Abstract
The effectiveness of faculty development (FD) activities for educators in UK medical schools remains underexplored. This study used a realist approach to evaluate FD and to test the hypothesis that motivation, engagement and perception are key mechanisms of effective FD activities. The authors observed and interviewed 33 course participants at one UK medical school in 2012. An observed engagement scale scored participants’ engagement while interviews explored motivation for attendance, engagement during the course and perception of relevance/usefulness. Six months later, using the realist framework, 12 interviews explored impact on learning outcomes/behavioural changes, the mechanisms that led to the changes and the context that facilitated those mechanisms. The authors derived bi-axial constructs for motivation, engagement and perception from two data-sources. The predominant motivation was individualistic rather than altruistic with no difference between external and internal motives. Realist evaluation showed engagement to be the key mechanism influencing learning; the contextual factor was participatory learning during the course. Six months later, engagement remained the key mechanism influencing learning/behavioural changes; the context was reflective practice. The main outcome reported was increased confidence in teaching and empowerment to utilise previously unrecognised teaching opportunities. Individual motivation drives FD participation; however engagement is the key causal mechanism underpinning learning as it induces deeper learning with different facilitating contexts at various time points. The metrics of motivation, engagement and perception, combined with the realist framework offers FD developers the potential to understand ‘what works for whom, in what context and why’.
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Acknowledgments
The authors wish to thank to all the participants at the essentials of clinical education course who took part in this study.
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Ethical standard
The study was approved by the University of Warwick, UK, research ethics committee.
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Appendix: realist evaluation interview data
Appendix: realist evaluation interview data
Contexts
Examples of positive experiences of FD
Yeah I really enjoyed it a lot more than I expected I would. I was interested in the education side of things but really got an awful lot more out of it. I didn’t think… Well I thought I’d enjoy it but I really, really enjoyed it, and I think it started me thinking about it as a career (16A).
I thought the course was very useful because it was very practical and I could see that I have been able to implement a lot of the ideas. I can see that it has influenced my teaching positively so I have a positive attitude towards the course and I’m glad I went on it (6J).
It’s been absolutely valuable for the work that I do as an educator in the Trust. The insight that I now have in terms of education has been really, really enlightening experience to have actually done the module. All in all it’s been really useful, really invaluable experience (14J).
Examples of lack of pedagogical knowledge
Prior to the course, I think one of the bigger gaps was the educational theory because I hadn’t had the time, opportunity or direction to look into it and I wasn’t aware of some of the literature that was out there and a lot of the broad principles. Now I am better grounded in the theoretical side of medical education and now I feel I can ground my teaching… it gave me a framework for my teaching. It has given me the underlying principles and theory where there was a big gap before (6J).
I didn’t realise there was so much theory behind education and educational practice. I really didn’t realise there was this much theory behind the way students are taught at the medical school and the reason we do bedside teaching… I just thought it just kind of evolved, but there actually is some basis behind the method (16A).
So teaching in the university we don’t have any pedagogical knowledge or theory. I teach medical students in the first term of the first year. Personally, I am relieved to have some formal training in education; to learn these theories and different styles because I’ve never had any training before (18J).
Examples of reflective practice
But I guess the personal reflection comes in afterwards with the learning portfolio and that’s where the individual development and direction can take place (4A).
I’m in a fortunate position where I do quite a lot of teaching and so I constantly reflect on what I’m doing (10J).
In terms of knowledge through the course itself but even more so through the write up and the directed reading and the exercises we do as part of the learning portfolio (11J).
I think without that write up at the end, the application of your knowledge would not be as thorough (22A).
Also I found at some points learning very challenging. You sort of reflect on your own, on how you learn in your own way and so, it was to identify, in many ways it was a self-analysis. It was identifying how I learnt, why I learnt like that, then oh goodness me there’s other ways of learning that other learners might use! And that sort of makes sense, you know (14J).
Example of feedback
Yes, certainly there were gaps in my knowledge and practice and one thing clear to me is certainly this issue of giving feedback which I, I have worked on. I’ve come to appreciate how important it is and in a sense I know, I now know how to provide it. So it is also much easier for me to do and of course knowing that it is important (9J).
Mechanisms
Examples of perception (usefulness and relevance)
Personally I’ve always found staff development to be great fun and really worthwhile (1A).
Fantastic, FD is very important. It keeps me up to date, it makes me a better teacher doesn’t it, the more you do the better you get at it ‘in theory’. I think that’s it, I think in many ways, it just makes you a better all-rounder doesn’t it? (2A).
I would say it’s very important because, it’s really helped me to develop as a practitioner you know to do the things that I’m teaching the students to do, doing them myself. I find having the students around is generally invigorating. They question what you’re doing and they make you think ‘why am I doing what I’m doing?’ so they improve your quality. It just gives you something different to focus on. Actually teaching it’s a very different thing from clinical practice (5J).
I think they’ve been very effective for me and I think that they are particularly effective if as I say they are linked with the problems that you are dealing with at the time and thing things you’re trying to sort out (18A).
Outcomes
I really learnt a lot about education theory. I learned a lot about, you know, how to teach a student through the different modalities that are there. You know, it gave me experience about how to teach them and how to give a lecture, how to write lectures, how to set out an exam, how to organise a module of a course even (11A).
I mean the faculty development just allowed me to… has allowed me to know what to do. I knew things needed to change but it’s sort of helped me made the changes (15J).
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Sorinola, O.O., Thistlethwaite, J., Davies, D. et al. Faculty development for educators: a realist evaluation. Adv in Health Sci Educ 20, 385–401 (2015). https://doi.org/10.1007/s10459-014-9534-4
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DOI: https://doi.org/10.1007/s10459-014-9534-4