowledge and understanding, or to develop theory, usually for consump-
tion by the academic community, whereas, as highlighted above, evaluation aims to
provide ‘useful feedback’ to inform and/or influence decision-making within the
community of practice. A moment’s reflection will reveal that there is considerable
overlap between the two processes.
The issue is continuously debated within the academic community, and although
no firm conclusions seem likely to be reached, it is reminiscent of discussions about
the difference(s) between research and clinical audit when the latter was first intro-
duced into medical practice in the late 1980s/early 1990s. A useful, albeit simplistic
perspective that helped clarify thinking was that research asked the question ‘what
is the right thing to do?’, whereas audit – evaluation? – asks either ‘are we doing the
right thing?’ or ‘are we doing the thing right?’ In this respect, evaluation, like audit,
is parochial, pragmatic, often political and sometimes just a bit ‘messy’. Evaluation
by its very nature involves making value-laden decisions about all stages of the
process from what questions are asked of whom, to how results are framed and dis-
seminated. The important thing is that these values are acknowledged and
articulated.
364 J. Spencer
17.5.1.3 What Is Good Practice in Evaluation?
Unfortunately, evaluation is often included as an afterthought, and may not be

afforded the depth of attention and methodological rigor it demands. As a conse-
quence, effort and resources may be wasted, inaccurate or irrelevant conclusions
drawn, and inappropriate decisions made. Guidelines for good practice in evalua-
tion have been produced by a number of organizations including the American
Evaluation Association (AEA) and the UK Evaluation Society (UKES). The AEA
guidance is underpinned by the philosophy that, despite a diversity of approaches
‘….the common ground is that evaluators aspire to construct and provide the best
possible information that might bear on the value of whatever is being evaluated’
(American Evaluation Association 2004, p. 1), and is structured around five key
principles. These are systematic inquiry, competence, integrity, respect for people
and responsibility. Difficulties of producing generic guidelines are acknowledged:
‘....it is impossible to write guiding principles that neatly fit every context in which
evaluators work, and some evaluators will work in contexts in which following a
guideline cannot be done for good reason’ (American Evaluation Association 2004,
p. 1). The UK Evaluation Society approached the issue from a different perspective
in attempting to capture ‘a diverse set of principles for action’ for different stake-
holders. So for example, the guidelines propose that evaluators need to be explicit
about the purpose, methods, intended outputs and outcomes, and to be realistic
about what is feasible. Participants must have the process fully explained and be
assured that outputs such as reports will be made available to them. Commissioners
of evaluation should provide access to documentation and data, and establish clear
principles for reporting and disseminating results. Finally, those undertaking self-
evaluation must ensure the process is built into the structure and function of the
institution, and that all involved are engaged from the start. At the heart of the
guidelines is a philosophy of transparency about the expectations and requirements
of all stakeholders, whoever they are (UKES 2013).
Guidance about evaluation, specifically in the medical education literature, has
also been published. In a comprehensive review, Goldie (2006) outlined key issues
in relation to the role of the evaluator, ethics of evaluation, choosing the ‘right’
questions, design and range of approaches, analysis and interpretation of findings,
dissemination of results, and influencing decision-making. Cook (2010) offered 12
pragmatic tips to guide evaluation, arguing that the two most important questions to
ask were ‘Whose opinion matters?’ and ‘What would be really meaningful to
them?’ Other important issues include focusing on desired outcomes before select-
ing instruments, considering the validity or trustworthiness of the data, and pilot
testing the evaluation process (Cook 2010).
Notwithstanding differences in aims and purposes, all are agreed that to be of
any value, evaluation must follow broadly similar precepts to research. It must be as
rigorous as possible, ask relevant questions using appropriate methods, adhere to
ethical principles, and report and disseminate the findings honestly. As with
research, there is no single ‘correct’ approach, only more (or less) appropriate ones.
17.5.2 Complex or Simple Intervention?
Related to the positivist paradigm that underpins much of the faculty development
research to date is the notion of a linear causal chain, whereby one event, the inter-
vention, leads to a specific outcome, with the educational event conceptualized as a
‘simple’ intervention, rather like treatment of a specific disorder with a drug.
Experimental approaches, such as the randomized controlled trial, which aim to
control for all variables, are the methods of choice in assessing such simple
interventions.
Yet even an apparently simple one-off workshop – the mainstay of faculty devel-
opment programs – may be surprisingly complex. Take for example a hypothetical
3 h training session for OSCE examiners in a regional medical school. Instructional
design combines a training model (describe, demonstrate, put in context, deliberate
practice with feedback, assessment) and an adult learning approach. There is pre-
session reading and the workshop itself comprises didactic input from the facilita-
tor, video demonstration, role play and group discussion, with access to
supplementary on-line resources for further study. Four facilitators of varying expe-
rience deliver the session in ten teaching centers around the region to clinical fac-
ulty, themselves with a range of experience and from different specialties; the
session is held at different times during the working day or evening depending on
site. Medical students are recruited for role play when they are available. It can be
seen that this intervention is far from simple, with many potential variables and
confounders, some that could be predicted and possibly controlled for, others which
are likely unknown or unpredictable. To ascribe cause and effect in terms of a sim-
ple outcome such as self-reported confidence in examining in an OSCE could be
seen as overly simplistic. Further, although this may tell us something about what
worked it would not necessarily be able to answer questions such as why it worked
or not, and in what circumstances. Clearly alternative approaches to researching
complex interventions such as this scenario need to be considered.
17.5.2.1 What Distinguishes a Complex Intervention from a Simple One?
Several features of a complex intervention have been defined:

• It is usually based on several hypotheses or working theories, some more well
defined and/or evidence-based than others.
• It will usually involve a wide range of participants (e.g. faculty developers,
administrators, course participants, learners).
• It may be a ‘long journey’ from design of the intervention to delivery, with suc-
cess dependent upon integrity of a cumulative chain of events.
• The chain is usually non-linear, with multiple pathways and feedback loops.
• Complex interventions are embedded in multiple social systems.
366 J. Spencer
In the words of Pawson et al. ‘complex service interventions, therefore, can be

conceptualised as dynamic complex systems thrust amidst complex systems, relent-
lessly subject to negotiation, resistance, adaptation, leak and borrow, bloom and
fade....’ (Pawson et al. 2005, S1:23). Acknowledging this, it can be seen that if we
wished to research the effectiveness of the hypothetical training session described
above, several approaches may be required to capture its complexities. As argued,
simply assessing pre-determined outcomes will not allow us to ask questions such
as ‘Why did the intervention work here and not there?’ and ‘What is it about it that
works for whom in what circumstances?’ In this respect, Cook (2012) suggested
three main reasons why researchers in medical education continue to address such
basic ‘what works?’-type questions (usually using single-group pre-test/post-test
studies): because they can; because they seem important questions to ask; and
because they see others doing it in the literature. In fact, an intervention, especially
if it is new and innovative, will almost certainly work, at least for a time. McCoubrie
(2007) has argued that innovations in education tend to be effective because of a
number of factors. Firstly, there is the so-called ‘Pygmalion effect’, whereby people
do better simply because they’re expected to; secondly, we encounter the ‘Hawthorne
effect’, whereby the act of observation (by the researcher) alters the behavior of
those being observed; and lastly, there is the ‘halo effect’, whereby performance is
different (though not necessarily always improved) simply because of the novelty of
the situation. In addition, innovations are often well funded and are championed by
an enthusiast and generally do well – until funding dries up or enthusiasm wanes
(McCoubrie 2007). Thus, an evaluation of an innovative or novel intervention using
participant satisfaction alone, whilst likely to show favorable results, will not
address questions such as why the innovation was successful.
17.5.2.2 Good Practice in Studying Complex Interventions
The science of researching and evaluating complex interventions has evolved over
the past decade. For example, the UK Medical Research Council published guide-
lines in 2000, which were updated in 2008 (Craig et al. 2008).
Key issues highlighted include:
• The importance of having a sound theoretical understanding of how the interven-
tion might cause change.
• Recognizing that an intervention’s apparent lack of effect may reflect implemen-
tation problems rather than lack of effectiveness per se, begging the need for a
thorough process evaluation.
• Allowing for adaptation to local settings may be more appropriate than strict
adherence to a standardized protocol.
• The need to carefully consider the trade-off between the importance of the inter-
vention and constraints on what evidence can be gathered about it.
• The importance of combining evidence from a number of sources.
The essence of the guidance is summed up thus: ‘Best practice is to develop

interventions systematically, using the best available evidence and appropriate the-
ory, then to test them using a carefully phased approach starting with pilot studies
targeted at each of the key uncertainties in the design, and moving onto an explor-
atory and then a definitive evaluation.’ (Craig et al. 2008, p. 8).
17.5.2.3 A Novel Approach to Evaluating Complex Interventions
Several novel approaches to evaluating complex interventions have been developed,

an example being ‘realist evaluation’. Its basic tenet is that, rather than seeing cau-
sality as ‘X follows Y’, and recognizing that underlying mechanisms may be hid-
den, it takes a so-called ‘generative’ view, i.e. to infer a causal relationship between
two events, X and Y, one needs to understand not only the outcome, but also the
mechanism(s), the context and the relationships between them. The underlying
question changes from ‘What works?’ to ‘What is it about this intervention that
works for whom, and in what circumstances?’ Realist evaluation emphasizes inter-
pretation rather than measurement or prediction and thus has an explanatory as
opposed to a judgmental purpose (Pawson and Tilley 1997; Pawson et al. 2005).
The kind of question a realist evaluation would address includes ‘What is it about
the intervention, or component of the intervention, that leads to a particular outcome
in a particular context?’ and this would usually be approached using qualitative or
mixed methods.
There is often no sharp distinction between simple and complex interventions.
Indeed, it has been argued that complexity and simplicity sometimes reside more in
the eye of the beholder than in reality. Further, many interventions may be equally
open to simple or complex analysis, and Petticrew (2011) argued that complexity
may be simplified for the purpose of assessing specific simple outcomes when it is
helpful to see and analyze them as such; the important issue is the nature of the
research question (Petticrew 2011).
17.5.3 Measuring Outcomes
Notwithstanding the importance of exploring process and context as discussed

above, there is still a need to assess the impact of interventions. This involves
assessing outcomes, whether intended and pre-defined, or unintended and ‘discov-
ered’ outcomes. This section will discuss two important methodological issues in
evaluating impact, namely Kirkpatrick’s framework and the use of self-report
measures.
368 J. Spencer
17.5.3.1 Kirkpatrick’s Framework
Kirkpatrick’s framework (Table 17.1) has been widely used to evaluate both educa-
tional interventions and as a framework for systematic reviews. It was originally
developed for use in the manufacturing industry, the intended aim being to provide
managers with easily identifiable and easy-to-measure outcomes, metrics to which
a market value could be ascribed. Interestingly, it was not Kirkpatrick’s intention
that it should be treated as a hierarchy, although that is how the framework is usually
used, with participant reaction ascribed the ‘lowest’ level, and impact on learners
(or, in healthcare, patients) the highest. Yardley and Dornan, building on previous
authors’ work, provide a detailed critique of Kirkpatrick in the context of medical
education (Yardley and Dornan 2012). Key criticisms include the fact that the
framework, or at least the way it tends to be used, assumes causal links (i.e. that
attainment of a lower level is a pre-requisite for a higher one). Secondly, the differ-
ent levels relate to different stakeholders (such as faculty developers, their learners
and the organization). Furthermore, evaluating against anticipated outcomes may
blind researchers to other (unintended or unexpected) outcomes, addressing the
question ‘was outcome X achieved?’ rather than ‘what were the outcomes of this
intervention?’ (A clinical analogy would be carrying out a drug trial looking only at
expected outcomes and not at side-effects.) Finally, it was apparently never fully
validated since it rapidly found widespread use (Yardley and Dornan 2012).
However, it does serve a useful purpose in terms of categorizing the range of pos-
sible outcomes and as such it is likely that Kirkpatrick’s framework, or variations
thereof, will continue to be used in research and evaluation. Users need to recognize
the practical and conceptual limitations, which if nothing else serves to remind us
that effective evaluation needs to be multi-dimensional.
17.5.3.2 A Theoretical Model of Learning Outcomes
Kraiger et al. (1993) developed a theoretically-based model of learning outcomes,

drawing on research and theory from a range of disciplines, including cognitive,
social and educational psychology, and human factors. In effect they elaborated
Kirkpatrick’s Level 2, classifying outcomes under three headings: ‘cognitive’ (sub-
classified hierarchically as verbal or declarative knowledge, organization of knowl-
edge, and cognitive strategies such as meta-cognition); ‘skills-based’ (acknowledging
the nature of skills development from initial acquisition, through ‘compilation’ to
automaticity); and ‘affective’ outcomes (including attitudinal and motivational out-
comes). They identified the learning constructs underpinning these outcome catego-
ries, highlighted relevant foci of measurement, and suggested potential evaluation
methods. For example, measurements of verbal knowledge would focus on amount
or accuracy of knowledge using tests of recall or recognition. On the other hand,
skills-based outcomes would usually require observational measures, and affective
outcomes some kind of self-report. The importance of ensuring measurement
instruments are ‘fit for purpose’ in terms of characteristics such as validity and
reliability cannot be over-emphasized (Cook 2010), although a degree of compro-
mise may be necessary for pragmatic reasons.
17.5.3.3 The Limitations of Self-Report
Self-report is a mainstay of research and evaluation whether it is in health, educa-

tion or social policy, and the faculty development literature is no exception. The
majority of studies in the systematic reviews described earlier used self-report;
indeed, this was often the only method used, for example asking participants whether
they found a course useful, or about changes in attitudes, gains in knowledge and
skills, or modification of behavior. Ultimately there is no other way to find out what
people think or feel than to ask them. It is important, however, to recognize the limi-
tations of self-report. A large body of research, much of it from cognitive psychol-
ogy, has shown that self-report i.e. accessing information from so-called
autobiographical (as opposed to semantic) memory, is notoriously flawed
(Tourangeau 2000). Apart from error inherent in any measurement, major potential
biases include social desirability of responding in a particular way and the pressures
to mis-report, for example to preserve self-image. More fundamentally, however,
every stage of the memory-making process, from encoding, through retrieval, to
recall and what has been called ‘reconstruction’ (i.e. filling in the gaps), is prone to
bias and error. This is so much the case that one author was moved to write ‘What
we retrieve from memory often consists of our current beliefs about an incident,
beliefs that reflect what we actually experienced (and remember), what we did not
experience but infer, and what we learned later on’ (Tourangeau 2000). In particu-
lar, people often have problems with recalling dates, sequences, and frequencies
(with a tendency to remember events as happening more frequently than they did).
A further confounding variable comes to bear when people are asked to appraise
their own performance. It is well recognized that people do not (and possibly can-
not) self-assess with any degree of accuracy (Eva and Regehr 2005). Taken together,
these issues beg the need for caution when interpreting data obtained from self-
report and where possible to triangulate by using more objective methods.
17.6 Recommendations for Future Research and Evaluation

in Faculty Development
The following list of issues for consideration has been distilled from the literature
reviewed in this chapter and is divided into two areas, the research process and the
content or focus of research. General recommendations for improving quality were
remarkably consistent across the four reviews and include greater collaboration
between educators and researchers and across disciplines, in particular with
370 J. Spencer
scholars based in the social sciences and humanities, better research training, and
more rigorous peer review.
17.6.1 The Research Process
Key practical messages from the literature about the process (i.e. how we undertake
research and evaluation) include the following:
• Ensure research is informed as much as possible by theory and evidence; this
will make the research more robust (and thus more useful), and strengthen links
between theory and practice.
• Focus on evaluating process and context as much as outcomes and impact; this
will help illuminate the complexity that characterizes all but the most basic
intervention.
• Undertake ‘clarification’ studies, as opposed to descriptive or ‘justification’ stud-
ies because addressing questions such as ‘why does X work in this situation and
not in that?’ is likely to generate more useful answers than simply asking ‘does
X work?’
• Consider using qualitative or mixed methods approaches whilst ensuring there is
congruence between study design, research questions, data collection methods
and analysis.
• Recognize the limitations of the single group pre-test/post-test design, and con-
sider using retrospective pre-post approaches (Skeff et al. 1992).
• Consider comparative studies, recognizing the need for larger samples, but not-
ing that valid inferences can be drawn from well-designed non-randomized stud-
ies, striving to ensure that the most appropriate method is used to answer the
questions posed.
• Where possible, use validated outcome measures, including newer methods of
behavioral or performance-based assessment; if using a ‘home-grown’ instru-
ment, make sure it is piloted and assess and endeavor to report its validity and
reliability, as well as its strengths and limitations.
• Describe both the intervention and the context in more detail; this will help col-
leagues make sense of the findings and also enable further research.
• Explore the core characteristics of the initiative (e.g. its theoretical foundation,
goals and content) as well as the educational features (such as duration and
format).
• Consider collaborating with colleagues in other disciplines.
17.6.2 Content or Focus of the Research
Potential areas for further research in faculty development emerging from the
reviews include:
• The consequences and impacts of interventions over longer time periods.
Intuitively one would expect long-term interventions to have better and more
sustained outcomes, but the evidence-base for this is currently slim.
• The social determinants of participation, such as the role of motivation and the
factors influencing it, to inform development of appropriate interventions.
• Which combination of blended learning is effective and for what reasons? Use of
blended learning approaches (i.e. combinations of face-to-face and on-line learn-
ing) is increasing; thus, it is important to understand what works for whom and
in what situations.
• Inter-professional education at basic/pre-registration level is increasingly the
norm. Given that faculty are diverse and often drawn from a range of profes-
sional backgrounds, it would be useful to know whether and how inter-
professional faculty development ‘works’.
• The relationship between organizational culture and faculty development, includ-
ing impacts at the institutional level.
• Development and sustainability of communities of practice and their role in pro-
moting professional development.
• The impact of different interventions, of varied duration or format.
17.7 Conclusion
This chapter has described and discussed the findings of recent reviews of research
into faculty development. Key features of effective interventions and strengths and
weaknesses of the research were highlighted, and a number of important issues
related to improving the quality of research were discussed. In their 2006 review,
Steinert et al. (2006) predicted there would be an increase in the number of well-
designed studies looking at objectively measured behavioral and systems-level out-
comes in the early twenty-first century. Encouragingly, there is some evidence that
this is the case. At the time of writing, a further systematic review is in process
looking at the literature on faculty development for teaching effectiveness published
since 2002. Preliminary analysis of around 130 papers has revealed more rigorous
study designs, a diversity of methods, and use of more robust outcome measures.
Despite concerns about quality, it would appear that the ‘state of the art’ is (to mix
metaphors) ‘alive and well.’
372 J. Spencer
17.8 Key Messages
• Systematic reviews have demonstrated the effectiveness of faculty development

interventions in terms of participant satisfaction, changes in attitudes, knowl-
edge, skills and behavior, developments at the institutional level, and impact on
student learning.
• Key features of effective faculty development include needs assessments, inter-
active techniques and collaborative approaches, opportunities for practice with
feedback, appropriately sequenced and multi-faceted activities, reflective
practice, and long-term interventions.
• Whereas research and evaluation differ in focus, aims and purpose, both
approaches must be rigorous and systematic, ask relevant questions using appro-
priate methods, adhere to ethical principles, and report and disseminate findings
honestly.
• Most faculty development initiatives are ‘complex interventions’ and novel
approaches to their evaluation, such as ‘realist evaluation’, should be
considered.
• Although Kirkpatrick’s framework is useful in evaluating outcomes, its limita-
tions should be recognized; similarly, the limitations of self-report measures
should be acknowledged.
• With both research and evaluation, there is no single ‘correct’ approach, only
more (or less) appropriate ones.
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Chapter 18
Promoting Scholarship in Faculty
Development: Relevant Research Paradigms
and Methodologies
Patricia S. O’Sullivan and David M. Irby
18.1 Introduction
If you ask faculty members how they are using what they learned in a faculty
development program, you might be surprised to hear how they have changed their
teaching practices and discovered a new community of fellow teachers. However, if
you tried to measure the impact of those faculty development programs using the
traditional approach to research, you might be puzzled to discover ‘no significant
difference.’ We (O’Sullivan and Irby 2011) struggled with this dilemma and found
that most research on faculty development follows the positivist paradigm. A para-
digm defines the prevailing model of exemplary practices for a community of
researchers; it illuminates areas for investigation and obscures others. The positivist
research paradigm assumes that reality is ordered, predictable and ultimately
knowable through objective measures and rigorous application of the scientific
method. Acting on these presumptions, researchers have postulated a mechanical
or linear model of faculty development that begins with a faculty development
activity where participants acquire new knowledge, skills and attitudes, which they
then employ or convey to learners, who in turn ultimately provide improved patient
care. Much of the published work on faculty development has followed this
paradigm. See Fig. 18.1 for a visual model of this approach to the study of faculty
development.
P.S. O’Sullivan, Ed.D. (*) • D.M. Irby, Ph.D.

Department of Medicine and Office of Research and Development in Medical Education,
University of California San Francisco School of Medicine, San Francisco, CA, USA
e-mail: [email protected]; [email protected]

376 P.S. O’Sullivan and D.M. Irby
Fig. 18.1 The traditional, linear model of faculty development research assumes a causal chain of
events, starting with a faculty development program, continuing through changes in actions
of individual faculty participants to changes in the actions of learners, and culminating in changes
to patient care (Adapted from O’Sullivan and Irby 2011, and used with permission of Academic
Medicine)
We argue that in order for the field of faculty development to advance, we need
to utilize other research paradigms and methodologies in addition to the positivist
paradigm with its emphasis on empirically driven randomized controlled studies.
We have divided this chapter into five sections. First, we review findings from prior
reviews of the literature on faculty development programs, focusing on the research
paradigms that the researchers chose for including or excluding studies in the
review. By and large, we find that these reviews have been overly constrained by
the predominance of the positivist paradigm. Second, we stress the importance of
working from a conceptual framework for faculty development, which can enrich
and broaden the inquiry process. Our framework for examining faculty develop-
ment (O’Sullivan and Irby 2011) leads to a broader set of questions requiring a
variety of research paradigms compared to the model in Fig. 18.1. Third, we explore
how four paradigms and their accompanying research methodologies can expand
the way in which we investigate faculty development programs, drawing on the
positivist, post-positivist, interpretivist and critical theory paradigms. Fourth, we
review three methodologies that are less frequently used in faculty development
research to explore their potential to provide new directions for faculty development
research: educational design research, success cases and sustainability narratives.
Finally, we describe how this discovery-oriented research fits into the broader arena
of scholarship, and how readers might begin to undertake scholarship in this exciting
area of faculty development.
18 Promoting Scholarship in Faculty Development: Relevant Research… 377
18.2 Prior Reviews of Faculty Development Research
Working within the positivistic paradigm, at least six systematic reviews of the
teaching improvement and faculty development literature have focused on the
effectiveness of faculty development practices (Amundsen and Wilson 2012;
Levinson-Rose and Menges 1981; McLean et al. 2008; Steinert et al. 2006; Stes
et al. 2010; Webster-Wright 2009). Most of these reviews sought to address the
question: What are the features of faculty development that make it effective? All
but the Amundsen and Wilson review (2012) grouped studies by format such as
workshops and consultations, by level or type of learning examined such as self-
report or observed behavior, and by individual variables such as duration of the
activity. The authors of these reviews lamented the meager generalizations that
could be gained from these studies. They also found it difficult to draw meaningful
conclusions because of the limited number of studies that met the review criteria,
which were highly influenced by the positivist paradigm. Adherence to such criteria
inherently eliminates research from alternative paradigms (to be described below),
thus restricting the usefulness and informative nature of such reviews.
Reading these reviews reminds us of watching a fly butting its head against a
window trying to get out of the house. It continuously repeats the process of
ramming the windowpane, but no matter how hard it tries, there is no way through
it. Yet, just a few feet away, the door is open to the outside and the fly could proceed
outside unimpeded if it would just switch course. Researchers studying faculty
development programs are somewhat like the fly in that we predominantly use a
limited set of research paradigms and research methodologies – attempting to
answer all questions using the positivist paradigm and quantitative methodologies.
We need to open the door and broaden our questions, paradigms and research
methodologies.
Amundsen and Wilson (2012) examined the prior literature reviews that focused
exclusively on effectiveness measures and reoriented their review of faculty
development in higher education to address two additional questions: ‘How are
educational development practices designed?’ and ‘What is the thinking underpin-
ning the design of educational development practices?’ Based on their review, they
found that studies could provide evidence for the following clusters of practice:
a skill focus on the acquisition of teaching skills and techniques (e.g. voice projection),
a method focus on mastery of a particular teaching method (e.g. problem-based
learning), a reflection focus on change in individual teacher conceptions of teaching
and learning, an institutional focus on institutional support for teaching improve-
ment, a disciplinary focus on disciplinary understanding to develop pedagogical
knowledge, and an action research or inquiry focus on individuals or groups of
faculty investigating teaching and learning questions of interest to them. The authors
argue that their review of the literature using clusters of practice resulted in an
enhanced understanding of faculty development and the situated nature of teaching

practice in the academic workplace, thereby overcoming the limitations of the prior
reviews. See Chap. 17 for a broader description of the results of these reviews.
18.3 A Conceptual Framework for Faculty Development
After reviewing literature from faculty development, continuing medical education,

teacher education, quality improvement and workplace learning, we proposed a
conceptual framework for conducting faculty development research (O’Sullivan
and Irby 2011). See Fig. 18.2 for a visual representation of this framework.
While our work preceded Amundsen and Wilson’s review (2012), we are struck by
the similarities of our conclusions. The core concept in our framework is about locating
faculty development within two separate but related communities: (1) the faculty
Fig. 18.2 The new model for faculty development research suggests that faculty development is
embedded in two communities of practice (the faculty development community and the workplace
community) and, to bring about desired change, requires the interaction of four primary components
(facilitator, participants, context, and program) with their associated processes (mentoring
and coaching; relationships and networks; organizations, systems, and cultures; and tasks and
activities) – all in the workplace (Used with permission of Academic Medicine: O’Sullivan
and Irby 2011)
development community and (2) the community of teaching practice in the workplace
(Billett 2001; Lave and Wenger 1991). The faculty development community is
often described as a ‘teaching commons’ (Huber and Hutchings 2005), which refers
to the real and virtual environments where faculty members discuss their questions,
concerns and challenges as educators, and learn new roles and new skills. The
second community, the workplace, can be situated in classrooms and clinical
settings where the teaching takes place. For the faculty development community
located in the teaching commons, the four key components are the participants,
the faculty development program, the facilitator, and the context in which the
program occurs (e.g. classroom, clinic, and online). For the workplace community
of teaching practice (i.e. the classroom and/or clinical setting), there are four
associated components in the model. Participants have relationships and networks
of associations with colleagues and learners in the work environment. The analogous
component to the faculty development program in the workplace is the tasks and
activities in the work setting. The parallel role of the facilitator is the mentoring that
might be available to faculty in the workplace setting. Finally, context relates to the
organization and culture of the workplace setting. Each of these components as well
as their interactions within and across communities represents critical areas in need
of further investigation.
To investigate all of the components in this framework, we need to ask an
expanded set of questions employing a broader array of research methodologies
that go well beyond those employed by the positivist paradigm. The conceptual
framework broadens the purview of research opportunities beyond faculty develop-
ment activities themselves in order to account for the powerful influences of the
workplace environment on the faculty members’ teaching practices. We encourage
research on the overall framework, on each separate component, on associations
among the components, and on how each component leads to a desired outcome.
All of this will be required to offer policy guidance to those responsible for leading
and funding faculty development programs.
18.4 Research Paradigms
Before describing the four research paradigms and associated research methodolo-
gies, we define the terms being employed. A research paradigm reflects the
philosophical underpinnings of knowledge development. ‘Paradigms are sets of
beliefs and practices, shared by communities of researchers, which regulate inquiry
within disciplines’ (Bunniss and Kelly 2010, p. 360). An example is the positivist
paradigm described above. The term methodology refers to the applied approach
to the study of a particular issue. Research methodologies are nested within broader
research paradigms or assumptions about the nature of the world, how we interact
with it, and how we know it. Examples of methodologies include experimental
design, surveys, correlational studies, ethnography, phenomenology and case studies.
Finally, tools are the specific research methods used to obtain information for a study,
such as cognitive tests, observation forms, interviews and focus groups.
The four research paradigms we include are drawn from the Bunnis and Kelly
(2010) review of research paradigms used in medical education research: positivism,
post-positivism, interpretivism and critical theory. We summarize them succinctly
here and elaborate on each more fully below. Positivism, the most prevalent para-
digm, assumes that reality is knowable and measurable. It uses the scientific method
to develop abstract laws in order to describe and predict patterns, and employs
quantitative methodologies to test hypotheses. Post-positivism assumes that objec-
tive knowledge of the world is not fully possible or accessible and therefore seeks
probable truths. In this paradigm, knowledge is developed through falsification
of hypotheses. Post-positivists use quantitative and qualitative methodologies.
Interpretivism asserts that reality is subjective and changing and therefore there is
no ultimate truth. Meaning is socially constructed, resulting in multiple and diverse
interpretations of reality. Interpretivism uses qualitative methodology to understand
various interpretations of phenomenon. Finally, critical theory argues that reality
may be objective but truth is continually contested by competing groups. Therefore,
knowledge is co-constructed between individuals and groups, and mediated
by power relationships. Scholars who adopt the critical theory paradigm utilize
quantitative and qualitative methodologies to advocate for change. These four
research paradigms, and their associated assumptions about the nature of the world,
influence the choice of research methodologies and tools. In the following sections,
we will briefly describe each paradigm and summarize its strengths and limitations.
Then we will provide examples that illustrate how that paradigm has been applied
to the study of faculty development. Finally, based on our conceptual framework
for studying faculty development, we suggest questions that could be explored
within each paradigm. See Table 18.1 for a summary of the paradigms, associated
methodologies, defining characteristics, typical research questions, and their relation-
ship to our framework of faculty development.
We acknowledge that there are a number of research methodologies that may
be applicable to faculty development that we have not included. We chose to be
selective rather than exhaustive. On the other hand, there are methodologies not
frequently used in faculty development research that could provide informative
answers. Consequently, our review of the research paradigms will be brief to
concentrate on some lesser-known methodologies that include: educational design
research, success cases and sustainability narratives.
18.4.1 Positivist Paradigm
While we argue for the importance of alternative paradigms, we believe that the
positivist paradigm can be an appropriate and important paradigm to answer a given
research question. The positivist paradigm is designed to discover what exists
through prediction and control, and is characterized by the scientific method
(Bunniss and Kelly 2010). This paradigm has framed educational research for over
18
Table 18.1 Research paradigms, associated research methodologies and their defining characteristics along with illustrative questions associated with faculty
development and related connections to the O’Sullivan and Irby conceptual framework for research on faculty development (2011)
Components of
O’Sullivan and Irby’s
Research Illustrative questions for faculty (2011) conceptual
Research paradigms methodologies Defining characteristics of methodologies development framework
Positivism Experimental and Explores cause and effect relationships Do structured reflection exercises Program
Quasi-experimental where causes can be manipulated to within workshops work better Tasks and activities in
produce different kinds of effects. than unstructured reflection? the workplace
Assumes random assignment of subjects Does training on feedback skills
and random assignment to groups improve participant feedback
Uses quantitative methods to residents?
Survey Describes and explains using many subjects How satisfied are participants with Program
and questionnaires. Explores causal faculty development programs? Facilitator
relationships and, where possible, uses What pedagogical strategies do
randomization. Employs quantitative faculty developers utilize?
methods
Post positivism Correlational Explores relationships to make predictions. Does it make a difference if Organizations, systems
Examines one set of subjects with two or participants in faculty and culture in the
more variables for each. Uses quantita- development programs come workplace;
tive and qualitative methods as individuals or as members Relationships and
of workplace teams? networks in the
workplace
Case-control/ Explores cause and effect relationships Does participation in a longitudi- Organization, systems
Promoting Scholarship in Faculty Development: Relevant Research…
prospective/ where causes already exist and cannot be nal faculty development and culture in the
retrospective manipulated. Examines programs that program accelerate academic workplace
already exist and looks backward to promotions? Mentoring and coaching
explain why components or programs Does having an instructional in the workplace
work. Uses quantitative and qualitative coach in the workplace
methods improve implementation
of teaching skills?
381
(continued)
382

Components of
Interpretivism Qualitative methods Employs direct observation, interviews and What relationships develop during Participants;
including ethnogra- document review to give a complete and after participating in Relationships and
phy, case study, snapshot of a case that is being studied. faculty development activities? networks in the
observation, Uses qualitative methods What is the developmental workplace
interviews, focus trajectory of faculty Participants;
groups, document members involved Organization,
review in faculty development? systems and culture
in the workplace
Educational design Involves an iterative process of small What is the consequence of Program; Relationships
research (mixed experiments using formative assessment altering a component of a and networks in the
methods) to test and refine educational designs faculty development program workplace;
based on principles from previous on how participants utilize the Organization,
research. Uses quantitative and component in their practice? systems and culture
qualitative methods in the workplace
Success cases Detects impact of activities by identifying What components of faculty Program; Tasks and
successful and unsuccessful implementa- development produce the activities in the
tions. Surveys most and least successful greatest impact on the workplace
cases and then conducts in-depth participants’ learners?
analyses of selected success cases. Uses
P.S. O’Sullivan and D.M. Irby
quantitative and qualitative methods

Components of
18
Critical theory Mixed methods Seeks to envision and advocate for a better How does serving as a faculty Participants;
future. Uses philosophical analysis and developer affect one’s Relationships and
other methods of inquiry to make a professional identity and networks in the
narrative case for empowerment and change relationships with workplace;
emancipation colleagues? Mentoring and
Who is advantaged by faculty coaching in the
development and who is workplace
marginalized? Relationships and
networks in the
workplace
Sustainability Engages experts and stakeholders in creating What would be needed to create a Whole model;
narratives alternative scenarios of the future. sustainable future for faculty Organization,
Involves analyses of each scenario using development in the clinical systems and culture
existing and new data. Creates scenarios workplace? in the workplace;
and recommendations based on analysis. Tasks and activities
Uses quantitative and qualitative in the workplace
methods
Promoting Scholarship in Faculty Development: Relevant Research…
383
a half century, with its focus on experimental research design, use of randomization,
quantitative measures (Cronbach 1957), and the presumption that the researcher is
objective and removed from the object being studied.
Over the last decade, there have been repeated calls for more rigorous educational
research, which typically means using experimental design in the positivist paradigm
(Feuer et al. 2002). True-experimental, pre-experimental, and quasi-experimental
research designs, as described by Campbell and Stanley (1963), seek to maximize
internal and external validity so that the results of a study can be assumed to be
causal and generalizable (Campbell and Stanley 1963). Since the medical sciences
hold the randomized-controlled trial (RCT) as the study design with the highest rigor
and quality (Hulley et al. 2007), there has been increasing expectation that RCTs be
part of health professions educational research. While RCTs cannot always be
conducted, researchers have embraced a number of quasi-experimental designs that
allow for elements of control from either historic or delayed intervention groups.
The strength of the positivist paradigm is the emphasis on internal and external
validity. Yet, this emphasis causes an inherent weakness. Creating studies with strong
internal validity means that many elements of the design of the study are controlled.
This limits the external validity since it makes it harder to generalize to other settings,
interventions or tools. However, given these trade-offs, internal validity is considered
most important. Maximizing internal validity includes reducing biases in interventions,
participants, tools and researchers. This is accomplished chiefly by randomizing
participants, pre and post intervention testing, and including control groups and tools
with good psychometric characteristics. Implementing such controls often precludes
studying what happens in the natural settings of classrooms and clinics. Additionally,
such designs may actually eliminate the very elements that characterize what happens
in educational interventions (Berliner 2002; Norman 2008). For an excellent sum-
mary of the methodologies associated with the positivist paradigm, see Norman
and Eva’s (2010) article. They include experimental, epidemiologic, psychometric and
correlational designs as well as reviews and meta- analyses as part of this tradition.
The positivist paradigm and experimental designs have been applied to the study
of faculty development programs, including programs for residents as teachers. For
example, Morrison et al. (2003) reported on a randomized, controlled trial of a longi-
tudinal residents-as-teachers curriculum. They provided a 13 h program on teaching
to 13 out of 23 residents in the program, and pre- and post-tested the residents using a
3.5 h, eight-station objective structured teaching examination (OSTE). While the
intervention and control groups had equivalent entering characteristics and pre-OSTE
performance, the intervention group residents significantly improved their pre-to-post
OSTE teaching scores while the control group residents did not. In another study,
Furney et al. (2001) randomly assigned residents, who act as teachers to students, to
an intervention and control group. One group received training in the use of the One
Minute Preceptor model of clinical teaching and the other did not. They assessed both
groups before and after by measuring student ratings of their teaching and by measur-
ing residents’ self-perceptions of their teaching abilities. Residents in the intervention
group reported greater use of One Minute Preceptor skills compared to control group
residents, which was confirmed by student ratings of the specific skills.
Using a quasi-experimental design, Hewson et al. (2001) used a retrospective

self-report along with trainee ratings in a time-series design to demonstrate the
effectiveness of a faculty development program. Both self and trainee ratings
showed improvement post faculty development. Another quasi-experimental design
used participants compared to non-participants (e.g. Corchon et al. 2011), although
this is a challenging design to implement because participation in faculty develop-
ment is voluntary and it is difficult to identify and recruit equivalent faculty who did
not participate in faculty development for a control group.
Considering our model, we could imagine using the positivist paradigm to address
a question about the interaction between the faculty development program and the
organization/culture within which the participants work. A research question might
be: ‘Could the outcomes of a faculty development program be improved by giving
participants materials to evaluate their work environment?’ Using the One Minute
Preceptor example by Furney et al. (2001) mentioned above, we might repeat the
pre and post measures used in that study, but randomly give half of the workshop
participants a tool to assess their workplace for resources and people that would
enable them to use the One Minute Preceptor model. Our hypothesis is that by giving
a checklist indicating potential ways to overcome barriers and gain support, participants
with the checklist will do better at implementing the micro-skills of the One Minute
Preceptor model in their workplace than those without such a checklist.
18.4.2 Post-Positivist Paradigm
The post-positivist paradigm seeks to maintain the positivist focus on objective truth
and the importance of experimental research methodologies but recognizes that
truth can only be imperfectly and probabilistically known. Researchers are not
objective observers, as the positivists believe, but rather are actors who bring their
own biases to what they observe, analyze and report. Post-positivists seek objectivity
by recognizing and seeking to minimize the effects of biases, and by seeking falsification
instead of verification as the positivists do. Post-positivists also do not exclude data
obtained from qualitative methods, thus rejecting the dichotomy between quantitative
and qualitative methodologies (Clark 1998). Clark (1998) argues that this shift is partly
due to recognizing that there are human elements operating even in an electron
microscope, thus questioning if any data are truly ‘objective’.
The post-positivists, like the positivists, adhere to strong research methodologies
and prefer experimental and quasi-experimental designs. However, they also use tools
such as surveys, interviews and focus groups, and therefore attend to issues of bias
more than the positivists. The strength of the post-positivist paradigm is the acceptance
of qualitative research methods while maintaining the focus on generalizability
and prediction, and the willingness to incorporate the natural context into the research.
The major limitation of the post-positivist paradigm, like that of the next two para-
digms (interpretivist and critical theory), is the inability to control external variables
that are part of the complexities of natural events, which in turn threatens validity
and reduces claims about generalizability. Unlike the interpretivist and critical
theory paradigms, the post-positivists are still focused on seeking objective truth.
An example of post-positivist research that fits our conceptual framework for
faculty development research includes a study by Moses et al. (2009). In order to
characterize the impact of a longitudinal faculty development program, the authors
examined two outcomes: (1) networks of education colleagues using pre-to-post
social network mapping, and (2) educational scholarship of participants employing
structured interviews. They found increased educational networks with participation
in the program but showed little effect on scholarly productivity. In another study,
Burdick et al. (2010) used a combination of pre and post surveys and interviews to
identify the utility and impact of an international educational leadership fellowship
program. They found that participants were actively engaged in applying the knowledge
and skills gained in the fellowship program to their home institutions.
Thinking as post-positivist researchers, we became interested in how to develop
mentors in the workplace, an important component of our conceptual framework.
We thought that we might use a quasi-experimental design to investigate how
mentoring influences team management skills in the workplace. Team members
from multiple work groups would be surveyed to determine the level of mentoring
they receive and the quality of team management skills they report in the workplace
prior to the intervention. All teams would then participate in a faculty development
activity on team management skills. One third of the teams would designate some-
one within their work group to serve as their coach or mentor upon return to the
workplace, one third of the teams would periodically receive coaching from an
outsider who is skilled in team management and mentoring, and the final third of
the teams would receive no mentoring in the workplace. The team members would
be resurveyed about mentoring and team management skills 3 and 6 months following
the intervention.
This proposed investigation and the other studies referred to above reflect the
components of our faculty development framework that relate to the application of
knowledge, skills and attitudes learned in the faculty development program to actual
practice in the workplace – including subsequent teamwork, scholarship and
educational networks. Applying the post-positivist paradigm to our model would add
to our understanding of participants’ practices once they return to the workplace.
18.4.3 Interpretivist Paradigm
The interpretivist paradigm posits that meaning is a socially constructed reality and
therefore there is no objective truth. Qualitative research methods are used to
illuminate the multiple and diverse perspectives or interpretations of reality held by
individuals and groups. The purpose of this paradigm is to describe, understand and
interpret human thought, interactions and discourse, including the reasons for such
actions. The basic method is inductive, beginning with the thoughts of specific
individuals or groups and building up to general themes and conclusions about their
thoughts, values and actions. It tends to be holistic, deeply contextual, and typically
an in-depth study of a few number of cases. Drawing on the disciplines of
anthropology, sociology and linguistics, qualitative research represents a cluster of
rigorous and diverse research methods, including ethnography, discourse analysis,
and case studies. Unlike positivist research that is driven by a hypothesis that is
being tested, qualitative analytic methods can take one of two different approaches:
(1) analysis that is driven by a theoretical position or (2) analysis that is inductively
built up from the data, known as grounded theory (Glaser and Strauss 1967; Strauss
and Corbin 1998).
Qualitative researchers gather information through observations, field notes,
reflective journals, interviews, focus groups and analyses of documents and materi-
als. Data are coded into themes and subthemes that iteratively lead to meaningful
generalizations (Braun and Clarke 2006). To validate the themes and interpreta-
tions, researchers often have multiple investigators code the data and corroborate
findings, and they conduct member checking to ensure that those who were inter-
viewed concur with the reports of their thinking, perceptions and beliefs (Lincoln
and Guba 1985). The strength of such research is the ability to uncover hidden
perspectives on a wide variety of issues, develop and confirm socially constructed
theories, and anticipate changes in future beliefs and actions of individuals and
groups. The limitations derive from the situated nature of the findings that raise
questions about generalizability.
One example of a study of faculty development that used the interpretivist
research paradigm is reported by Steinert et al. (2010) who sought to understand
why some clinical teachers regularly attend faculty development activities and
others do not. They conducted focus groups with 23 clinical teachers who attended
their workshops. Using thematic analysis of focus group transcripts, the team
discovered that regular participants perceived that workshops facilitated their
personal and professional growth; the topics were viewed as relevant to their needs
as teachers; and participation in the program generated a new and supportive
network of colleagues. Participants also valued learning and self-improvement.
Barriers against participation were also identified along with suggestions for
increasing participation. The results were used to design future workshops, based
upon the recognition that motivation, values and social dimensions are important
components of faculty development.
Using our framework for research on faculty development, investigators using
the interpretivist paradigm might conduct a qualitative study to examine those who
actually conduct faculty development, specifically identifying their background
preparation, pedagogical content knowledge (i.e. transformations of subject-matter
knowledge into instructionally powerful teaching scripts that facilitate student
learning (Shulman 1986)), beliefs about teaching and learning, reflective practices,
improvement strategies, identity formation and career trajectories as faculty
developers. Specific research questions might include: How do faculty developers
describe their identity and its formation? How does being a faculty developer affect
their everyday work? What impact does the role of being a faculty developer have
on them, the faculty development teaching commons and the larger community of
teaching practice? The tools employed could include interviews, focus groups,
debriefs from observations and reviews of recordings of teaching practices, reviews
of workshop materials, and examination of curriculum vitae.
18.4.4 Critical Theory
Critical theory is a school of thought that draws on the social sciences to examine,
critique and advocate for change in culture and society. The most common meaning
of critical theory arises from sociologists who have used philosophies such as
Marxism, idealism and post-colonial theory to challenge social injustices; a less
common meaning of critical theory comes from literary criticism. The social critical
theory model confronts positivist assumptions along with any accompanying forms
of authority, hegemony and injustice. The focus is on the use of language, symbol-
ism, communication and meaning to empower human beings and to challenge
established power and authority. Research methods include the use of linguistics,
rhetoric and most of all philosophical analysis. This narrative form of scholarship
can examine and critique individual, group and organizational relationships of power
and privilege, opening up for scrutiny commonly accepted dimensions of culture
and values. However, this paradigm is held hostage to the conceptual framework
that shapes the critique (e.g. Marxism, idealism, post-colonial theory), the limited
generalizability of the recommendations advocated based on that theory, and the
challenges to the findings coming from alternative theories. Critical theory is a
rhetorical, narrative vehicle for advocating and achieving social justice.
This paradigm is infrequently used in research on faculty development but offers
some interesting perspectives on these activities. Bleakley et al. (2008) and Bleakley
(2011) have written extensively using this paradigm, examining such topics as the
democratizing force of medical education research; post-colonial dilemmas in
global medical education; and power, identity and location in medical education.
When considering the critical theory paradigm and our framework of faculty
development, we could pose questions such as: How are faculty members empowered
to become excellent teachers through faculty development? Who is advantaged
by faculty development and who is marginalized? What does this do to the power
relationships and the culture of the institution? How are institutional resources differen-
tially allocated to support faculty in their roles as teachers, researchers and clinicians?
What are the power differentials in academic departments and promotions committees
between researchers and educators? Critical theory examines, describes, exposes and
challenges inequities at all levels and can be a powerful voice for change.
18.5 Alternative Research Methods
In addition to the research paradigms describe above, we will describe some

additional promising research methodologies, often involving mixed methods, to
address questions posed from our faculty development framework. Mixed methods
represent a methodology that can be used within multiple research paradigms and
can move faculty development research forward. We describe three promising
methodologies with accompanying faculty development examples: design research,
success cases and sustainability narratives.
18.5.1 Design Research
Design research is a methodology that has evolved over the last 30 years and is
nested under the post-positivist and intepretivist paradigms. The goal of design
research is to develop formative experiments to test and refine educational designs
based on principles derived from previous research and to address theory and prac-
tice simultaneously (Collins et al. 2004). As a methodology, it serves to address
theoretical questions in the real world recognizing the need to generate research
findings from formative evaluation. Collins et al. (2004) developed the approach as
a means of determining what was implemented versus what was intended. They
wanted to examine a range of outcomes that exceeded the ones commonly focused
on in educational research. In general, the approach is to make theoretically driven
design changes and to test them in a practical environment in order to determine
their impact in a formative manner. Thus, it is an iterative process of examining
prototypes.
For faculty development, an example might be to study a workshop where teach-
ing scripts are shared and discussed to improve feedback skills. This could be fol-
lowed by a survey of skill use, which, after careful reflection on the theoretical and
empirical guidelines for improving feedback, might lead to another workshop that
includes role-plays to practice feedback scripts. A subsequent survey might find
need for additional tips on giving feedback to learners experiencing difficulty. Next,
an email reminder with feedback tips related to micro-skills might be sent as follow-
up. These rapid cycles could use small samples of participants to quickly revise
program components following theory-based guidelines.
Educational design research follows a series of interventions over an extended
period of time using multiple methods. Bereiter (2002) asserts that design research
can help to sustain an innovation and focuses the research on the future instead of
the past. In the case of an innovation, the researcher must be a close collaborator
with the designer and be an interventionist vs. an objective observer (Bereiter 2002;
McKenney and Reeves 2012).
To report a design experiment, a researcher would include goals and elements of
the design, a description of the settings where implemented, description of each
phase implemented, outcomes found and lessons learned (Collins et al. 2004).
Dolmans and Tigelaar (2012) provide a useful guide for design-based research in
medical education.
Educational design research is pertinent to faculty development because it allows
for the examination of evolving program innovations. Using educational design
research, we would start a series of micro-cycles, which involves performing the
steps of the research with small samples of participants and short time lines as we
illustrated with the feedback workshop example above (McKenney and Reeves
2012). In the analysis and exploration stage, we would identify and diagnose the
problem to be addressed, primarily by exploring relevant literature and data that we
may have from previous offerings or participants’ subsequent performance related
to the specific skill. In the example above, this stage was captured by the components
added to the faculty development program. Performance reported by participants
indicated a gap and thinking about this gap from a theoretical perspective resulted
in incorporating skill practice. This analysis would be followed by the design
and construction phase where we would carefully document how we arrive at the
solution to the problem and then construct the prototype using principles we had
identified from the literature. In this case, we would add an in-workshop simulation
to practice the skill, and get and receive feedback. The third phase in the micro-
cycle is evaluation and reflection. As the goal was to improve the use of feedback
skills, the follow-up reminder of micro-skills represented a theoretically justified
intervention. Did it work? Why or why not? All of this information would then be
used to reject, refute and/or refine the design principles. From this, the prototype is
redesigned and the micro-cycle repeated. Using such a series of micro-cycles,
faculty developers would be in a position to argue for the best way to do faculty
development to teach a specific skill. This approach links nicely to knowledge trans-
lation, which is discussed in Chap. 19.
18.5.2 Success Cases
A method that could be employed even within an educational research design

methodology is called the success case method, which seems well aligned with
studying faculty development. This method fits within the interpretivist paradigm.
Brinkerhoff and Dressler (2003) describe the success case method as the analysis of
extreme groups using case study and storytelling. The core purpose is to discover
how well an initiative is working and to identify the contextual factors that support
successful implementation.
As Brinkerhoff (2005) notes, there is more to achieving the desired effects of
training than putting on a good training program. He points out the problem of relying
on the Kirkpatrick framework (Kirkpatrick 1994) that does not include inquiry
beyond the training event itself and fails to account for the larger performance environ-
ment. Kirkpatrick proposed four levels of training program evaluation: participant
reaction, learning, behavior change, and results. Faculty developers may refine an
offering to perfection, but a participant’s work environment may restrict implemen-
tation of the instructional strategy in their own workplace. To make faculty development
successful, we need to analyze what happens once participants return to their
workplaces. The success case method is designed for this type of inquiry.
This method has two major components: (1) a brief self-report survey that
identifies levels of success in implementing an innovation, which is based on the
conceptual model used to design the intervention; and (2) a sample of the most and
least successful participants, who are randomly selected to receive an in-depth

interview to ascertain what, when and how they used the intervention; what results
were achieved; how valuable were the results; and what factors enabled success.
The summary report would include the initial quantitative survey results and the
in-depth qualitative analysis of the cases.
Olson et al. (2011) provide a detailed description of how the success case method
was used to identify ways in which continuing medical education activities, closely
related to faculty development, contributed to implementation of tobacco cessation
practice guidelines in outpatient practices. In this study, Olson et al. (2011) used
clinical outcome data to identify success cases (i.e. clinical practices). For the in-
depth interviews, they sought input only from participants who had implemented
the guidelines successfully; believing that there was little benefit in interviewing
unsuccessful cases where people might not be as forthright about describing why
they failed to implement the program. At each selected site, up to three persons were
interviewed to obtain multiple perspectives. The authors concluded that even though
they only studied success cases, it did provide valuable insights that generated
hypotheses for future testing.
Recently, a faculty developer asked us which of our workshops was most highly
rated by participants. The question prompted a thought about studying this question
employing the success case method. Using existing workshop ratings, we could
select the highest rated and lowest rated workshops, selecting one or two from each
category. Then, through in-depth interviews with selected participants who attended
those workshops, we could identify specific features of the workshops that made
for success or failure. In addition, the success case method could also allow us to
explore barriers and supports for faculty development, such as networks of relation-
ships, institutional structures, personal commitments, and intellectual and personal
characteristics (Caffarella and Zinn 1999).
18.5.3 Sustainability Narrative
Sustainability narrative is a research methodology that resides outside the normal

modes of inquiry for the education community. This methodology explores the
development of a society through the lens of human and environmental systems
(Swart et al. 2004) and imagines what the future would be like if people’s lives were
improved, without compromising the economic systems on which they depend
(Kemp-Benedict 2006). For example, closing a factory to improve the quality of air
would not lead to sustainability if people no longer have a place to work. Translated
into faculty development, sustainability narrative could be used to imagine future
programs, examine different scenarios for their growth and deployment, and create
strong support for such programs without compromising resources or interfering
with workplace practices.
An example of a sustainability narrative arose at our university from a desire to
develop a cadre of faculty members both at UCSF and at international institutions
who could lead faculty development workshops on an occasional, part-time basis.
From a sustainability narrative approach, we would develop scenarios asking how

this program might look in the future to be sustainable given economic concerns
and key stakeholder expectations. Scenarios might answer questions that are faculty
centered such as: how promotion and tenure criteria might change to sustain these
faculty developers; how compensation might be altered to support these faculty
developers; and how recognition can be enhanced for faculty developers. Other
scenarios could describe the future providers who were the recipients of teaching
from those who participated in faculty development. There could be scenarios
depicting sustained hospital/clinic-based faculty development groups that improve
patient care. Thinking about all of these aspects to craft a narrative would change
the kind of research that would be undertaken and would be quite different from a
traditional faculty development evaluation depicted in Fig. 18.1.
The sustainability research process involves having experts and stakeholders
develop narratives (Kemp-Benedict 2006) that address the future, explore alternative
scenarios, and provide plausible stories that include issues such as resources as well
as the resilience and incentives of the system (Swart et al. 2004). From the example
above, the scenario could be quite complex if we explore how to expand faculty
development to other sites and countries or it could be very narrow if we focus on a
single campus-level faculty development center. Decisions about the scope of the
scenario drive the selection of a research design. However, the designs will not be
simple because they will need to address a number of issues (Swart et al. 2004) such
as: does the way we study our scenario address local issues or more global issues?
How are the financial impacts addressed? Where does this research and emphasis on
sustainability fit with institutional priorities? The research methodology integrates
both a quantitative approach by developing a quantitative model of variables that
can be measured in the scenario and a qualitative approach to analyze other aspects
of the scenario. Additionally, there is a major focus on addressing marginalized
groups. Thus, this method fits within the critical theory paradigm.
Various authors have suggested different steps (Alcamo 2001; Swart et al. 2004)
to the sustainability narrative process, but overall the process includes:
1. Bringing together a sufficiently large and diverse group of experts and stakeholders
to generate ideas about the future; they call this developing the storyline, which
includes making assumptions visible. A writing team transforms the generated
input and scenarios into a narrative.
2. Using rigorous research methods, based on the narrative, decide what should be
incorporated in the analysis and what data should be collected as baseline.
3. Developing a model that can be tested quantitatively and/or use the scenarios
developed to guide a qualitative investigation. The qualitative analysis involves
exploring the possibilities of surprise as well as the steps toward change.
4. Writing the final product as a coherent and engaging story about options for
the future.
A way of employing this process for faculty development would be to ask experts
and stakeholders to describe the future of faculty development. In Table 18.2, we
offer sample questions (Sarriot et al. 2008). By responding to these questions, experts
Table 18.2 Questions for experts and key stakeholders for developing a sustainability scenario
Experts and key
stakeholders Possible questions
Providers What services are most critical for faculty development in medical
education? What capacities will individuals need to deliver these
services?
Health care units How does the local clinical or hospital organization function? What
affordances and hindrances do they provide for faculty development?
Local supports How will the university be mobilized to ensure that the necessary faculty
development occurs? What are the local units that can be used?
Communities What are the communities and how are they organized? How will the
community create demand for faculty development? What will be
their expectations?
Outside actors What do accrediting organizations for students, residents and employees
expect? What should faculty development do to ensure that
improvements are made? What resources are needed?
and stakeholders would provide the researcher with information to develop scenarios
that could be crafted into a sustainability narrative pertinent to faculty development.
Armed with the narrative, the next step would be to complete a baseline assessment
of relevant components of the faculty development program. The data collection
likely would use a combination of methods including survey, focus group, and
review of existing data. This step can precede or happen in conjunction with the
model-building step. The model of what should be happening in the future is derived
from the narrative. Then, using existing data, the model would be tested using a
variety of research methods. The last step is to iteratively collect data, refine the model,
and write the ‘story’, based on the narrative, describing a reasonable expectation
of what could happen next.
For faculty development programs, it may not be essential to follow all of these
steps, but the initial one opens new kinds of questions that can be studied. Some
might see the first step as akin to a needs assessment, but the focus is on the future.
Also, coming from the critical theory paradigm, the experts and stakeholders may
represent groups whose voices have not been heard in the past. The narrative devel-
oped could address relationships of power, such as the clinic director’s willingness
to allow providers to participate in faculty development and/or implement an
innovation promoted in the faculty development program within his or her clinic.
We think this method would be applicable to the study of each component of our
model of faculty development as well as the model as a whole.
18.6 Faculty Development Researchers
While educators are encouraged to conduct research on faculty development, they

may lack adequate training and resources to do so. Some medical schools have
invested heavily in educational research and faculty development, and in the process
have created strong cultures of educational scholarship while others have not. In
either case, faculty members interested in conducting educational research are
encouraged to either seek educational research consultation and/or training through
participation in faculty development programs or graduate programs in education or
medical education. Educational researchers in offices of medical education can
be helpful in framing the research from a learning theory perspective, identifying
relevant literature, honing a researchable question, designing and conducting a
study, and analyzing and reporting the results. Another strategy is to find colleagues
who share a common interest in educational research and work collaboratively on a
research project. Often these colleagues can be found in academies of medical
educators (Irby et al. 2004; Searle et al. 2010), longitudinal faculty development
programs (Gruppen et al. 2006), education committees, and educational leadership
positions. Collaborative research not only overcomes a sense of isolation but also
offers one of the best ways to advance the work, ensure completion of tasks, and
disseminate the results. Such collaborations can be established locally or can be
created with colleagues within and across specialties beyond the institution. Regardless
of research strategy adopted, rigorous research on faculty development is difficult to
do well. Using our conceptual framework for research on faculty development along
with the paradigms and methodologies described in this chapter, we hope that those
interested in advancing understanding of faculty development will find important
questions and appropriate research methods in this chapter.
We have focused largely on the scholarship of discovery, which creates new
knowledge about faculty development. Boyer (1990), however, argues that there are
other important forms of scholarship beyond discovery. These include: integration
of knowledge as in a review of the literature or an integrative conceptual framework;
application of knowledge as in connecting theory to practice; and teaching as in
transforming and extending knowledge for the benefit of learners. Others have
elaborated on the scholarship of teaching and learning to offer guidelines for its
description and assessment (Glassick et al. 1997). Finally, the criteria for evaluating
educators for academic advancement have been defined for the roles of direct teaching,
curriculum development, advising and mentoring, educational leadership, learner
assessment, and educational research (Simpson et al. 2007). We recommend these
resources to our readers.
18.7 Conclusion
In this chapter, we have described four paradigms and their associated methodo-
logies that can be deployed to investigate faculty development programs, and we
have advocated for an expanded set of questions derived from our conceptual
framework for research on faculty development. Most of the research on faculty
development to date has been related to the community created during faculty
development activities, or within the teaching commons. Much less research
has addressed the workplace community of teaching practice. As our examples of

hypothetical research studies on faculty development describe, there are many
areas where further research is needed. Such research could help guide decisions
about the most effective strategies to adopt in order to change teaching practices
in the workplace.
We have asserted that the assumptions of the positivist paradigm and to a lesser
extent post-positivist paradigm are unduly restricting the publication, funding and
research on faculty development. We have offered alternative ways of looking at
faculty development by offering an expanded set of paradigms and research
methodologies. However, we acknowledge two important factors that may hinder
the use of alternative paradigms, methodologies and tools. First is the dominant use
of positivist and post-positivist paradigms by reviewers in journals. Reviewers may
apply positivist and post-positivist paradigms to their critiques of studies conducted
in the interpretivist and critical theory paradigms and thus reject them for publication.
Therefore, it behooves authors of such research on faculty development to write
clearly about their paradigms, methodologies and tools in order to provide strong
evidence for the rigor of the methodologies. Second, researchers in this field are
often expected to demonstrate positive outcomes of educational interventions on
the improvement of patient care. This challenge will be more difficult to overcome
but is still worth confronting.
We generated our model, in part, to illustrate the multiple relationships among
faculty development and workplace communities. The workplace environment
often mediates the individual’s ability to implement the skills acquired. Thus, the
connection to improved patient care must be studied through this mediated lens.
Researchers using alternative paradigms and associated research methods and a
newer faculty development model will be better equipped to describe the effects
of faculty development on the participants, their learners, and where possible on
the patients that they serve. This will expand the current focus on the faculty
development participants toward examining the impact on workplace settings where
teaching takes place.
We hope that this chapter inspires others to be willing to ask diverse questions
about faculty development and apply less well-known paradigms and methodologies
to inquiry on faculty development. In addition, we encourage readers to join the
large community of researchers who are willing to engage in sustained programs
of study on faculty development programs over time. There is much to explore in
faculty development and many ways of doing so.
18.8 Key Messages
• Research on faculty development has been overly constrained by adherence to

the positivist research paradigm and its associated use of randomization, control
groups, and quantitative methods.
• The O’Sullivan and Irby (2011) conceptual framework for research on faculty
development expands the areas of inquiry by proposing two distinct but overlapping
communities: the community created by faculty development activities, referred to
as the teaching commons, and the community of practice in the workplace where
teaching occurs (in classrooms, clinics and online).
• To investigate these two different communities, four research paradigms will
need to be used: positivist, post-positivist, interpretivist and critical theory. Each
of these paradigms has associated research methodologies and tools.
• Three additional research methods offer promise for illuminating various aspects
of the faculty development framework: educational design research, success
cases and sustainability narrative.
• Engaging in research on faculty development requires establishing a network
and taking advantage of local and national resources.
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Chapter 19
Knowledge Translation and Faculty
Development: From Theory to Practice
Aliki Thomas and Yvonne Steinert
19.1 Introduction
Faculty developers are expected to support faculty members through state-of-the-art

learning activities, including courses and workshops, and to ensure that new learning
is integrated into practice and sustained over time. They must also make sure that
the design, implementation and evaluation of faculty development activities are
informed by the most up-to-date research in the field. Knowledge translation (KT)
is a process that has the potential to meet these expectations.
KT is increasing in importance in fields such as public health, medicine and
rehabilitation research (Canadian Institutes of Health Research 2012; Davis et al.
2003; Glasgow et al. 2003). It also has important implications for medical education
and faculty development, although this link has not been fully explored to date. KT
is a term used to describe a process designed to address a longstanding issue: the
underutilization of available scientific findings and evidence-based research in
systems of care (Davis et al. 2003; Grol and Grimshaw 2003; Grol and Jones 2000).
KT is considered an interactive, non-linear and interdisciplinary process used to
move knowledge into practice and includes all the steps between the creation of new
knowledge and its application. That is, KT aims to bridge the research-practice
A. Thomas, Ph.D., OT (c), erg (*)

Occupational Therapy Program, School of Physical and Occupational Therapy and Centre
for Medical Education, Faculty of Medicine, McGill University, Montreal, QC, Canada
Y. Steinert, Ph.D.

400 A. Thomas and Y. Steinert
gap by promoting the integration and exchange of research and evidence-based

knowledge into clinical practice in order to improve outcomes for consumers,
students and patients (Canadian Institutes of Health Research 2012; Landry et al.
2003; Nutley et al. 2003). Furthermore, KT requires ongoing collaborations and
exchange among all relevant stakeholders, including researchers within and across
disciplines, health care providers, educators and patients (Sudsawad 2007).
The concepts underlying KT and the term itself are not new to the field of
continuing medical education (Akl et al. 2009; Farmer et al. 2011; Flodgren et al.
2011; Forsetlund et al. 2009; Grimshaw et al. 2003; Horsley et al. 2010; Salerno
et al. 2002; Skeff et al. 1992). In this context, the KT focus is on transferring
new scientific evidence regarding developments in diagnostic measures and new
treatment approaches into the clinical setting in order to improve practice and
optimize patient care.
The application of KT to faculty development has not been explored as extensively.
However, the implications of knowledge translation for faculty development can
include: (1) basing faculty development programs on the best available knowledge
and/or scientific evidence; (2) using educational and other knowledge translation
strategies that are known to be effective; (3) recognizing that, in the absence of
scientific evidence to support faculty development activities or when scientific
knowledge is not congruent with existing practices or values, alternative sources
of knowledge are needed; and (4) conceptualizing faculty development activities as
knowledge translation interventions in their own right.
This chapter, which focuses on the applications of KT in faculty development
and on faculty development as a legitimate KT intervention, is divided in three
sections. First, we define KT, discuss the key objectives of KT and examine the
applications of KT and the KT process to faculty development. Second, we describe a
framework for integrating knowledge into clinical practice: the knowledge-to-action
(K2A) cycle. We conclude the chapter with an illustration of how KT concepts can
be applied to faculty development, using an example of the K2A process for a
faculty development intervention on ‘giving effective feedback’.
KT is an essential component in the creation, exchange, synthesis and applica-
tion of knowledge in health care and educational contexts. We hope that the chapter
will be useful in helping the reader apply the principles and concepts of KT to the
development, implementation and evaluation of faculty development programs.
19.2 Knowledge Translation: Definition and Objectives
19.2.1 What Is Knowledge Translation?
Many terms have been used to describe the process involved in transferring knowl-
edge into action (McKibbon et al. 2010; Straus et al. 2009). For example, Graham
et al. (2006) reviewed the terms and definitions used to describe the knowledge to
19 Knowledge Translation and Faculty Development: From Theory to Practice 401
action process (e.g. ‘implementation science’, ‘dissemination’, ‘diffusion’, ‘knowledge

transfer’, ‘uptake’ and ‘knowledge exchange’). The Canadian Institutes of Health
Research (CIHR) define KT as:
A dynamic and iterative process that includes synthesis, dissemination, exchange and
ethically-sound application of knowledge to improve the health of Canadians, provide more
effective health services and products and strengthen the health care system. This process
takes place within a complex system of interactions between researchers and knowledge
users which may vary in intensity, complexity and level of engagement depending on the
nature of the research and the findings as well as the needs of the particular knowledge user
(CIHR 2012).
Two important concepts are highlighted in this description. First, given that knowl-
edge creation (knowledge from original research), knowledge synthesis (knowledge
from systematic reviews and clinical practice guidelines) and knowledge dissemina-
tion (publications in peer-reviewed journals and presentations at scholarly confer-
ences) are not sufficient to affect knowledge use and change practice (Straus et al.
2011), there is a shift from passive diffusion or simple dissemination of knowledge
to active and conscious participation of both knowledge producers and knowledge
users. Additionally, a collaborative interaction between researchers and knowledge
users at every step of the KT process is believed to facilitate optimal use of research
evidence and other forms of knowledge in clinical practice (Grimshaw et al. 2002;
Lavis et al. 2003; Oborn et al. 2010). The second concept of importance in this
definition is that of the ‘knowledge user’. Knowledge users or ‘end-users’ can be
anyone within the health care system, including clinicians, educators, multidisciplinary
teams, patients and decision-makers. While the assumption is that knowledge
users are those individuals who, for the most part, integrate the knowledge in their
practice, knowledge users can be extensively involved in the knowledge creation
and exchange processes. Indeed, the KT framework discussed in this chapter advo-
cates for a participatory model whereby end users are involved in developing
research questions and are actively involved in carrying out the research activities.
19.2.2 Why Is Knowledge Translation Important?
Despite the rise in available scientific research findings and the many advantages of
using knowledge from research to inform clinical practice (Duncan et al. 2002;
Grimshaw et al. 2006), numerous studies have found that health professionals do
not readily integrate findings from scientific research into clinical decision-making
(Cabana et al. 1999; Korner-Bitensky et al. 2006; McGlynn et al. 2003). Recognition
of the gap between what is known to improve patient outcomes and what is used
in daily practice has led to a burgeoning interest in KT across the health professions.
Developing effective KT interventions that maximize clinicians’ knowledge about
best practices is an important step towards closing the knowledge-to-practice gap
in the clinical setting as well as in the context of educational practice and faculty
development.
19.3 Applications of Knowledge Translation to Faculty

Development – and Faculty Development as
a Knowledge Translation Intervention
The overriding goal of faculty development is to support the development of faculty

members in their multiple roles (e.g. teachers, researchers, administrators) (McLean
et al. 2008; Steinert 2000, 2011). Moreover, there are many possible outcomes for
faculty members participating in faculty development activities, including changes
in knowledge, skills and attitudes in teaching, research and leadership practices
(Steinert et al. 2006, 2012), with the ultimate goal of improving student outcomes
and patient care.
Consider the following example that can help illustrate one application of KT in
faculty development: A faculty development team is interested in promoting the
use of scoping study methodology in medical education. Scoping studies use a
rigorous and systematic multistep process for identifying, reviewing and sum-
marizing a broad body of literature, including published research, reports and
consultations with experts. One objective of the faculty development activity could
be as follows:
At the end of the workshop, participants will identify the 6-step scoping review methodology
as outlined in the Arksey and O’Malley (2005) framework and identify one question that
could be addressed using this methodology.
Participants could use the knowledge gained from this faculty development
activity to conduct a scoping review on a topic of interest in medical education or to
develop a more focused research question.
At the same time, participants and faculty developers could ask a number of
potential questions about a faculty development activity on ‘the applications of
scoping reviews in medical education’. A clinician could ask: ‘What will I learn?’
‘Will I be able to apply what I learned?’ ‘Who can help me identify review topics
that are most amenable to a scoping review?’ Members of the faculty develop-
ment team may ask: ‘What is the educational evidence that would inform the best
methods for teaching health professionals about a new literature review methodol-
ogy (e.g. workshop, didactic presentation, academic detailing, audit with feedback).
‘What knowledge and skills do participants need in order to carry out a scoping
review? ‘What educational methods should be used during the faculty development
activity? ‘What data should be gathered regarding the impact of the workshop on
participants’ ability to conduct a scoping study’?
All these questions encompass constructs linked to KT. Questions about the
design, implementation and assessment of outcomes are undoubtedly of the utmost
importance for faculty development teams, program evaluators, researchers and
educators. These questions represent essential elements of best practice in faculty
development and embody the many possible contributions that faculty development
activities and research can make to faculty development practice and scholarship.
A faculty development team will need to answer all these questions as they design,
develop and evaluate the impact of a faculty development activity intended to

promote the knowledge and skills needed to effectively conduct scoping reviews in
medical education.
19.4 The Knowledge Translation Process: Using

an Established Framework
How does knowledge creation and exchange occur? How is knowledge integrated in
practice and how is it used in a sustainable and effective manner? These questions
are currently at the heart of many KT researchers’ agendae. Whether the focus is
on creating and summarizing research findings and other forms of knowledge, on
identifying the individual and organizational factors that will support or hinder
research uptake in clinical settings (Estabrooks et al. 2003; Gravel et al. 2006) or on
developing and evaluating the effectiveness of various KT interventions (Armstrong
et al. 2011; Farmer et al. 2011; Gagliardi et al. 2011), there is no dearth of research
activity in this area. Most KT scholars would agree that the field is at an important
juncture as researchers, policy-makers, practitioners and educators strive to design
and evaluate KT interventions that will lead to behavior change and improved
practice outcomes.
Given the complexity of changing clinical and educational practice environments,
and the multiple factors that can influence that change, several authors recommend
that the implementation of research findings in practice be guided by conceptual
models or frameworks (Graham et al. 2006; Sudsawad 2007). Frameworks can help
to explain and predict the intended change and identify the multiple factors that can
increase or decrease the likelihood that this change will occur (Graham et al. 2008).
Furthermore, the use of a framework which considers the different stakeholders
involved in knowledge creation, exchange and translation emphasizes the notion
that all groups should focus their efforts on action plans that take into account the
opinions and contributions of all those who will be involved in, and affected by, the
proposed change (Graham et al. 2008).
A KT framework that would meet this expectation for a faculty development
initiative would consider the needs, expectations and contributions of a faculty
development team, participating clinicians and educators, and the organization that
employs the health professionals. The framework would support the implementa-
tion of mechanisms that promote a collaborative approach to identifying the
knowledge gaps, the feasibility of various interventions aimed at changing practice,
and the primary outcomes of interest.
At the same time, we should note that although frameworks can assist stakeholders
in their pursuit of best practices, no one framework can capture the complex
interactions of knowledge creation and knowledge use in all practice settings. Due
consideration must therefore be given to the limits of any one framework. The
application of the various constructs embedded in many frameworks in any given
area of practice, whether it is in healthcare, medical education or faculty development,

is only possible insofar as there is available knowledge and evidence. Furthermore,
the source, nature and relevance of the evidence used to inform practice must be
acceptable to all stakeholders. We acknowledge that faculty development may
not yet have a substantive body of published rigorous research to inform most
decisions. We also recognize that there may be epistemological concerns regarding
the various sources of evidence used to inform faculty development practices and
some skepticism about what can and should be considered the gold standard in
terms of ‘evidence’. Moreover, we recognize that there may be limits to the applica-
bility of empirical research in the day-to-day contexts of most faculty developers.
For these reasons, we have chosen to discuss one framework, which we present as a
guide rather than a gold standard to be used as a prescriptive tool, that crosses all
contexts and addresses all practice issues in faculty development.
19.4.1 The Knowledge-to-Action Framework
Several models and frameworks have been developed to guide KT efforts and
address individual users’ perspectives as well as contextual factors. It is beyond the
scope of this chapter to describe this body of literature in any detail; we invite the
reader to consult the work by Estabrooks et al. (2006), Graham et al. (2007) and
Sudsawad (2007) for more comprehensive discussions of these frameworks.
In this chapter, we discuss the ‘knowledge-to-action’ (K2A) framework developed
by Graham et al. (2006). We favor this framework because of its conceptual clarity
and ease of use, and also because of its applicability to faculty development, as will
be illustrated later in the chapter.
The K2A framework falls within the social constructivist paradigm which ‘privileges
social interaction and adaptation of research evidence that takes local context and
culture into account… and offers a holistic view of the KT phenomenon by integrating
the concepts of knowledge creation and action’ (Graham and Tetroe 2010). The
framework is the result of a review of more than 31 planned action theories. Planned
action theories, which fall under the larger umbrella of change theories (Tiffany and
Lutjens 1998), are prescriptive theories used to predict how various stakeholders
will respond to planned and/or anticipated change situations and support change
agents in their attempts to influence the factors that will facilitate the change in
practice (Graham et al. 2006). The significance of using planned action theories in
the development of the K2A framework rests with the notion that the planning
and implementation of change in practice can only be achieved with an in-depth
understanding of the individual and organizational factors that describe behaviors
and support or impede the implementation of change.
The cyclic nature of the K2A process and the important role of feedback
loops are key concepts underpinning this framework (Graham et al. 2006). Of sig-
nificance to both researchers and practitioners is the notion that the K2A framework
considers various sources of information as knowledge, including knowledge

from research findings as well as other forms of knowing such as experiential
knowledge (Graham et al. 2006). Experiential knowledge refers to learning from
colleagues and experience through reflection and is considered a requirement for
integrating and making sense of the knowledge that emerges from scientific research
(Rycroft-Malone et al. 2004).
19.4.2 Knowledge-to-Action Components
The K2A framework is comprised of two main components: (1) knowledge creation
and (2) action. Each component contains several phases. The K2A considers
knowledge creation and synthesis (knowledge cycle) and knowledge application
(action cycle) as iterative processes that are constantly interacting and informing
each other. The boundaries between knowledge creation and application are fluid,
suggesting once again a bidirectional and dynamic relationship between the two
major components of KT (Straus et al. 2010).
19.4.2.1 Knowledge Creation Funnel
At the center of the K2A conceptual framework lies the knowledge creation funnel.
The funnel represents the creation of knowledge from research findings and
outcome evaluations that will be translated to the knowledge users. Figure 19.1
shows that knowledge creation consists of three phases: knowledge inquiry, knowl-
edge synthesis, and knowledge tools and products. The ‘knowledge inquiry’ stage
consists of original research or ‘first generation knowledge’. It constitutes the many
primary studies that address a particular question. The ‘knowledge synthesis’ stage
includes research summaries such as systematic reviews where the available research
on a given question is appraised and summarized. ‘Knowledge tools’ consist of the
best available research further synthesized into tools such as practice guidelines,
decision-making algorithms, and educational modules intended to help end-users
apply new knowledge. As we move down the funnel, the knowledge becomes more
and more synthesized and potentially more useful to the end users (Tetroe 2011).
Chapters 17 and 18 give a number of useful suggestions on how this research could
be framed or conducted.
19.4.2.2 Action Cycle
Surrounding the funnel are the seven major action steps or stages that comprise the
knowledge-to-action model derived from the review of the planned action theories
discussed earlier. The action cycle is depicted by a circle with arrows, which
Fig. 19.1 The knowledge-to-

action framework: A model
for knowledge translation
(Graham et al. 2006;
Reproduced with permission
from the lead author)
suggests that the steps in the process need to be followed in sequence. The authors
acknowledge that this is not always possible in real life contexts. In fact, they argue
that KT interventions rarely take place in environments where the knowledge
gaps are clearly defined and where the actions required for changing behaviors are
readily implementable and sustainable (Tetroe 2012). Thus, the stages can occur
simultaneously or sequentially, and the knowledge creation segment can impact
upon a number of the stages at different points in time (Graham et al. 2006). For
example, as new scientific evidence emerges, is synthesized and ready for dissemi-
nation, stakeholder groups responsible for translating the knowledge into practice
must verify that the knowledge or new scientific evidence is adapted to the context.
If the knowledge is not relevant or adapted in a manner that makes its use appropriate
in a particular context, the target group is unlikely to use it.
The seven stages involved in moving knowledge into practice are: identifying
a problem in practice or a gap in knowledge and identifying, reviewing, and
selecting the knowledge to be implemented to address the gap; adapting or cus-
tomizing the knowledge to the local context; evaluating the determinants of the
knowledge use (barriers and facilitators); selecting, tailoring and implementing
interventions to address the knowledge or practice gap; monitoring the knowledge
use in practice; evaluating the outcomes or impact of using the new knowledge; and
determining strategies for ensuring that the new knowledge is sustained (Graham
et al. 2006).
19.5 Application of KT in Faculty Development:

A Case Example
In this final section, we describe each stage of the K2A framework in detail, illustrating
the application of the cycle by using an example of a faculty development interven-
tion on ‘giving effective feedback’. The following scenario will serve as the context
for our faculty development initiative:
You are a new member of a faculty development team housed in the Faculty of Medicine of
a research-intensive university. You are contacted by a departmental leader at one of the
local teaching hospitals to tell you that his staff could benefit from learning about how to
give effective feedback to students. You spend a few minutes on the phone asking questions
about ‘the problem’ and find out that students who come on rotation to this department have
complained that the staff (including nurses, physicians and residents) give feedback at the
wrong time and in front of patients, that the feedback is often very negative and degrading,
and that there is very little feedback on how students can improve. You are now charged
with the responsibility of designing a faculty development intervention that will address the
needs or feedback ‘problem’ in this department.
We will now demonstrate how we can use the K2A cycle, including both the knowl-
edge creation and action cycles, to design, implement and evaluate the outcomes of
a faculty development activity as a KT strategy intended to help clinical teachers
learn about giving effective feedback. We begin with the action cycle and move to
the knowledge creation funnel as we discuss the fluid and permeable boundaries
that exist between the two components.
19.5.1 Identifying the Knowledge-to-Action Gaps

and Identifying, Reviewing and Selecting
the Knowledge to Be Implemented
This stage consists of two steps: identifying an important problem in practice or a

gap in knowledge and returning to the knowledge creation funnel to identify, review
and select the knowledge needed to address the problem. In addition, this first step
should consist of rigorous methods and consultations with key stakeholders. Needs
assessments can be used to identify gaps in knowledge and practice.
Returning to our case example, the faculty development team must identify the
nature of the problem by gathering all the relevant information regarding the
feedback problem at the designated site. A discussion with the departmental leader
will generate key information about the characteristics of the students (e.g. demo-
graphic information; level of training) as well as those of the teaching faculty
(e.g. clinical experience, teaching experience, formal training in teaching, previous
faculty development on giving effective feedback). The team can also ask for examples
of situations where there was ineffective feedback. To promote collaboration and
exchange among clinical teachers and leaders at this site, the team should collect
clinical teachers’ perspectives regarding the nature and delivery of feedback. This
can be done with a face-to-face meeting or through a written needs assessment.
Student perceptions of feedback at this site would also be helpful.
The second step consists of identifying, reviewing and selecting the appropriate
knowledge and/or evidence needed to address the problem. There are two categories
of knowledge or evidence that are needed in our case example. The first is evidence
on ‘feedback’ as the central construct. For example, what evidence is available on
the characteristics of effective feedback? What does the literature tell us about when
and where to give feedback and about the types of feedback that should be given in
different situations and with different levels of learners? (Bienstock et al. 2007;
Hewson and Little 1998; Milan et al. 2006). The second type of evidence relates to
the effectiveness of different interventions designed to address the identified need.
For example, this would consist of evidence about how to plan, deliver and evaluate
a faculty development activity on providing effective feedback (e.g. Brukner et al.
1999; Holmboe et al. 2001; Salerno et al. 2002; Skeff et al. 1992). This evidence can
emerge from faculty development or educational research and might include
preferred modes of delivery (e.g. workshop, short course, on site in-service), selection
and training of workshop facilitators (e.g. peers, experts in the field), the use of
educational materials (e.g. handouts, books, articles, online tutorials) and the dura-
tion of the intervention (e.g. half day, full day, blocks of time spread throughout an
extended period). Should a workshop be considered the ‘method of choice’, evidence
related to this format (e.g. interactive plenaries, small group discussions, mixed
format), and participant evaluations of workshops (i.e. anonymous or not, multiple
choice vs. open ended) should be reviewed.
A literature search for evidence on both types of knowledge, often in collabo-
ration with an expert librarian, is also necessary. The identified literature should
then be appraised for its quality and relevance to the identified problem, as is
typically the case with scientific evidence used in clinical practice. All informa-
tion that will be useful in the design, implementation and evaluation of a faculty
development intervention on giving effective feedback should be retrieved and
reviewed.
Although there is available evidence on the topic of giving effective feedback, it
is still recommended that faculty development teams consider additional options in
situations where there is no available evidence or research. In situations where there
is a scarcity of rigorous faculty development research evidence, it is recommended
that the team solicit the assistance of other faculty development colleagues at their
institution, or at other institutions, for suggestions on how to design a specific
workshop. Alternatively, the team can design the activity based on sound pedagogi-
cal principles of adult learning that may have been used to design other faculty
development initiatives. In fact, this may be an ideal opportunity to conduct the first
evaluation of this type of KT intervention and disseminate the results. Consulting
the various stakeholders about their preferences regarding both the content and the
modes of delivery is essential for providing a tailored program that will meet the
needs and expectations of all.
19.5.2 Adapting or Customizing the Knowledge

to the Local Context
In this second stage of the K2A process, the value, appropriateness and usefulness
of the knowledge are considered in light of the needs of the particular practice
setting. KT experts advocate for a participatory process whereby all relevant
stakeholders and potential knowledge users are consulted to ensure that the knowledge
is appropriate, relevant and useful.
Once the literature and other possible sources of knowledge have been reviewed,
appropriate findings can be used to inform a preliminary design of a faculty develop-
ment intervention (i.e. a workshop or other educational method). A meeting should
be scheduled with the relevant stakeholders to discuss the proposed content, the pre-
ferred method for delivering the content, the length and format of the intervention,
the materials to be used, and other design and implementation issues of importance.
‘Customizing or adapting the knowledge’ is key at this stage. Both sources of
knowledge (feedback content and best methods for delivering the content) may
need to be ‘customized’. For example, if teachers in this example face similar chal-
lenges as those found by Kogan et al. (2012), the intervention should focus on both
cognitive and affective factors, including the tension of balancing positive and nega-
tive feedback, perceived self-efficacy, and the teachers’ perceptions of residents’
insight, receptivity and skill. On the other hand, if the quality of feedback is poor
(e.g. Kaprielian and Gradison 1998), the intervention might focus on specific feed-
back strategies and characteristics (Hewson and Little 1998). Given the research
findings on the role of reflection and experiential learning in enhancing feedback
processes (Hewson 2000), role-plays or simulations (Gelula and Yudkowsky 2003;
Stone et al. 2003) may be considered a worthwhile instructional method. Suppose,
however, that the participants are not interested in taking part in a role-play activity.
An alternative to having them do a role-play is to have the facilitators participate in
the role-play, as this can be less intimidating for participants. An additional way to
customize the knowledge is to conduct the role-play (or simulation) privately in a
room with a facilitator only, rather than in the presence of the larger group. Another
aspect of the evidence-informed methods that can be modified or customized is the
duration of the KT activity. Suppose that there is evidence that supports offering
training on feedback over three short sessions (Hewson 2000) but that this is not
realistic in this setting due to time constraints, the intervention can then be offered
over two longer sessions or the sessions can be offered over a longer period of time.
While this alternative is not evidence-based, it may be the only option for this site
and may result in better attendance and reduced attrition over time.
19.5.3 Evaluating the Determinants of the Knowledge

Use (Barriers and Facilitators)
This stage consists of assessing the barriers that can limit the uptake of the knowledge
so that the barriers may be targeted by specific strategies. Barriers can be specific to
the individual (e.g. lack of time, lack of experience in a given domain, lack of
knowledge, lack of self-efficacy, negative attitudes) or related to the organizational
environment (e.g. insufficient resources, lack of access to learning resources).
This is a challenging step in the K2A cycle as there are many possible facilitators
and barriers that can have an impact on the design and implementation of the faculty
development activity that has been designed. The barriers can be about the knowl-
edge of feedback or about the implementation of the faculty development activity.
In our example, possible barriers at the individual level may include negative
attitudes towards faculty development, lack of motivation, and lack of relevant expe-
rience. Results from a needs assessment may reveal that participants do not wish to
attend faculty development activities, do not value group discussions or question the
benefits of this type of professional development activity. Another possible barrier
may be that the group is heterogeneous with participants of varying levels of experi-
ence, motivation and interest in the activity.
System-level or organizational barriers include lack of dedicated time to partici-
pate in professional development activities, heavy clinical caseloads, and an organi-
zational culture that does not privilege professional development. The organization
may, for example, agree to support participants to attend the activity but without
remuneration. Or, it may encourage continuing medical education for best clinical
practice, but may not support professional development activities related to teach-
ing. Additionally, another common barrier to the uptake of health-related evidence
in practice is individual and/or organizational attitudes towards the value of research
versus the value of experience and the perceived legitimacy of each as sources of
knowledge for clinical decision-making. Similarly, in the context of faculty devel-
opment, there may be resistance to the new feedback ‘practices’ as some may be
skeptical about the legitimacy of the research evidence, favoring experiential
knowledge and expertise as superior forms of knowledge.
It is a critical part of the faculty development team’s role to identify the potential
supports and barriers as early as possible in the process and to discuss ways to
address these without alienating either one of the stakeholder groups.
19.5.4 Selecting, Tailoring, Implementing and Monitoring

the KT Interventions
In this stage, interventions to facilitate and promote awareness and implementation

of the knowledge are selected, tailored and then executed. Interventions can target
the individual, although, depending on the specific barriers that have been identified,
they may also need to target the organization. KT interventions can be single
or multi-component, and can include educational interventions such as courses, on-
site workshops, audit and feedback, outreach visits, and reminders. KT interventions
can also target policy and organizational changes aimed at promoting changes in
culture and increasing support as well as funding for training.
In this case, the KT intervention (i.e. the faculty development activity on giving
effective feedback) will be designed using the literature that was retrieved and
appraised, the expert consultations, the information gathered from the stakeholders
regarding the nature of the problem, as well as the knowledge of the barriers and
facilitators to the implementation of the activity.
At this stage of the K2A cycle, it is useful to work with content experts (experts
on giving effective feedback) as well as process experts or expert faculty development
teams. When the activity has been designed, the unit leader should be consulted to
confirm that it is suitable and that it meets the original identified needs.
The implementation phase of this step in the cycle consists of the delivery of the
KT feedback intervention that has been planned for this site. As is the case with any
faculty development activity, be it a workshop or online tutorial, contingencies can
be built in to deal with unforeseen situations such as a different number of participants
than expected, problems with technology, and lack of participation or interaction.
19.5.5 Monitoring Knowledge Use
In this stage, one must consider the type of knowledge that will be monitored (Straus
et al. 2010). Several descriptions of knowledge use exist in the context of KT
interventions. Nomenclature most frequently seen in the KT literature is instrumen-
tal, conceptual and persuasive use of knowledge (Alkin and Taut 2002; Dunn 1983).
Instrumental use refers to a concrete application of the knowledge in practice.
Conceptual use refers to changes in understanding or attitudes without any effect on
actual behavior or change in practice. Persuasive use consists of using knowledge
as a persuasion tool to convince others to support certain positions or opinions
(Alkin and Taut 2002).
To assess the use of knowledge, appropriate indicators should be developed and
different tools or measures assessing those indicators should be used. An important
consideration in this stage is that the impact of the knowledge on the end user,
whether it is a patient or a learner, must be evaluated. According to Straus et al.
(2010), the monitoring stage should consist of rigorous evaluation methods including
both qualitative and quantitative methods. The challenge of evaluating complex
interventions is highlighted in Chap. 17.
In the feedback scenario, a number of different measures can be used. For
conceptual use of knowledge, a scale assessing beliefs and attitudes can be used. It
may also be useful to conduct a qualitative assessment through interviews or focus
groups to ascertain whether there have been changes in attitudes and beliefs about
the impact of a faculty development activity on participants’ feedback practices.
Changes in knowledge can be assessed with a short answer quiz or online survey.
Measuring instrumental use of knowledge will be a greater challenge. Objective
measures of behavior change are considered the gold standard; however, they are
costly and challenging to implement. Chart audits, observation, video with simulated
recall, and consultations with learners to inquire about the impact of teachers’
feedback practices can be useful methods for measuring the impact of a workshop
on actual feedback practices. In the absence of the necessary resources to conduct
these types of evaluations, participants’ perceptions of the impact of the KT inter-
vention on their feedback practices can be obtained using self-report questionnaires
and interviews.
19.5.6 Evaluating the Outcomes or Impact

of Using the New Knowledge
This stage consists of evaluating the impact of the KT process in order to determine
if implementation of the new knowledge was successful and worthwhile. It specifi-
cally consists of measuring desired changes in levels of knowledge and attitudes as
well as changes in practice following the KT interventions.
In our example, a key outcome of the KT intervention on giving effective
feedback is that participants will apply effective principles of feedback with
learners. The two major knowledge outcomes that should be measured in this stage
of the K2A are: (1) participants’ knowledge about what giving constructive feed-
back entails, their attitudes about giving feedback, and their beliefs about the value
of giving effective feedback (conceptual) and (2) participants’ use of effective feedback
strategies in practice (instrumental).
When planning the evaluation of effectiveness, both the purpose of the evalua-
tion and the selection of the measures need to be carefully considered. The purpose
may be to collect evidence that justifies the faculty development resources devoted
to the design and implementation of the KT intervention on providing effective
feedback, to demonstrate that the KT activities have an impact on knowledge and
practice regarding giving effective feedback, or to evaluate specific features of
the activity (e.g. the use of a particular educational strategy) if there is no evidence
for that strategy in the literature. The outcomes of the activity should also be assessed
with the objective of disseminating the findings and contributing to the body of
literature on faculty development. Researchers or program evaluators can be
consulted to assist with designing the outcome measures and evaluation process,
measuring the outcomes, and analyzing the data. (See Chap. 18 for additional informa-
tion on research paradigms and an alternative framework for exploring the impact
of a faculty development activity.)
With regard to the type of measure or evaluation tool, this depends upon whether
there are existing measures for the outcome of interest (e.g. Sender Liberman et al.
2005; Stone et al. 2003). Identification of available measures is typically done at
the planning stage of the K2A cycle, during the literature review. Measures with
strong psychometric properties should be used when available. If there are no exist-
ing measures on the impact of faculty development interventions on effective feed-
back practices, a new measure can be developed, but it will need to be validated and
pilot tested prior to its use.
19.5.7 Sustaining Knowledge Use
The final stage of the action cycle consists of planning and managing changes to
implementation strategies in the face of evolving contextual factors and/or barriers
by cycling back through the action cycle. According to the K2A cycle, ‘sustained
knowledge use refers to the continued implementation of innovation over time
and depends on the ability of the knowledge users and the organization to adapt
to change’ (Davies and Edwards 2009, p. 165). Although this stage is later in the
K2A cycle, KT experts advocate for considering this stage as early as possible in
the implementation process.
For our feedback example, the faculty development team can schedule a follow-
up phone call or administer an online survey to assess the continued impact of the
KT intervention on conceptual and instrumental use of the feedback knowledge.
Site visits and the use of reminders are useful strategies for discussions of sustain-
ability and changes in the practice setting (Bloom 2005). They can also serve as
incentives for uptake of new knowledge. Whichever method is selected as part of an
assessment of sustainability, it should be evidence-based, feasible and acceptable to
the relevant stakeholders.
Evidence-based strategies include strategies that are known to be effective and
efficient for monitoring knowledge use. The literature may, for example, suggest
that online surveys yield a higher response rate than mail surveys and are more
effective than focus groups for identifying some of the sustainability issues
(Dillman 2000). Teachers (i.e. the participants) and managers should be consulted
at different times and confidentially in order to allow them to disclose their
opinions freely. Essentially, three important questions should be addressed at this
stage: (1) How is the knowledge about giving effective feedback being used? (2)
If it is not being applied, what are the main reasons? (3) What next steps can
be taken to support educators and the organization in implementing effective
feedback strategies?
It is essential that the monitoring plan be feasible. Ambitious and resource
demanding strategies may yield less than optimal outcomes. New measurement
tools take time to develop and validate, making it challenging to move forward in a
timely manner. Consider what resources are available and will yield the best infor-
mation regarding sustainability of the knowledge use.
Acceptability is another important factor in this stage of the K2A cycle. For
example, participants may not accept to be interviewed, and individuals at the
managerial level may not support a monitoring phase. The teachers’ and managers’
ability to sustain the change, that is to continue to implement effective feedback
strategies, must be considered at this stage. Ability can be influenced by affordances
in the environment (e.g. having enough learners to practice with, having a manage-
able workload) and by individual factors such as motivation, external recognition
of changes in behavior, and confirmation or validation that changes in the behavior
(feedback practices) improve learners’ experiences.
19.6 Conclusion
As valued members of faculty development teams and potential contributors to the

broader scholarship of faculty development and knowledge translation, we urge the
reader to consider his or her role in this important enterprise.
The K2A is a framework that offers a useful structure for conceptualizing and
organizing KT activities and evaluating their impact on desired outcomes. The
framework presents the boundaries between knowledge creation and action as
open and fluid. This suggests that faculty development activities can and should
be conceptualized as important KT interventions that are grounded in scientific
research as well as in other accepted and valued sources of knowledge. These
interventions must be assessed and disseminated widely in an effort to add to the
knowledge creation component of the KT process. Implementation studies that
describe the processes used to transfer new knowledge in practice will yield results
that could equally inform the action cycle. Results from original research, or from
syntheses of available research, should in turn be used to promote best practices in
faculty development activities. It is vital for both faculty development practice and
scholarship that the results of the evaluation and/or research be integrated back into
the knowledge creation component.
Faculty development teams should be encouraged to disseminate all aspects of
their interventions (planning and development, evaluation, successes, challenges),
and when appropriate, present their research findings at scholarly conferences
or submit manuscripts for publication in relevant journals. They should also be
encouraged to find ways to disseminate their results to the important stakeholder
groups that were involved in the various stages of the K2A process. The different
groups should find ways to collectively discuss the results from implementation
studies, explore the applications of the new knowledge in practice, and discuss what
processes need to be put in place to ensure that new knowledge is embraced, used
and sustained in practice.
Knowledge dissemination will not only help other faculty development teams in
the future as they plan and implement their own faculty development activities/KT
interventions, but it will add to the body of literature on faculty development
research. As with any field of study, the scientific evidence that emerges from this
research can improve teaching practices, strengthen the field, increase the body of
knowledge, and support continued scholarship.
19.7 Key Messages
• Faculty development activities should be conceptualized as KT interventions

intended to improve medical education and faculty development practices.
• The design of faculty development activities as KT strategies should be informed
by the best available research in the field.
• Rigorous methods for assessing the impact of faculty development (KT) activities
on practice are needed.
• Dissemination of knowledge obtained from assessments of effectiveness and
outcome measures of the faculty development interventions as KT strategies
are essential for building a body of research and practice in the field.
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Part VI
Conclusion
Chapter 20
Faculty Development: Future Directions
Yvonne Steinert
20.1 Introduction
The chapters in this book have addressed the scope of faculty development, common
approaches to the professional development of faculty members, practical applica-
tions, and the central role that research, scholarship, and knowledge translation can
play in creating evidence-informed faculty development. In this chapter, we will
build on lessons learned and chart a number of future directions as faculty develop-
ment in the health professions moves forward. These directions include: moving
away from the notion of one-time development to ongoing learning, and in the
process, shifting our emphasis from the workshop to the workplace; attending
equally to all faculty roles and expanding our focus from the individual to the
organization; building on available evidence and previous success in the design and
delivery of formal faculty development programs; introducing faculty development
early in the careers of students at all levels of the educational continuum; mapping
a research agenda for faculty development that includes new paradigms, methods
of inquiry, and foci for investigation; and learning from each other.
20.2 Moving from the Workshop to the Workplace
As stated in Chap. 1, faculty development has historically been viewed as a planned

program, something that is ‘done to’ faculty members, rather than an activity in which
they engage on an ongoing basis. In many ways, it is time to alter our thinking about
faculty development and embrace a broader view that moves us away from the notion


422 Y. Steinert
of development to learning, from one-time training to ongoing professional

development, and from the classroom (or workshop) to the workplace.
The plea to move from one-time development to ongoing professional learning
has been made by a number of educators in the field of higher education (e.g. Clarke
and Hollingsworth 2002; Knight 2002). As Webster-Wright (2009) noted, profes-
sionals learn from a range of activities that include formal programs, interactions
with colleagues, and learning on the job. Several authors in this volume have
also underscored the importance of learning from experience (O’Sullivan and Irby
Chap. 18; Swanwick and McKimm Chap. 3; Steinert Chap. 7), which includes role
modeling and reflective practice (Mann Chap. 12) as well as peer coaching and
mentorship (Boillat and Elizov Chap. 8). However, despite an increasing awareness
of the role of informal learning in the professional development of health professionals
(Eraut 2004), we must ask ourselves what has prevented us from recognizing
workplace learning as a legitimate form of faculty development to date. Is it that we
take experiential, workplace learning for granted? Or is it that such learning lacks
‘visibility’, credibility, and accountability? Irrespective of the underlying reasons,
research and dialogue about how faculty members develop, in both formal and
informal settings, are imperative. Moreover, although the importance of workplace
learning may appear self-evident, we need to find innovative ways to render informal
learning more ‘visible’.
Building on the work of Billett (1996) and Eraut (2004), Chap. 7 describes the
role of workplace learning in faculty development. Although we will undoubtedly
continue to promote formal (structured) faculty development initiatives, we must
value learning in the workplace, promote strategies that reinforce transfer to the
workplace, and reach health professionals who do not attend formal faculty
development activities. We should also examine cultural differences in workplace
learning and contemplate whether workplace learning is, in fact, a cultural practice.
20.2.1 Valuing Learning in the Workplace
As outlined in Chap. 7, we need to recognize and validate learning in the workplace.

We should also heed lessons learned in other fields and deliberately use the workplace
as an environment for learning, attempting to facilitate engagement, make expert
guidance more intentional, and strengthen affordances while diminishing organiza-
tional barriers. Billett (2002) has said that engagement is a fundamental pre-requisite
for learning in the workplace. As faculty members and faculty developers, what
can we do to heighten engagement? If possible, we should also try to decrease the
perceived distinction between working and learning (DuFour 2004), promote
the notion of learning for and in the workplace, and remember that enhancing
individual learning in the workplace can strengthen organizational capacity (Bierema
1996). The literature suggests that postgraduate medical education is characterized
as ‘a process of learning from experience’ (Teunissen et al. 2007, p. 763). Would it not
be possible to characterize faculty development in a similar fashion?
20 Faculty Development: Future Directions 423
20.2.2 Enhancing ‘Transfer of Learning’ to the Workplace
In discussing the transfer of knowledge from educational settings to the workplace,

(Eraut 2004) describes five inter-related stages:
…the extraction of potentially relevant knowledge from the context of its acquisition and
previous use; understanding the new situation (a process that often depends on informal
social learning); recognizing what knowledge and skills are relevant; transforming this
[knowledge and skill] to fit the new situation; and integrating [new competencies] with
other knowledge and skills in order to behave differently in the new situation (p. 256).
As faculty members and faculty developers, we should carefully consider this com-
plex process and the strategies that can facilitate transfer in the design and delivery
of formal faculty development programs and activities.
In discussing workshops and seminars, de Grave et al. (Chap. 9) highlight
the need for us to pay more attention to the transfer of learning to the workplace
and stress the following key characteristics, adapted from Grossman and Salas
(2011): learner attributes (including cognitive ability, self-efficacy, motivation to
learn); the design of the faculty development event (including behavioral modeling
and realistic training environments); and the nature of the work environment (including
support and the availability of follow-up). Clearly, we should acknowledge these
factors in the design of our activities and work to ensure careful monitoring and
follow-up. In our own setting, participants have valued ‘booster sessions’, often
3–6 months after a formal activity, as well as the availability of post-workshop
consultations. Embedding new knowledge and skills in the workplace is a key
challenge for all of us.
20.2.3 Bringing ‘Formal’ Faculty Development Activities

to the Workplace
It would also be beneficial to bring formal faculty development activities to the

workplace. In describing attendance at formal activities, it has been said that ‘those
who need faculty development the most, attend the least’ (Steinert et al. 2009,
p. 42). It is interesting to note that most faculty development activities have
traditionally been conducted away from the workplace, requiring faculty members
to take their ‘lessons learned’ back to their own contexts (Steinert 2012). Perhaps
it is time to reverse this trend and think about how we can penetrate the work
environment and integrate formal activities into the natural setting in which health
professionals work. In a study on why faculty members participate in faculty
development (Steinert et al. 2010b), participants specifically requested ‘outreach
activities’, described as formal professional development in their place of work.
As one participant commented, ‘I would like to see faculty development come
out of the medical school [building], and go into the hospitals…’ (p. 905). It is
clearly more difficult to ‘stay away’ from faculty development if it is conducted
onsite, with the chair or unit director in attendance.
424 Y. Steinert
20.2.4 Developing Communities of Practice
The development of a community of practice as an outcome of faculty development

has been discussed in a number of chapters in this volume (e.g. Anderson et al.
Chap. 14; Cook Chap. 11; Gruppen Chap. 10; O’Sullivan and Irby Chap. 18). That
a community of practice can facilitate faculty development has also been shown
(Steinert et al. 2010a). The challenge is to build on Wenger et al.’s (2002) design
principles (e.g. design for evolution; open a dialogue between inside and outside
perspectives; invite different levels of participation; create a rhythm for the
community), outlined in Chaps. 7 and 14, and help faculty members to find a com-
mon purpose and shared language, opportunities for dialogue and meaningful
exchange of information, and joint activities and practices. By working together and
participating in a larger community, health professionals can build new knowledge
and understanding, develop approaches to problems faced in the multiple facets
of their diverse roles, and achieve a sense of belonging (Steinert 2010). Describing
and evaluating this trajectory is an additional direction for future inquiry.
20.3 Expanding the Focus of Faculty Development
As noted in Chap. 1, faculty development should address all faculty roles, including
that of teacher and educator, leader and manager, and researcher and scholar.
Professional development in this area should also aim to enhance career development
and organizational change. A similar argument has been made by Drummond-
Young et al. (2010) who state that a comprehensive faculty development program
in nursing should include instructional development, professional development,
leadership development, and organizational development.
20.3.1 Addressing all Faculty Roles
Although faculty members and faculty developers might all agree with expanding
the focus of faculty development, as discussed at the 1st International Conference
on Faculty Development (2011), the literature and many of the authors in this book
continue to emphasize the educational role of faculty members. Why is this? Is it
that faculty members are least prepared for this role? Is it because early efforts in
faculty development primarily focused on teaching improvement (as outlined in
Chap. 2)? Although the answer to this question is not obvious, the sociocultural
and economic contexts in which faculty development initiatives unfold may play a
role. For example, faculty development offerings are often designed in response to
‘urgent’ educational needs, and ‘service’ to the community may be the first priority.
This observation might partially help to explain the emphasis on teaching improvement
and the apparent focus on the individual. So might the recent emphasis on the
professionalization of teaching (Eitel et al. 2000; Purcell and Lloyd-Jones 2003),
though the development of standards for all faculty roles may well be forthcoming.
At the same time, funding for educational development may be more readily
available than resources for career development (which may be perceived as a
‘luxury’), and leadership development and research capacity building may not be
seen to require formal development. In fact, some might even believe that leadership
is a ‘mystical and ethereal’ process that is not amenable to change (Kouzes and
Posner 1995). Despite these possible reasons, however, it would be worthwhile for
us to become more mindful of how we invest in faculty development and how we
can systematically address all faculty roles, many of which overlap and are often
carried out simultaneously. Health professionals in all settings (including the
university, the hospital, and the community) need to be prepared for complex and
demanding roles that go well beyond teaching, and a broader focus would benefit
both individual faculty members and the organizations in which they work.
20.3.2 Shifting from an Individual to an Organizational Focus
As highlighted by Jolly (Chap. 6), faculty development initiatives need to explicitly

try to influence the organizational culture. Such efforts are needed to support the
individual faculty member’s growth and development as well as the institutional
environment in which education, leadership, and research takes place. Hafler et al.
(2011) describe a ‘hidden curriculum’ that affects faculty members in multiple
ways. As these authors observe:
…efforts to improve the instructional value, impact, and/or relevance of formal faculty
development programs will be dictated in part by the broader array of cultural messages that
faculty members encounter as they go about learning what being a ‘good faculty member’
means (Hafler et al. 2011, p. 442).
This observation is an additional call for faculty development efforts to address the
organizational culture, sustain individual change, recognize faculty members’
accomplishments, and facilitate effective participatory practices. So is the observation
by Hodges (Chap. 4) and Goldszmidt et al. (2008) that, despite participation in
formal activities designed to foster research, many faculty members may not
actually conduct more (or better) research because of organizational factors that
include a lack of research support, ‘protected time’, and a community of practice
committed to scholarship. Awareness of the organization’s values and goals is also
essential in order to embed faculty development in the organization, as is attention
to those elements that foster ongoing change and development (e.g. Snell Chap. 13).
In diverse ways, expanding our focus from the individual to the organization will
help to increase capacity, foster and sustain innovation, and reward excellence.
426 Y. Steinert
20.4 Building on Evidence and Previous Success
Thomas and Steinert (Chap. 19) describe the role of evidence in the design and
delivery of faculty development initiatives. Although the evidence base in faculty
development is not as firmly established as in other fields, we should strive to
develop programs based on what we know – from both empirical studies and from
our collective experiences. Moreover, despite the suggestion of a renewed emphasis
on professional learning in informal settings, formal (structured) faculty develop-
ment programs are here to stay. The literature to date has provided us with important
information about what works in the design and delivery of formal initiatives
(Spencer Chap. 17), including the use of a range of instructional methods (e.g. small
group discussions, interactive exercises, role plays or simulations), the promotion
of experiential learning and reflective practice, the provision of feedback and
effective peer relationships, and the enhancement of relevance and application
through project work. We should incorporate these elements into our program
design and build on ‘key features’ that appear to be associated with positive outcomes
(Steinert et al. 2006, 2012).
20.4.1 Creating Comprehensive, Stage-Specific Programs
Silver (Chap. 16) suggests that we consider the design and delivery of comprehensive
faculty development programs that can ‘serve the multiple needs of teachers,
educators, researchers and administrators’. This recommendation encourages us to
think programmatically and move away from ‘one-time events’, even though the
latter have the advantage of enticing new participants (Steinert et al. 2010b). In
describing faculty development to enhance teaching effectiveness, Hodgson and
Wilkerson (Chap. 2) suggest that we should build comprehensive programs that are
developmental in nature (Dreyfus and Dreyfus 1986) and that can demonstrate that
faculty members have achieved varying levels of competency. Using a competency
framework (e.g. Academy of Medical Educators 2012; Milner et al. 2011; Molenaar
et al. 2009; Srinivasan et al. 2011), as suggested by Hodgson and Wilkerson
(Chap. 2), can help to monitor the achievement of faculty milestones and progress
over time. In a similar vein, and describing the role of faculty development in build-
ing research capacity, Hodges (Chap. 4) proposes that it would be worthwhile to
create developmental, articulated programs that progress from short courses to
longer programs, fellowships, and graduate degrees, as the interests, skills, and needs
of faculty members evolve. Leslie (Chap. 5) also describes stage-specific faculty
development activities, depending on the career stage of a faculty member. For
example, early career faculty may have different needs than mid-career faculty; they
may also prefer different ways of meeting those needs.
Regardless of the scope of the faculty development endeavor, the common
denominator rests on the value of a comprehensive program that is responsive to the
needs and priorities of faculty members and the organizations in which they work.
The literature also demonstrates increasing evidence regarding the merit of programs
that extend over time (Gruppen Chap. 10; Hodges Chap. 4; Steinert et al. 2006),
suggesting that longitudinal programs yield more lasting results. In line with this
observation, de Grave et al. (Chap. 9) recommend that we reconsider the role of
workshops and seminars in the repertoire of faculty development initiatives and
explore how they can be integrated into longitudinal programs, allowing for cumu-
lative learning and practice.
20.4.2 Choosing a Conceptual Framework to Guide Program

Design and Delivery
As suggested in a systematic review of faculty development to promote leadership,

faculty development should be grounded in both theory and empirical evidence
(Steinert et al. 2012). Models and principles of teaching and learning (Mann 2002)
should inform the planning and development of interventions, and relevant theoretical
frameworks should guide the choice of content and process. In a review of 55 com-
munity leadership development programs, Russon and Reinelt (2004) observed that
programs did not articulate a program theory or ‘theory of change’ to describe ‘how
and why a set of activities are expected to lead to outcomes and impacts’ (p. 105).
As highlighted by de Grave et al. (Chap. 9) and Silver (Chap. 16), there is a clear
need to identify and describe the conceptual frameworks that underpin our work.
At the same time, no single theory can explain how faculty members develop
their skills and expertise in a variety of domains. As a result, we should choose a
conceptual approach that can guide program design and delivery. For example, if we
choose to view faculty development through the lens of expectancy-value theory
(Eccles and Wigfield 2002; Heckhausen 1991), also described by Silver (Chap. 16),
we might want to examine how our professional development activities can trigger
faculty members’ expectancies and values. According to this theoretical framework,
we orient ourselves to the world according to our expectations and values (Steinert
et al. 2009). Eccles and Wigfield (2002) have defined expectancies as ‘beliefs about
how one will do on certain tasks or activities’ and values as the ‘incentives or
reasons for doing the activity’. In most faculty development activities, at least two
expectancies (Heckhausen 1991) come into play: (1) the subjective probability
of attaining an outcome in a specific situation and (2) the subjective probability of
an outcome to be associated with specific consequences. For example, if health
professionals believe that faculty development activities (be they formal or informal)
can enable personal and professional growth, and that they are relevant to their
needs, they may be more likely to participate. Awareness of these motivational
factors (and their theoretical foundations) can also influence the design and delivery
of most faculty development initiatives.
Alternatively, and as suggested in Chap. 1, situated learning theory can guide
the design and development of a faculty development program or activity. Situated
428 Y. Steinert
learning is based on the notion that knowledge is contextually situated and

fundamentally influenced by the activity, context, and culture in which it is used
(Brown et al. 1989). This view of knowledge, as situated in authentic contexts, and
its key components of cognitive apprenticeship, collaborative learning, reflection,
practice, and articulation of learning skills (McLellan 1996), has important implica-
tions for our understanding of faculty development. In a similar fashion, workplace
learning (Billett 1996; Eraut 2004) and communities of practice (Wenger 1998), as
outlined in Chap. 7, can guide our work in this area. Clearly, we need to heed the
advice of de Grave et al. (Chap. 9) and articulate the theoretical (or conceptual)
approaches that inform our faculty development practices.
20.4.3 Integrating Alternative Approaches
Part III describes a number of faculty development approaches that are used less
frequently: peer coaching and mentorship (Boillat and Elizov Chap. 8) and online
learning (Cook Chap. 11). How could these approaches be integrated more fre-
quently into faculty development programs and activities? How can we capitalize
on the benefits of peer-assisted learning and multiple mentoring in both formal and
informal settings, and how we can promote enhanced online learning opportunities?
In addition, how can we utilize simulation and other advanced technologies for
faculty development? The Objective Structured Teaching Encounter (OSTE) is one
example of how simulated practice can be used to facilitate professional learning
(Boillat et al. 2012; Stone et al. 2003). However, the range of possibilities for using
simulation to promote faculty development for all faculty roles is infinite (Ellen
et al. 1994; Johnson et al. 1999; Krautscheid et al. 2008), and in many ways, the
principles described by Cook (Chap. 11), that include a needs analysis, adherence
to principles of instructional design, and careful planning and evaluation, apply in
this context as well.
20.4.4 Promoting Reflection and Reflective Practice
In examining key features of effective faculty development programs, the role of

reflection – and reflective practice – emerges as a critical ingredient to professional
learning. As Raelin (1997) has said, ‘reflection constitutes the ability to uncover
and make explicit to oneself what one has planned, observed or achieved in practice’
(p. 567). This author also postulates that reflection is as important to learning as
experience, for without contemplation, ‘lessons to be learned’ may be overlooked.
However, despite this observation, and those of other authors (e.g. Lachman and
Pawlina 2006; Schön 1983), very little is known about how the process of reflection
unfolds. In addition, few authors have explicitly described the reflective process
in structured faculty development initiatives (e.g. Branch et al. 2009). As Mann
(Chap. 12) has stated, the role of reflection in faculty development will warrant
more attention in the future and we will need to carefully examine ways in which to
stimulate and nurture critical thinking in the development of health professionals as
educators, leaders, and researchers.
20.4.5 Encouraging Interprofessional Faculty Development
The role and importance of interprofessional education and practice has been widely
acknowledged. A number of interprofessional faculty development initiatives have
also been described in the literature (e.g. Brashers et al. 2012; Silver and Leslie
2009), all of which have the potential of achieving identified goals and overcoming
barriers to interprofessional collaboration and practice (Steinert 2005). Anderson
et al. (Chap. 14) describe how faculty development can promote interprofessional
education and practice. It is our belief that one of the most powerful ways to break
down perceived barriers (or silos) and to enhance mutual respect and collaboration
is by working together to meet common goals. Interprofessional faculty development
can achieve this goal, by modeling the way and helping to create interprofessional
communities of practice.
20.5 Starting Early in the Careers of Future Faculty

Members
Although the primary focus of this book has been the development of faculty
members, many authors across the health professions have expressed the view that
faculty development should start early, often at entry to university (Busari and
Scherpbier 2004; Dandavino et al. 2007; Gonzalez et al. 2003; Zsohar and Smith
2010). Undergraduate, graduate, and postgraduate students in the health professions
teach in a variety of settings. In fact, in one study, it was estimated that postgraduate
students spend as much as 25 % of their time in teaching activities, including
the supervision, instruction, and evaluation of students and more junior trainees
(Seely 1999). At the same time, learners across the educational continuum have
identified teaching as an important part of their responsibilities and have expressed
interest and enthusiasm in learning about their educational roles (Bing-You and
Sproul 1992; Busari et al. 2002).
In examining medical education in particular, Dandavino et al. (2007) outline a
number of reasons why undergraduate students should learn about teaching. As they
suggest, students will become future faculty members and many of them will take
on significant teaching roles. In addition, education is a core component of the doctor-
patient relationship and it is anticipated that students will become more efficient
communicators as a consequence of learning about teaching. It is also hoped that
they will become better learners as a result of increased knowledge about teaching
430 Y. Steinert
and learning. Similar observations have been made about graduate and postgraduate
students. For example, studies have shown that postgraduate students contribute
significantly to the education of students (Edwards et al. 2002) and that students
perceive them as playing a critical role in their training (Sternszus et al. 2012;
Walton and Patel 2008).
In many ways, the content of faculty development for undergraduate, graduate,
and postgraduate students mirrors what we encounter in faculty development for
practicing health professionals (Busari et al. 2006; Pasquinelli and Greenberg 2008;
Soriano et al. 2010; Wamsley et al. 2004; Zsohar and Smith 2010), with a primary
emphasis on teaching improvement. Program modalities are also similar and include
workshops and seminars (e.g. Bardach et al. 2003; Nestel and Kidd 2002), student-
or resident-as-teacher programs (Edwards et al. 2002; Pasquinelli and Greenberg
2008), and elective activities in medical education (Craig and Page 1987). Not
surprisingly, the majority of teaching improvement programs are rated positively by
learners, who value the experiential nature of activities, the role of feedback, and the
learning that occurs ‘on the job’.
At the same time, although most of the relevant literature focuses on students
(at all levels of the continuum) as teachers, the need to prepare learners for leadership
and management roles has been highlighted by some authors (Berkenbosch et al.
2012; Blumenthal et al. 2012; Gonzalez et al. 2003), and as Ackerly et al. (2011)
have stated, ‘the active cultivation of future leaders is [urgently] required’ (p. 575). It
should also be noted that leadership (or management) and research (or scholarship)
are included as core competencies in different educational frameworks, as outlined
by Snell (Chap. 13), and as a result, training in this area aligns well with both
curricular expectations and health care priorities. As is the case with faculty
members, faculty development in this area must address the multiple roles that
future faculty members can play.
20.6 Mapping a Research Agenda for Faculty Development
As stated in Chap. 1 and summarized by Spencer (Chap. 17), research on the impact
of formal (structured) faculty development activities has shown that overall
satisfaction with programs is high and that participants recommend these activities
to their colleagues. Faculty members also tend to report a positive change in atti-
tudes, knowledge, skills, and behaviors following a particular program or activity;
impact on learners or colleagues is less frequently observed, as is change at the
organizational level. The literature to date has also helped to identify ‘key features’
of successful faculty development programs, though less is known about ‘how’ or
‘why’ change occurs.
From a methodological point of view, studies in this field have been limited by
a number of challenges that characterize much of medical education research
(Spencer Chap. 17), making conclusive statements and generalizations to other
settings difficult. For example, the majority of studies in this area use descriptive,
single-group designs to examine outcomes. These designs confound the ability to
attribute outcomes directly to the intervention (Steinert et al. 2012) and make
appraisal difficult. In addition, a number of studies either rely entirely on post-
intervention measures or collect data several years after the intervention took place
(Steinert et al. 2006, 2012), making the ‘attribution of change’ equally challenging.
Researchers have also under-utilized qualitative methodologies which, in many
ways, can more easily capture the process of change. In addition, and as outlined by
O’Sullivan and Irby (Chap. 18), there has been an over-emphasis on a positivist
paradigm.
However, the need for research in this field has never been greater, as we try
to promote scholarship and academic inquiry, inform ‘best’ practices, and remain
responsive to organizational needs and priorities. The timing is also opportune, as
we have witnessed a world-wide increase in departments and centers dedicated to
medical education research and scholarship (Steinert 2012).
20.6.1 Considering Alternative Research Paradigms,

Methodologies and Methods
Recommendations for moving the faculty development research agenda forward are
described in detail in Chaps. 17 and 18. In this section, we will only highlight some
of the suggestions made.
20.6.1.1 Moving Beyond a Positivist Paradigm
O’Sullivan and Irby (Chap. 18) have wisely suggested that we consider moving
away from a positivist tradition and conduct research framed by post-positivist,
interpretivist, and critical theory research paradigms, using associated methodologies
to enrich our understanding of faculty development. As these authors have stated, ‘a
paradigm defines the prevailing model of exemplary practices for a community of
researchers; it illuminates areas for investigation and obscures others’ (O’Sullivan
and Irby Chap. 18). Changing paradigms would enable new perspectives and
encourage us to consider innovative conceptual approaches and methodologies.
20.6.1.2 Ensuring That Research Is Informed by a Conceptual

Framework
We stated earlier that faculty development programming should be informed by

theoretical models and approaches; so should research and scholarship. With this in
mind, O’Sullivan and Irby (2011, Chap. 18) suggest that we use a new conceptual
432 Y. Steinert
framework that incorporates the notion of a faculty development community and a

workplace community to conduct research in this area. In particular, these authors
propose that we study the relationship between these two communities, their power
and influence, and the impact of both on the culture and practices of the institutions
in which they evolve. Using this framework can also lead to a broader set of questions
(described in Chap. 18) and reinforces the value of examining workplace learning
and communities of practice (as highlighted in Chap. 7). Additional theoretical
frameworks are also summarized by Silver (Chap. 16) and other authors (e.g. de
Grave et al. Chap. 9). Irrespective of which conceptual approach we adopt, we
should strive to utilize theory in the design of our research and in the interpretation
of our results.
20.6.1.3 Acknowledging the Complexity of Faculty Development

Interventions
Spencer (Chap. 17) discusses the challenge of evaluating complex interventions and
reminds us that the boundaries between research and evaluation are fluid. He also
reinforces the perception that faculty development is a complex process. As outlined
in Chap. 17, complex interventions are usually based on several working theories,
some more well defined or evidence-based than others; they involve a wide range of
participants (which in this case would include faculty developers, administrators,
course participants, learners, and colleagues); and they are embedded in multiple
social systems. In addition, the process is usually non-linear, with multiple pathways
and feedback loops, and success is dependent upon a cumulative chain of events.
These characteristics clearly describe formal (structured) faculty development
activities, where many intervening, mediating variables (e.g. personal attributes,
individual status, and responsibilities) interact with uncontrollable, extraneous
factors. They also imply that we should select methodologies that can capture the
complexity of faculty development interventions as well as the process of change.
20.6.1.4 Incorporating New Methodologies and Methods
As suggested above, we need to move away from an over-reliance on experimental

and quasi-experimental designs and consider qualitative designs, using phenomenology,
ethnography, case studies, and mixed methods (Drescher et al. 2004; O’Sullivan and
Irby Chap. 18; Steinert et al. 2012). In many ways, qualitative methodologies would
allow us to tease apart the process of change, corroborate anecdotal observations,
and capture faculty members’ stories. We should also consider using the methodolo-
gies suggested by O’Sullivan and Irby (Chap. 18). Educational design research
is pertinent to faculty development because it allows for the examination of
evolving program innovations. The researcher attends to program goals and design,
a description of how the intervention unfolds, achieved outcomes, and lessons
learned (Collins et al. 2004). Success cases, which can be used concurrently with
design research, fit within an interpretivist paradigm. Success cases aim to reveal
how well an initiative is working and try to identify the contextual factors that
support successful implementation (Brinkerhoff and Dressler 2003). This methodol-
ogy aligns well with the perceived need to examine the role of contextual factors in
faculty development. Sustainability narratives are considered by O’Sullivan and
Irby (Chap. 18) to be a research methodology that lies ‘outside the normal modes
of inquiry for the education community’ as it explores the development of a society
through the lens of human and environmental systems and imagines what the
future would be like if people’s lives were improved (Swart et al. 2004). However,
the use of both this methodology and that of narrative research (Lieblich et al. 1998)
would enable a rich understanding of the faculty development process as well as
individual and organizational change.
Much has been written about the need to improve the research methods used in
this field of inquiry (Steinert et al. 2006, 2012). Suffice it to say that we should use
validated outcome measures, including newer methods of behavioral or performance-
based measures of change. As well, we should utilize multiple methods and data
sources to assess process and outcome. To date, we have witnessed an over-reliance
on self-assessment methods and survey questionnaires to assess change. Moving
forward, we should consider the use of alternative data sources and try to ascertain
as many stakeholder perspectives (e.g. students; colleagues) as possible. Lastly,
irrespective of the methodologies chosen, we should ensure congruence between
study design, research questions, and data collection methods.
20.6.2 Exploring New Areas of Inquiry
In different ways, each chapter in this book suggests a new focus of inquiry. In this
section, we will highlight only a few areas for further investigation that cut across a
number of the authors’ recommendations. We also invite the reader to contribute to
the suggested research agenda.
20.6.2.1 Analyzing the Process of ‘Formal’ Faculty Development

Programs and Activities
Although the need to assess faculty development outcomes and impact remains a
priority, we should carry out process-oriented studies to better understand how
change occurs as a result of formal (structured) interventions. As an example, we
should consider expanding the focus of outcome-oriented studies to compare how
different faculty development interventions promote change in faculty members’
competence and performance (Steinert et al. 2012). That is, it would be worthwhile
to compare different faculty development approaches (e.g. workshops, seminar
series, longitudinal programs) and the methods used in these formats (e.g. role plays
or simulations; peer feedback or reflection) to enable an understanding of which
434 Y. Steinert
faculty development ‘features’ contribute to changes in faculty members’ performance

(Steinert et al. 2006). In discussing research capacity, Hodges (Chap. 4) suggests that
we should examine the relationship between different types of faculty development
programs and long-term success in research. Similarly, Friedman et al. (Chap. 15)
recommend that we look at success factors in existing international partnerships,
with specific attention to relationship factors. It would also be worthwhile to tease
apart ingredients of success within specific programs (e.g. peer-peer interaction;
project work; online follow-up). For example, Mann (Chap. 12) describes how
current programs designed to promote reflective practice appear to be effective but
time-consuming. Assessing the differential contributions of key features would help
us to determine the design of relevant and feasible initiatives that best meet faculty
members’ needs and realities. Cook et al. (2008) suggest that we should pursue
‘clarification’ studies (in addition to ‘description’ and ‘justification’ studies) to deepen
our understanding and ‘advance the art and science of medical education’ (p. 128).
This recommendation, to understand ‘why’ or ‘how’ something works, is particularly
relevant in this context.
The assessment of change, within the individual (e.g. how did faculty members’
attitudes and values change) and over time (including the ‘durability of change’ and
factors which help to sustain change) would also be worthwhile. Russon and Reinelt
(2004) make an interesting distinction between outcomes (i.e. changes in attitudes,
behavior, knowledge, and skills) and impact (i.e. the long-term future social
change that a program works to create). Given health professionals’ roles in creating
educational, social, and health care change, assessment over time is critical. In
addition, many of the outcomes anticipated in a planned faculty development
program take time to emerge. This serves as a further reason to promote longitudinal
assessment and follow-up.
Knight (2002) asks whether professional learning happens ‘in ways assumed by
delivery models which concentrate on provision of courses, workshops and other
events…’ (p. 230). We clearly need to explore this question in more depth, examine
the impact of alternative approaches such as peer coaching and mentorship (Boillat
and Elizov Chap. 8), and online learning (Cook Chap. 11), and begin to compare
‘formal’ and ‘informal’ ways of learning.
20.6.2.2 Understanding How People Learn in the Workplace
As highlighted in Chaps. 1 and 7, health professionals learn about their faculty roles
in both formal and informal ways. However, although ‘there are strong indicators
that a great deal of learning takes place in the workplace, relatively little appears to
be known about how people learn informally or about the relative value of different
types of learning experiences’ (Cheetham and Chivers 2001, p. 269). Even less is
known about how health professionals learn in the workplace, and we should try to
build on lessons learned in postgraduate medical education (Teunissen et al. 2007),
clinical medicine, and dentistry (Cook 2009), using qualitative research methodolo-
gies to try to better understand this process. Clarke and Hollingsworth (2002) have
argued that it is time to shift our thinking away from programs that ‘change teachers’
to viewing faculty members as ‘active learners shaping their own professional
growth through reflective participation in professional development programs and
practice’ (p. 948). This perspective, together with that suggested by O’Sullivan
and Irby (Chap. 18), provides a research agenda for the future. It also underscores
the need to understand the role of role modeling, reflection, and engagement in
workplace learning.
A number of authors in this book (e.g. Anderson et al. Chap. 14; Mann Chap. 12;
O’Sullivan and Irby Chap. 18) have suggested that future research in this area
should incorporate current understandings of communities of practice, with
attention to how they evolve, how they function, and how they can lead to individual
and organizational growth and development. Such research would also be helpful
in illuminating how communities of health professionals can be developed
and sustained. At the same time, we need to think about how workplace learning
and communities of practice can lead to enhanced learning for leadership and
research. Not surprisingly, most of the work in this area has focused on the role
of the teacher and educator.
20.6.2.3 Examining the Process of Becoming a Faculty Member
Although this volume has underscored the importance of looking at both formal
and informal approaches to faculty development, little is known about the ongoing
formation of faculty members. In a previously described study, Steinert (2012)
explored the process of becoming a medical educator as seen through the eyes of 12
medical educators. A number of themes emerged in this study, including the notion
of volition, on-the job-learning, mentorship and role modeling, and belonging
to a community of experts. It would now be interesting to study how health profes-
sionals learn to become faculty members and fulfill their responsibilities as leaders
and researchers.
Leslie (in Chap. 5) and other authors (Lieff et al. 2012; Starr et al. 2003) have
highlighted how we need to further understand the development of an academic
identity, examining how it is developed within the health professions context, how
it evolves over time, and how it can inform professional learning and practice.
Leslie also points out that examining the formation of academic identity in associa-
tion with networks of colleagues who have similar identities might allow us to learn
more about collaborative scholarship and how faculty development can play a role
in enhancing identity. Exploring faculty members’ beliefs would also be beneficial,
as core beliefs are likely to be a primary determinant of faculty members’ behaviors
(Williams and Klamen 2006). Interestingly, we often provide faculty development
in a vacuum, paying little attention to identity or beliefs. In addition, the research
that has looked at this area has primarily focused on the educational role of health
professionals, examining faculty members’ conceptions of learning (Swanwick and
Morris 2010; Young 2008), beliefs about teaching (Light and Calkins 2008), and the
436 Y. Steinert
role of disruption and transformation in faculty development (Kumagai 2010).

Clearly, personal beliefs, values and conceptions are pivotal elements in all faculty
roles and merit exploration.
20.6.2.4 Evaluating Context and Organizational Change
As stated at the outset (and in many of the book’s chapters), professional development
(be it formal or informal) occurs in a complex environment in which many unfore-
seen and unpredictable variables play a role. As a result, we should try to conduct
more studies in which the interaction between different factors is investigated,
highlighting ‘under what conditions and why an intervention might be successful
or not’ (Steinert et al. 2006, p. 522). Jolly (Chap. 6) and Billett (1996) identify a
number of ways in which the organization (or institution) can influence the process
of faculty development. Systematic and sustained research on the organizational
(and contextual) factors that both promote and hinder the professional development
and learning of faculty members is indicated. So is the need to assess the impact of
faculty development on the organization.
In various chapters, we have said that faculty development can – and should –
enhance organizational capacity. However, we need to move beyond anecdotal
observations and aspirations and verify whether this assertion is, in fact, true.
The dearth of research assessing the impact of faculty development on the organiza-
tion is surprising (Steinert et al. 2006, 2012). Is this because organizational
change is difficult to measure? Is it because of medicine’s historical focus on the
individual (Bleakley 2006)? Whatever the reason, there is a clear need to assess
outcomes and impact at the organizational and systems level. Research in this
area will also provide valuable insights that can help to guide future policies and
practices.
20.6.3 Ensuring That Research Informs Practice
No discussion of research on faculty development in the health professions

(knowledge creation) would be complete without talking about how work in this
area can inform our practice (knowledge-to-action). As outlined by Thomas and
Steinert (Chap. 19), there are seven stages in moving knowledge into practice that
include: identifying a problem in practice, or a gap in knowledge, and identifying,
reviewing, and selecting the knowledge to be implemented to address the gap;
adapting or customizing the knowledge to the local context; evaluating the determi-
nants of the knowledge use; selecting, tailoring and implementing interventions to
address the knowledge or practice gap; monitoring the knowledge use in practice;
evaluating the outcomes or impact of using the new knowledge; and determining
strategies for ensuring that the new knowledge is sustained (Graham et al. 2006).
As faculty members, researchers and faculty developers, we would be wise to

consider the fluid nature of this process and ensure that our faculty development
practices are informed by the ‘best’ available evidence.
20.7 Learning from Each Other
Nora (2010) points out that ‘No medical school can accomplish its mission independent
of other organizations’ (p. S46). This is clearly true in the area of faculty develop-
ment as well. Based on our collective experience (e.g. 1st International Conference
on Faculty Development 2011) and the findings in this volume, there is mutual
benefit in collaborating with universities and teaching hospitals, community hospitals
and ambulatory sites, research institutes, and regional, national, and international
organizations dedicated to the advancement of health professions education, leader-
ship, and research. Although partnerships require time and attention, collaboration
can help us to achieve goals that any one individual or organization may not.
In a similar vein, it would be beneficial to learn from, and collaborate with,
colleagues outside of medicine. For example, as many authors in this book suggest,
we can learn important lessons from colleagues in education (e.g. Clarke and
Hollingsworth 2002; Webster-Wright 2009; Wenger 1998) and management
(e.g. Kotter 1996; Nonaka and Takeuchi 2011), to name but a few. Moreover, by
working together, we can enhance educational capacity, promote leadership and
organizational growth, and develop a rigorous research agenda and network.
At the same time, the globalization of health professions education, research, and
practice is evolving (Bleakley et al. 2008; Hodges et al. 2009; Marchal and Kegels
2003), and it will remain important to situate faculty development in a global
context. Friedman et al. (Chap. 15) describe a number of successful international
partnerships that benefit individuals, organizations, and society. They also highlight
some of the elements that are key to building successful partnerships, including
the partners themselves, available human, financial, and material resources, and a
sense of engagement. Additionally, they identify factors leading to successful (and
sustainable) partnerships that encompass frequent bilateral communication, a clear
agenda and mutual goal-setting, adequate resources, and cultural competence.
Cognizance of these factors, as well as the cultural ‘positions’ and attitudes that
underlie our work (Bleakley et al. 2008), would enhance our ability to move forward
in this area. Over 20 years ago, Boelen (1992) addressed the need for global action
in medical education reform and detailed an agenda that included quality education,
strategies for change management, and the monitoring of progress made. These
priorities remain equally important today and faculty development has a critical role
to play in making these changes happen (Steinert 2011). More recently, Silver
(Chap. 16) has suggested that it is time to build and sustain an international faculty
development community. In multiple ways, it would be worthwhile to explore an
international agenda for faculty development and find ways to share accumulated
‘know how’ and build on our collective expertise.
438 Y. Steinert
20.8 Conclusion
‘The changing roles of faculty members will continue to drive the changing nature of
faculty development practices, as will the evolution of the organizations in which we
work’ (Steinert 2000, p. 49). Future directions for faculty development research and
practice include: moving away from the notion of one-time development to ongoing
learning, expanding the focus of faculty development, building on available evidence
and previous success, introducing faculty development early in the careers of future
health professionals, mapping a rigorous and meaningful research agenda for faculty
development, and learning from each other. As stated at the outset, faculty develop-
ment is an investment in the social capital of the organizations (or institutions) in
which we work and an ‘outward sign of the inner faith that institutions have in their
workforce’ (Bligh 2005, p. 120). Leslie (Chap. 5) suggests that being part of a culture
that embodies a ‘spirit of inquiry, discovery and innovation’ is important to health
professionals. We would add that faculty members are equally motivated by a sense
of curiosity, creativity, and commitment, wishing to excel in all that they do. Faculty
development is a way in which to foster this pursuit of excellence.
20.9 Key Messages
• Moving forward, we must find ways to recognize the role of workplace learning
in faculty development and bring ‘formal’ activities to the workplace.
• Expanding the focus of faculty development to include all faculty roles as
well as an emphasis on the organization will enhance both individual and orga-
nizational capacity.
• Promoting faculty development ‘early’ in the careers of undergraduate, graduate,
and postgraduate students will help to prepare future faculty members.
• Creating a research agenda for faculty development involves the use of new
paradigms, methodologies, and methods as well as areas of inquiry that promote
an understanding of the process of formal programs, how people learn in the
workplace, and how health professionals become faculty members.
• Learning from each other will enable the sharing of resources and expertise
and help to create new partnerships and communities of practice that support
ongoing professional development.
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Innovation and Change in Professional Education 11

Yvonne Steinert Editor

SCOPE OF THE SERIES

For further volumes:

ISBN 978-94-007-7611-1 ISBN 978-94-007-7612-8 (eBook)

Library of Congress Control Number: 2014930985

© Springer Science+Business Media Dordrecht 2014

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com)

This Springer Series focuses on innovation and change in professional education.

Montreal, QC, Canada Yvonne Steinert, Ph.D.

Yvonne Steinert is a clinical psychologist and Professor of Family Medicine in the

of innovation, scholarship, and excellence. Without this ‘community of practice’,

1 Faculty Development: Core Concepts and Principles ......................... 3

Part II The Scope of Faculty Development

2 Faculty Development for Teaching Improvement ................................ 29

Part III Approaches to Faculty Development

7 Learning from Experience: From Workplace Learning

10 Intensive Longitudinal Faculty Development Programs ..................... 197

Part IV Practical Applications

12 Faculty Development to Promote Role-Modeling

Part V Research and Scholarship in Faculty Development

17 Faculty Development Research: The ‘State of the Art’

20 Faculty Development: Future Directions .............................................. 421

Liz Anderson Department of Medical and Social Care Education, University of

Brian Hodges Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Faculty development has become an increasingly important component of health

Y. Steinert, Ph.D. (*)

Y. Steinert (ed.), Faculty Development in the Health Professions: A Focus 3

1.2 Common Goals and Definitions

Faculty development, or staff development as it is often called, refers to that broad

1.3 The Rationale for Faculty Development

In the last decade, we have witnessed a significant growth in faculty development

The proliferation of formal faculty development programs is also linked to a growing

1.4 The Context in Which Faculty Development Occurs

Faculty development in the health professions takes place in an ever-changing

1.4.1 Healthcare Delivery

1.4.2 Clinical and Academic Environments

1.4.3 Educational Trends and Opportunities

1.4.4 The Role of Context

As is evident in this section, no discussion of faculty development would be

1.5 The Scope of Faculty Development

1.5.1 Teaching Effectiveness

1.5.2 Leadership Development

As mentioned previously, health care delivery, clinical practice, and medical

management, conflict resolution and negotiation, team building and collaboration,

1.5.3 Research and Scholarship

1.5.4 Career Development

The academic environment is increasingly complex. As Leslie (Chap. 5) points out,

Other authors have described faculty development as an ‘organized, goal-directed

1.5.5 Organizational Change

1.6 Approaches to Faculty Development

Health professionals develop their competence as faculty members in a number of

Online Learning Workshops & Seminars

Peer & Student Feedback Longitudinal Programs

faculty development and provides a pictorial description of how faculty development

1.6.1 Learning from Experience

most of the published literature in the health professions focuses on formal

1.6.2 Peer Coaching and Mentorship

1.6.3 Workshops and Seminars