| Abstract|| |
This report describes and explores the impact of a series of faculty-led faculty development programs underpinned by principles of distributed educational leadership. We aimed to prepare faculty for their roles as facilitators and assessors in a newly implemented problem-based (PBL) graduate entry medical program. We asked participants attending a series of faculty development programs to evaluate workshops attended using an in-house designed survey. Overall descriptive statistics for all workshops and qualitative feedback for PBL workshops alone were examined. It was concluded that clinical faculty who are not specialized in medical education can offer high-quality, well-accepted training for their peers. Faculty development, underpinned by a distributed leadership approach which supports learning organization tenets, imaginative, flexible and democratic approaches to developing and nurturing expertise at all levels of the organization, is likely to lead to improvements in medical education. Despite the limitations of the survey approach to evaluation of faculty development programs, the information provided is useful both as a basis for decision making and program improvement.
|How to cite this article:|
Elzubeir M. Faculty-led faculty development: Evaluation and reflections on a distributed educational leadership model. Saudi J Kidney Dis Transpl 2011;22:90-6
|How to cite this URL:|
Elzubeir M. Faculty-led faculty development: Evaluation and reflections on a distributed educational leadership model. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Oct 14];22:90-6. Available from: http://www.sjkdt.org/text.asp?2011/22/1/90/74364
| Introduction|| |
Faculty development has assumed heightened importance in recent years and for various reasons associated with change in medical education will continue to do so for the foreseeable future.  It is now generally accepted that educational training as an educator and preparing to teach in the health professions requires the acquisition of knowledge and skills that go beyond disciplinary expertise. , Hence, faculty development initiatives designed to address acquisition of knowledge and skills are now offered in many healthcare professions.
It is evident from the international literature that there are often overlapping descriptions of faculty development. Steinert and Mann  describe faculty development as, "A planned program or set of programs, designed to prepare institutions and faculty members for their various roles, with the goal of improving instructors' knowledge and skills in the areas of teaching, research and administration". Whitcomb  describes the goal of faculty development as to sustain the vitality of faculty members, both now and in the future. Furthermore, according to Swanwick,  faculty development should go beyond teaching teachers how to teach to include efforts to enhance educational infrastructures and build educational capacity for the future.
The associated challenges appear to require not only different ways of thinking about faculty development but also educational leadership.  The concept of distributed leadership is one such activity which is receiving increasing attention in the education improvement literature.  Leadership becomes a process in which leaders are not seen as individuals in charge of followers, but as members of a community of practice.  Therefore, distributed leadership calls for all members of the organization to be active and accountable and involves shared governance and a more participatory process. , Furthermore, as schools engage in complex collaborative arrangements, distributed forms of leadership will be required to cross multiple types of boundaries and to share ideas and insights.  It has, however, been contended that distributed leadership is merely a theoretical tool for abstract analysis of leadership practice; , but in terms of its practical application, there is little known about how it occurs and to what end.
The present paper describes and examines outcomes of a postgraduate medical education faculty development initiative that contributes to our understanding of how a distributed leadership model is applicable to faculty development in postgraduate medical education.
| Methods and Materials|| |
The College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, adopted a four year problem-based learning (PBL) web-based graduate-entry medical program in 2004. The college is affiliated with a large reputable 900-bed tertiary care teaching hospital and utilizes over 200 consultants from the hospital for teaching and assessing clinical competence. They have made educational leadership a significant part of our improvement plans and as a means of achieving our goals.
All faculty members engaged in the education and assessment of students were invited to attend workshops from 2004 to 2007. PBL and assessment were focused on throughout the four year implementation of this program.
Design of the PBL workshops was based on the underlying belief that workshop participants should understand the process of learning being utilized by students, the typical roles and behaviors in the process, and the role and responsibilities of facilitators in guiding this process, in order to be effective educators. It was also anticipated that workshop participants would acquire a better understanding of differences between traditional large-group teaching and small-group facilitating. With these aims in mind, annual PBL workshop content included:
- Rationale of PBL
- Process of PBL
- Who is who in the tutorial group?
- Group dynamics
- Assessment in PBL
- Lectures in PBL
Six assessment workshops were conducted from 2004 to 2007. The aim of these workshops was to provide faculty with an understanding of the principles of assessment and procedures involved in developing quality assessment items. Workshop content included:
The planners of both workshops were committed to employ instructional methods modeled on the kind of active learning consistent with concepts of adult learning theory , integral to our new curriculum. Furthermore, planners were committed to providing opportunities for participants to discuss concerns amongst peers in an emotionally safe, nonthreatening environment. Program evaluation was considered important to determine the impact on faculty perceptions, as well as to assess the need for modifications to the program based on their input.
- Principles of assessment
- Writing high-quality MCQs A and R types
- Modified Essay Questions (MEQs)
- Objective Structured Clinical Examination (OSCE)
- Item analysis
A rapid feedback form designed in-house was distributed to all participants immediately following completion of each workshop session to rate the quality of presentation, relevance, clarity of content and the expertise of the presenter for purposes of enhancing future programs. In addition, a comprehensive questionnaire was filled by participants to evaluate each workshop in relation to clarity of objectives, relevance, implementation, duration, quality of reading materials and overall satisfaction with the course. Respondents were asked to rate each statement on a Likert-type five-point scale (1 = Poor, 5 = Excellent).
Participants were also asked about the aspects they liked the most about the workshops, the general concerns they had about the topics, what take-home points they gained from workshops, and areas they felt were missing or would like to see receive more coverage. Similar responses were grouped to identify recurring themes. In the interests of brevity, only comments relating to PBL are reported in this paper.
| Results|| |
Over the past four years there were a total of 150 participants attending both PBL and assessment workshops, approximately 38 male and female participants per year. All participants completed questionnaires, immediately following workshops (100% response). Means and standard deviations for responses on session evaluation questionnaire items, 2004-2007 were generated using SPSS Version 12.
[Table 1] shows that participants were highly satisfied with the formal sessions provided in PBL and assessment workshops, and they perceived that their trainers were highly effective. Contents were clear and well organized; expertise of presenters was perceived very good as was the overall satisfaction with the value of the presentations to their learning.
[Table 2] shows that respondents were also highly satisfied with the overall organization of these workshops, quality of materials used to enhance learning as well as the facilities and general set-up of the workshops. A positive change in attitudes to the subject matter was perceived by most respondents and there was a perceived increase in knowledge. Almost all indicated that they would recommend the workshop to others.
|Table 2: Means and standard deviations for responses on questionnaire items, 2004– 2007, regarding|
overall evaluation of PBL and assessment workshops.
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Responses to open-ended questions regarding PBL workshops only are reported in [Table 3], [Table 4], [Table 5], [Table 6] and [Table 7]. Aspects participants liked best about PBL [Table 3] included the student-centered, small group, and active learning nature of the process. The fact that a clinical problem/case was the trigger for learning and that the process provided opportunities for integration of the biomedical and clinical sciences. Provision of challenge and stimulation in an interactive learning environment were also the aspects that the participants liked about PBL. Concerns about PBL [Table 4], however, included readiness of our students for this way of learning, re-conceptualization of the role of the teacher and the need for good facilitator preparation, development and quality assurance. Main take-home points gained by participants [Table 5] included the benefits of PBL, new educational concepts, methods and roles being applied by the College of Medicine and their relevance to clinical education. Areas which the participants wished to receive more coverage [Table 6] included assessment of PBL, planning and implementation including preparation of facilitators, teaching materials and how to improve group discussions and communication skills of students. Reasons for recommending the PBL workshop to others [Table 7] included raising awareness about PBL, the fact that the workshop was very practical, provided previously missing information and guidance for trainers about facilitation of PBL and their other educational roles and responsibilities.
|Table 6: Areas that the participants felt were missed/would like to see receive more coverage.|
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|Table 7: Why would/wouldn't participants recommend this workshop to others?|
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| Discussion|| |
The primary purpose of the study was to assess the effectiveness of the faculty-led faculty development initiative, a model of instructional development support that was underpinned by this distributed leadership approach. Hence, our faculty were not appointed to a position of educational leadership; they grew into it, and therefore, in this sense, educational leadership was located not in the individuals per se but in a community of practice. Gronn  describes this form of leadership as "an emergent property of a group or network of individuals in which group members pool their expertise".  In this way, our clinical teacher leaders helped other teachers to embrace goals, to understand the changes that are needed to strengthen teaching and learning and to work toward improvement. 
A distributed leadership model is likely to contribute to an internal capacity for development and medical education improvement. There is growing evidence pointing toward the importance of capacity building as a means of sustaining educational improvement. ,, Others have also drawn attention to the influence of context, internal and external culture on the extent to which distributed leadership can be achieved. ,
While distributed leadership lacks a widely accepted definition and the evidence base is still relatively new, 6, 18, 22, 23 a clear message emerging from the literature is that it provides a useful descriptive and analytical tool for thinking about educational development and leadership.
Our survey revealed valuable insights regarding the quality and effectiveness of our workshops. Attendance was high and participants rated the expertise of colleague presenters favorably. The literature indicates that factors contributing to participation in faculty development activities include on-site expertise, supervisor attitude and institutional culture.  In addition, recommendation of the workshop to others achieved the highest rating among participants.
Another outcome of this study was a perceived positive change in attitudes to the subject matter. This is an important outcome which has also been reported in other studies.  Through a process of acquiring new knowledge, participants were given opportunities to examine/re-examine core instructional beliefs, assumptions and values. In this regard, it appears that trained faculty working with peers provided a good opportunity for perspective transformation, critical reflection, and questioning. , Contributors to the social constructivist, PBL and transformative learning literature ,, stress that learning is most effective if it is embedded in social experience and situated in authentic problem-solving contexts requiring cognitive demands relevant for coping with real-life situations.
Kegan  argues that a transformation can occur when a person undergoes a process of questioning personal assumptions, regardless of the outcomes in terms of changes in practice. However, medical education evaluation studies are often criticized for not demonstrating impact.  In this regard, I suggest that changes in teaching behaviors and assessment practices should be the subject of a future study in our context. Furthermore, an examination of the factors within participants' clinical contexts, that may affect their ability to act on their new knowledge and skills, will give further insights into the barriers associated with practice change. It is nevertheless encouraging to note that meaningful improvement in instructional skills can be maintained among clinical instructors after even a brief workshop. 
Quantitative and qualitative evaluation outcomes support the conclusion that clinical faculty who are not specialized in medical education can offer high-quality, well-accepted training for their colleagues and the faculty development initiatives contribute to organizational development by helping to enhance professional academic skills of clinicians who in turn have played a significant role in developing similar skills in their peers.
A great deal more is nevertheless needed if both local and international faculty development is to be successful. Participant suggestions that will contribute to our future program enhancement efforts include expressed desires for ongoing follow-up training and support for new facilitators, assessment of PBL, and improvement of students' communication skills. Future challenges may also be to ensure that faculty development is always a priority and that the potential released in innovations of this kind is utilized and channeled into wider forms of professional development.
Finally, it is necessary to acknowledge the limitations of this study. First, I have only documented and reflected upon our institutions' practices that have contributed to and maintained a distributed leadership model of faculty development. Without further research, the description presented here provides only indications of its occurrence in our context. Second, due to the relatively small numbers of participants, the survey findings may not be generalizable to a wider population.
| Acknowledgment|| |
My thanks to Prof. Mohi Magzoub, Chairman, Department of Medical Education, King Saud Bin Abdul Aziz University for Health Sciences, College of Medicine, who provided access to the evaluation data and conceived the idea of writing up the outcomes.
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Department of Medical Education, College of Medicine, King Saud bin Abdul Aziz University for Health Sciences, Riyadh
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]