Definitions of Faculty Development
The purpose of early faculty development programs or “teacher training” was to prepare faculty to teach, which was their primary responsibility at that time [4]. Since those early programs, faculty development has expanded as the roles and duties of medical education faculty, especially clinicians who are making a career of academic medicine, have stretched beyond teaching to include research and administrative duties.
Faculty development has been described in various ways: as a “continuous training process, whereby the creativity, productivity, and longevity of faculty members [are] improved” [5], as “a planned program designed to prepare institutions and faculty members for their various roles” [6], as any planned activity to improve an individual’s knowledge and skills in areas considered essential to the performance of a faculty member in a department or a residency program (e.g., teaching skills, administrative skills, research skills, clinical skills)” [7], and as programs that provide the intellectual tools and skills to assist faculty members in accomplishing their academic goals [8]. On the basis of these definitions, few formal faculty development programs, such as fellowships and curricula leading to degrees, are limited to the subject of how to teach. Teaching clinicians interested in improving their teaching skills will find that much of their education in teaching will come from their departments and institutions, independent learning using printed and online resources, and presentations at professional meetings.
The term competency is used to describe either what an individual should be able to do to perform the duties of a job or what knowledge, skills, and attitudes will be acquired as a result of training [9]. Both definitions are of value, as the first describes the duties of teaching clinicians and core faculty and the second describes faculty development programs and independent learning. The expectations of clinician–teachers, including faculty members who want to teach only in the clinical setting and those who want to make academics their primary focus, are expanding, so an examination of the skills and duties expected of all clinicians who teach is a valuable endeavor.
Practicing in An Academic Setting
Some academic environments, usually in community hospitals, have two types of faculty members: (i) physicians who want to spend most of their time in clinical practice, do some bedside teaching and supervise physicians in training, and deliver an occasional formal teaching presentation and (ii) those who aspire to become core faculty, with the requirements that they teach, engage in scholarly activity, and provide service to their institution and specialty. Other academic environments, often in university settings, require that all faculty members fulfill the obligations of teaching, scholarly activity (defined by many universities as research), and service. It is critical for young faculty to decide the type of environment they wish to practice, as this decision will drive the type of faculty development they need and the kinds of activities they engage.
Excellence in teaching is not enough for success or promotion in a university setting. Faculty members must demonstrate scholarly activity. Although, on the surface, all universities and medical schools seem similar in their requirements, they vary widely in how they define and value various activities and the amount and types of activities that are acceptable to ensure promotion. The culture of the institution drives these value systems. A faculty member who wants to practice clinical medicine and teach will not do well in an environment and culture that emphasizes and values research and acquisition of grants to support that research. Fortunately, the university culture is slowly changing: the definition of “scholarly activity” is being broadened beyond “discovery of new knowledge” as medical school deans realize that they need clinicians to teach medical students and residents and to provide clinically generated revenues to support the school [10, 11].
Community-based teaching programs put much less emphasis on research and scholarly activity. But even in these community settings, core faculty must engage in scholarly activity to satisfy the program requirements of creating a scholarly learning environment for residents, delivering a well-designed curriculum, and teaching effectively as well as to fulfill the requirements of RRCs for faculty scholarship. For further details, see the ACGME website [3]. For all these reasons, faculty development programs have a diversity of goals and teach many topics in addition to “how to teach.”
Necessary Knowledge and Skills
A survey of junior faculty members in emergency medicine revealed a perceived need for and a deficiency of training in the teaching-related topics listed in Table 23.1 [12].
Table 23.1 Self-perceived faculty development needs for teaching.
| Bedside teaching |
| Lecture development |
| Presentations |
| Medical simulation |
| Evidence-based medicine |
| Use of technology in education |
| Curriculum design and development |
| Evaluation |
Adapted from [12] Farley H, Casaletto J, Ankel F, et al. An assessment of the faculty development needs of junior clinical faculty in emergency medicine. Acad Emerg Med 2008; 15: 664–668 by permission of John Wiley and Sons Ltd.
All faculty practicing in USA in programs accredited by the ACGME need to know the ACGME’s General Competencies in order to teach them and assess residents’ abilities to practice them. The competencies are published at the ACGME website [3] along with information on how to teach and assess them. Faculty members must model these practices and behaviors so that residents can learn the expectations of the specialty of emergency medicine for practicing the core competencies. The Council of Emergency Medicine Residency Directors (CORD) published a series of reports that interpret the competencies for emergency medicine [13–18].
Clinicians as Teachers
The expert clinical teacher needs a deep knowledge of the practice of emergency medicine, the desire to teach, and a willingness to learn how to teach. Personal attributes of teaching clinicians are extremely important and often determine the individual’s success or failure in regard to teaching. Bedside teaching should encourage higher-order thinking in learners to help them develop their skills in analyzing and solving patient problems [19]. Competencies needed for effective clinical teaching are listed in Table 23.2.
Table 23.2 Recommended bedside teaching skills.
| Listening to presentations and making suggestions on patient evaluation and treatment | Encouraging higher-order thinking by encouraging problem solving, critical thinking, self-assessment, and learner recognition of uncertainties and gaps in knowledge |
| Demonstrating history taking and physical examination techniques | Modeling the thinking process by verbalizing reasoning for obtaining specific information |
| Teaching procedures | Modeling actions if needed, allowing early learners to verbally rehearse actions before beginning a procedure, giving assistance if needed, and providing feedback as necessary |
| Providing feedback | Informing learners that they are being given feedback, integrating feedback into the discussion of “how the case went,” allowing learners to discuss what they felt went well and what they would do differently on the next case, and providing your suggestions |
| Providing assistance as needed to all learners regardless of experience | |
| Feedback given to residents and medical students during or after a case is valued by the learners | |
| Assessing and evaluating performance | Observing performance in selected situations will allow more accurate and informed assessments |
| Teach and model the ACGME general competencies | Know, practice, and teach them |
Wilkerson and Irby [20] noted, “whereas it was once assumed that a competent basic or clinical scientist would naturally be an effective teacher, it is now acknowledged that preparation for teaching is essential.” In the past, many teachers limited themselves to either bedside teaching or lecturing. Several articles offer practical suggestions on how exemplary teachers can teach in busy emergency departments [21] and other settings when time is short [22], how to supervise [23], and what emergency medicine learners value in their teachers [24].
Didactic teaching is required of all core faculty members. Lecturing remains a common method of formal didactic teaching. A recent trend emphasizes teaching strategies that foster “active learning.” This approach encourages learners to construct meaning and develop their skills in solving clinical problems. Examples include small-group discussion, case-based teaching and learning, and team-based training [23, 25, 26].
Emergency physicians are branching out into high- and low-fidelity simulation and the use of multimedia. Widespread access to the Internet, improved technology, and lower costs encourage distance instruction, both in real time and asynchronously. Distance instruction is provided through webinars, websites that archive resources, and interactive learning modules for self-instruction. All these types of education allow emergency medicine faculty to find a niche for the development of expertise. The only requirement is to identify what you like to do so that you will devote the time and effort to becoming an expert. Formal courses, focused on teaching, are discussed in detail later.
Process for Faculty Development
In the ideal process for faculty development, the faculty member first finds a mentor (Chapter 4). This person can help the faculty member clarify goals and then perform a needs assessment, identifying gaps in knowledge, skills, and training. At this point, a search for faculty development resources should begin. As each portion of the faculty development plan is completed, the mentor can then assist the faculty member to evaluate the success of the plan. The next step is to reassess changes in goals and plan future activities in professional development.
In reality, the process of faculty development is not usually as carefully planned as these listed steps would suggest. Goals and circumstances can change quickly or need modification. Still, keeping the process in mind can be very helpful, especially at the beginning of an academic career and at transition points. For many new faculty members, the immediate need is to “learn how to teach effectively.” The most important decision is whether a clinician wants to devote his or her main efforts to direct patient care, supervision, and bedside teaching, with occasional delivery of a didactic presentation (teaching clinicians), or whether he or she wants to broaden into a role as core faculty or master teacher.
Most faculty development programs have elements that include teaching, scholarly activity, and professional development because successful academic physicians need all these skills and knowledge. The goal of many university faculty development programs is to educate physicians who intend to specialize in medical education within the medical school setting [27].
Developing a Customized Program
Many medical educators, especially early in their careers, seek to construct a self-study program because they lack the time to engage in a structured program with a set curriculum and attendance requirements. Components of independent study include reading articles on teaching and attending lectures or workshops to gain “tips and pearls” from expert clinicians who teach and from educators who have made a career in academics. Constructing a customized “curriculum” results in a systematic approach to fill gaps in knowledge, gain necessary skills, and avoid redundancy. The course of study does not need to be extremely involved; at the very least, it should include techniques for bedside teaching, presenting lectures, facilitating small-group discussions, organizing procedural workshops, and mentoring. Other skills to be mastered include public speaking, making effective handouts and slides, and searching the literature, not only in the National Library of Medicine but also within the literature on education and psychology (for this, a librarian is an invaluable resource). A curriculum can be designed by reviewing formal faculty development programs and then selecting the areas of knowledge that pertain to bedside and didactic teaching. After compiling the customized curriculum, speak to the mentor for advice.
Two short courses that might appeal to aspiring medical educators are the Advanced Cardiac Life Support (ACLS) Course for Instructors and the Advanced Trauma Life Support (ATLS) Course for Instructors. Both courses are devoted to teaching strategies that are useful in various situations. The American College of Emergency Physicians (ACEP) and the Emergency Medicine Foundation sponsor a teaching fellowship that is longer than the aforementioned courses and requires the completion of a curriculum development project. CORD sponsors “Navigating the Academic Waters,” which includes presentations on bedside and didactic teaching. Brief details of these and some other appropriate courses are presented in Appendix Appendix 23.1.
Appendix 23.1 Selected formal faculty development courses emphasizing teaching methods.
| Name | Sponsoring organization | Contact information |
