|Year : 2008 | Volume
| Issue : 3 | Page : 175
Online Faculty Development for Medical Educators: Experience of a South Asian Program
Anshu1, P Bansal2, SG Mennin3, WP Burdick4, T Singh5
1 MGIMS, Sevagram, India
2 MUHS, Aundh, Pune, India
3 University of New Mexico School of Medicine, Sao Paulo, Brazil
4 FAIMER, Philadelphia, USA
5 CMCL-FAIMER Regional Institute, Ludhiana, India
|Date of Submission||06-Feb-2008|
|Date of Acceptance||20-Oct-2008|
|Date of Web Publication||30-Nov-2008|
Professor of pathology, MGIMS,Sewagram
Source of Support: None, Conflict of Interest: None
Context: India has the highest number of medical schools in the world. Teacher shortages and inadequate training of existing faculty are a major problem. On-line faculty development and learning is a plausible component of developing medical teachers in the essentials of pedagogy.
Methods: An on-line faculty development learning process utilized by Regional Institute Fellows of the Foundation for Advancement of International Medical Education and Research (FAIMER) is described. This faculty development program begins with a face-to-face meeting followed by an 11-month intersession on-line experience, then another face-to-face meeting and a second 11-month intersession on-line experience. During each on-line session, Fellows participate in discussions on topics which they identify based on their learning needs. The on-line program is highly interactive and Fellows and faculty serve as moderators. Discussions have a conversational tone and a semi-structured format which Fellows develop along with the faculty moderator. The participants share their personal and professional experiences and the moderator 'wraps up' with a summary of the learning posted at the end of the month. Faculty facilitate the discussion, sharing appropriate resources and clarifying issues when necessary.
Conclusions: More than the content exchanged, the interpersonal learning environment facilitated effective learning, and rejuvenated the learning experiences and network established during the face-to-face sessions. In view of its cost-effectiveness and the flexible choices it offers, focused, moderated, interactive on-line faculty development and learning needs to be considered seriously as a medium offering opportunities to medical educators and other professionals.
Keywords: Faculty development, distance learning, on-line discussions
|How to cite this article:|
Anshu, Bansal P, Mennin S G, Burdick W P, Singh T. Online Faculty Development for Medical Educators: Experience of a South Asian Program. Educ Health 2008;21:175
Rapid proliferation of medical schools in India has led to an acute shortage of teaching faculty and has had an impact on the overall teaching quality. At the present time, India has the highest number of medical schools in the world (FAIMER, n.d.) with 271 medical colleges (MCI, n.d.). Presently, very few schools have faculty development programs in place, and faculty development programs in the past have not been adequate, with limited success (Supe & Burdick, 2006).
The recent growth of on-line collaborative learning provides an attractive and feasible option for faculty development in medical education. This article describes the early phase of the implementation of an on-line component of a faculty development program sponsored by FAIMER (Burdick et al., 2006) and implemented as part of the CMCL-FAIMER Regional Institute (CMCL-FRI) at the Christian Medical College, Ludhiana, India.
The FAIMER Fellowship Program
The CMCL-FRI is designed for health professions educators who have the potential to play a key role in improving education at their schools (Burdick et al., 2007). Eligibility for a CMCL-FRI Fellowship is a permanent faculty position in a health sciences school, submission of an education innovation project proposal and expression of institutional support for the project. The projects undertaken by 2007 Fellows are listed in Table 1. The basic structure of the course is similar to the FAIMER Institute in Philadelphia but in an abridged form (Burdick et al., 2006). Applicants must submit a curriculum innovation project to be carried out at the Fellow’s home institution which serves as the focus for Fellows’ learning. The program is uniquely designed to focus on education methods and leadership skills and, at the same time, to develop strong professional bonds with other health professions educators around the world (Burdick et al., 2006). Sixteen Fellowships are offered every year. During 2006, 16 Fellows representing eight medical schools from six states of India were enrolled, while in 2007, 15 Fellows from seven medical schools representing six states of India joined the program.
Table 1: Curriculum innovation projects carried out by 2007 Fellows
The Fellowship is divided into four sessions over a two-year period and includes two on-site residential sessions and two on-line distance-learning sessions. The residential sessions are compulsory for all Fellows. The first residential session, which is of one-week duration and marks the beginning of the course, is foundational and addresses four areas: (a) education; (b) leadership and management; (c) building a community of practice; and (d) refinement of the Fellow’s education curriculum project. The second phase is the on-line session, called the ‘Mentoring and Learning Web’ (ML Web), which begins immediately after the residential session and which lasts 11 months. During this period, the Fellows also carry out the curriculum innovation projects at their home institutions. It is followed by a second residential session, again of one-week duration, and then another on-line session of 11 months. There is a period of overlap in the program during the second residential session for the last year’s Fellows and the first residential session of the current year’s Fellows so that Fellows from the first and second residential sessions can interact and join in collaborative learning. First-year Fellows are assisted in completing their curriculum innovation projects through a co-mentoring relationship with a second-year Fellow. In addition, Fellows from both classes participate actively in deepening their understanding and practice in health professions education and scholarship through the ML Web discussions and preparation of an oral/poster presentation related to their innovation project (see Figure 1).
Figure 1: Structure of the Fellowship program
The CMCL-FRI was established in 2006 and is, at the present time, running in its third year. One group has successfully completed the Fellowship program, while another is midway through it. Thirteen topics have been discussed as part of the ML Web component of the program (see Table 2). The present communication describes the process of ML Web on-line learning as a means for continued faculty development. The process is illustrated for the 2007 group of Fellows using an example of the discussion from one particular month.
Fellows are briefed about the ML Web process and learn how to interact in and operate a listserv (an electronic mailing list which enables Fellows to communicate with the entire group). Listserv communication etiquette is emphasized and Fellows are encouraged to share resources and seek help on the ML Web.
Fellows then work collaboratively and brainstorm to define a range of topics which they think are important for on-line discussion during the next 11 months. A list of topics is made and each Fellow votes for three that they perceive to be the most important. This process of multi-voting is repeated more than once, if required. The most popular topics are selected for discussion and a schedule of one topic per month is made for the year. Fellows volunteer to moderate specific sessions, depending upon their interests, and FAIMER faculty members (list appended at the end) volunteer to participate in the discussions every month. Curriculum innovation projects are also reviewed during two of the on-line discussion months, with emphasis on what is working, what is not working and what help is required. The list of seven topics generated by the 2007 group is shown in Table 2.
Table 2: Topics discussed on-line by the Fellows of 2007 and 2006 classes
Prior to the scheduled monthly activity, the moderators and faculty confer on-line to plan how the topic session will be introduced, conducted and brought to closure. Topics are usually subdivided and gradually introduced to the on-line group. On the first of each month, the moderators provide a short introduction of the topic together with a list of key articles and web links as initial reading material.
Example of an on-line discussion: ‘Reliability and Validity of Assessment Tools’
The on-line discussion on reliability and validity of assessment tools can illustrate the above process. Twelve Fellows of the 2007 group from the CMCL-FRI participated in this on-line discussion. One of the authors (A) was the moderator, while two others (PB and TS) were the faculty coordinators. Other authors (WB, SM) contributed as needed.
The topic was discussed over four weeks and was introduced to learners by the moderators with a short on-line ‘handout’ followed by suggested reading material sent as e-mail attachments. Next, a series of open-ended questions were posed which dealt with Fellows’ ability to identify reliable and valid assessment tools. ML Web participants were expected to respond to the questions within one week of questions being posted on the listserv.
In the first week, learners built up their concepts of reliability and validity, types of reliability and validity and debated on their importance in assessment. Members shared resources on the topic and clarified definitions of terms such as construct validity. The second week saw learners discussing factors which affect reliability and validity. Practical examples from day-to-day problems in assessment were shared and learners argued about the need to balance reliability and validity. The validity of assessment tools used in various examinations in India in different situations was debated. The third and fourth weeks were reserved for discussion about the strengths and weaknesses of different assessment tools. Fellows dwelt in detail on the deficiencies of the evaluation systems at their schools and how each assessment tool could be strengthened with modifications. Sharing personal experiences with assessment (for example, how they introduced Objective Structured Clinical Examination, OSCE, in their departments, how they tried to make oral examinations more objective or what problems they faced in assessing students and how they dealt with them) formed a large part of the learning process.
Since three of the authors (SM, WB, TS) are also members of the FAIMER Institute listserv in Philadelphia, comments, observations and resources from the regional listserv were frequently shared with Fellows worldwide through a common listserv in Philadelphia, and vice versa. After responses from Fellows began to arrive on-line, the moderators and faculty added their comments and helped to steer the group discussion.
Twelve out of 15 Fellows participated in the on-line discussions during the month. Seven Fellows posted more than 10 e-mails each on the topic. Eight faculty members and four Fellows from the previous year’s class participated in the on-line discussions. A total of 293 e-mails on the topic were exchanged during the month (see Table 3). The ratio of fellows to faculty mails was 6.27:1.
Table 3: Participation, email exchanges and resources shared in 2007 on the listserv
Issues discussed and debated in the on-line discussion included among others: Does oral examination still have a place in examinations for medical undergraduates? How valid is valid enough? Which evidence of validity is more important? Can you compare the concept of reliability/validity with sensitivity/specificity (see Table 4)?
Table 4: Examples of issues discussed and debated in the on-line discussion on Reliability and Validity
Both faculty and Fellows used the on-line forum to share resource material with other learners. For example, during this discussion six Fellows and five faculty members posted a total of 38 different documents related to reliability and validity of different assessment tools. Some of these can be viewed at http://reliability.validity.googlepages.com/compiledresources and http://reliability.validity.googlepages.com/suggestedreading. The entire learning process of the above-mentioned discussion can be viewed in detail at http://reliability.validity.googlepages.com/home.
The tone of the ML Web learning was conversational, rather than ‘bookish’. To ensure that the endeavor was not reduced to an exercise in literature searching, personal input was sought and group members were urged to share their experiences. Interactivity ebbed and flowed due to other commitments of learners and, at times, it was necessary to interject a dramatic question or anecdote to revive lagging interest.
The web learning process provides opportunities for reflective thinking and engagement in meaningful dialogue with peers and experts in a virtual classroom environment. This process allows learners to proceed at their own pace within the monthly discussion period. Since the process is learner-centered and topics are relevant to the learners’ interests, it is not too difficult to attract and hold their attention. Effort is made to ensure participation from all Fellows and in the event a particular Fellow is being ‘silent’ on the listserv, one of the authors (TS) is responsible for initiating contact with that Fellow through personal e-mail, phone call or sms (short messaging service).
On-line learning and discussions are not commonly used in India despite a high penetration of telecom and the Internet. There may be a number of reasons for this, some of which include cultural bias, a general lack of credibility for distance education and lack of support from concerned regulatory bodies for such initiatives. However, our experience suggests that it is possible and pedagogically useful to use the on-line learning mode for faculty development, especially when the group is motivated. Berge (2000) has cited the advantages of asynchronous communication: it is flexible; allows students time to reflect; lends itself to a situated learning approach whereby students can relate to ideas being discussed in their own working environment; and it is cost-effective.
The initial residential session allows Fellows to interact in person before they plunge into the ML Web learning process. Cooperative learning promotes positive interdependence, face-to-face interaction, personal responsibility and collaborative skills (Chickering & Gamson, 1991). The highly interactive and residential nature of the contact session creates a bonding based on common professional interests, as well as personal interaction, which sets the pace for effective and meaningful learning for both Fellows and faculty.
There has to be a focus on interactivity, otherwise communication becomes limited and may be merely one-way (Keegan et al., 2005). Peer pressure stimulates most participants to reflect and add to the discussion. Positive signs of encouragement from the faculty and participants also play a role in engaging low-profile learners who may be lurking in ‘cyber hibernation’. Active learning may not occur in an on-line environment unless the interaction is deliberately planned and encouraged by the instructor (Moore & Kearsley, 1996). Even participants who are not ‘vocal’ and are following the discussion can enhance their knowledge from ‘listening’ to ongoing discussions. These participants, often nicknamed ‘lurkers’ (Freeman & Anderson, 2007), are also thought to be learning from the ongoing discussions. The addition of reference and resource documents stimulates further interest and helps to meet specific needs for information.
The faculty play a facilitating role and assist in clarifying confounding issues, emphasizing important points and referring Fellows to key references. They interrupt and bring the discussion back on track when it begins to go astray. They draw attention to differing perspectives and conflicting opinions, elicit debates and share their experiences.
The listserv provides learners a chance to constantly monitor their learning in order to make meaningful progress. Participants give prompt feedback of whether they have understood concepts or agree with them. As in a traditional classroom, feedback benefits the learners most when it provides them an opportunity to identify misconcepts and revise their thinking (Bransford et al., 1999).
The ML Web is a platform to share resources, both in terms of academic material and professional and personal experiences. Learners have the choice of deciding what they want to learn. While ‘netiquette’ demands that the group does not engage in inconsequential gossip, an undertone of humor and a conversational approach encourages keener participation. The informality of the approach contributes to making learning fun. Our experience has shown that while elaborate literature searches can yield silence from learners, open-ended questions and personal experiences grounded in scholarship elicit immediate voluminous responses. Most hesitant learners find interactions on the listserv addictive after an initial warming-up phase.
The moderators should be willing to allow sufficient freedom to the learners to participate at their own pace and convenience. Since most of these learners have to share other professional responsibilities as well, it is natural for participation to be low at certain times. It was typically exemplified during the month professionalism was being discussed. During the same month, a national conference on medical education was organized in India. Since most of the faculty attended the conference, the participation on the listserv was low.
The program has been running in its third year now and the initial response has been very encouraging. We are in the process of evaluating the effectiveness of the intervention in terms of learning outcomes and will need some more experience to demonstrate the outcomes of this approach to faculty development.
Since on-line learning is a relatively new technique, best practices are still developing and have not yet been widely shared. Therefore, a promising tool has remained relatively underutilized despite its bright prospects (Hoffman, 2005). It becomes important to share these early experiences and reflections from our on-going ML Web experience. The on-line process helped to rejuvenate interest in faculty development using self-selected topics and facilitated interactivity. In addition to the content exchanged, the interpersonal touch facilitated enthusiastic learning.
Fellows have explored many innovative ideas while moderating discussions, including distributing compiled summaries, verbatim discussions and resources in the form of pdf files with linked resources and preparing websites to document the entire learning process. This process of making a comprehensive summary of the entire discussion at the end of the month is now standard practice, as is preparation of a website. This information is shared with the entire group and with members of other FAIMER Institute listservs.
Focused, moderated, interactive on-line faculty development and learning must be considered seriously as a medium offering opportunities to busy medical educators and other professionals. The ML Web approach used by the FAIMER Institute Fellows offers great promise to help meet the needs for faculty development in India and elsewhere.
The following faculty members participated in the discussions during 2006 and 2007:
International: William Burdick, Page Morahan, Debby Diserens (all from FAIMER, USA), Stewart Mennin (Brazil), Janet Grant (UK Open University)
Indian (FAIMER Fellows): Tejinder Singh, Daljit Singh (both from Ludhiana), Avinash Supe (Mumbai), Vivek Saoji, Arun Jamkar (both from Pune), Rita Sood (Delhi), Rashmi Vyas (Vellore)
Indian (Others): BV Adkoli (Delhi), Nirmala Rege, Chandrakant Patankar (both from Mumbai), Payal Bansal (Pune), Jugesh Chhatwal (Ludhiana)
Moderators for the session on Validity and Reliability: Anshu and Chetna Desai (both are 2007 Fellows from the West part of India)
All the Indian Faculty have been involved in faculty development programs at the National level.
Berge, Z. L. (2000). Components of on-line classroom. In R. E. Weiss, D. S. Knowlton & B. W. Speck (Eds.), New Directions for Teaching and Learning: Principles of Effective Teaching in the On-line Classroom (pp. 23-28). San Fransisco: Jossey Bass.
Bransford, J. D., Brown, A. L., & Cocking, R. R. (1999). How people learn: Brain mind experience and school. Washington DC: National Academy Press.
Burdick, W. P., Morahan, P., & Norcini, J. J. (2006). Slowing the brain drain: FAIMER education programs. Medical Teacher, 28, 631-634.
Burdick W. P., Morahan P. S., & Norcini J. J. (2007). Capacity building in medical education and health outcomes in developing countries: the missing link. Education for Health, 20(3), Article 65. Retrieved 2 June 2008 from: http://www.educationforhealth.net/articles/subviewnew.asp?ArticleID=65
Chickering, A. W., & Gamson, Z. F. (1991). New Directions for teaching and learning: Applying the seven principles for good practice in undergraduate education. San Francisco: Jossey Bass.
FAIMER (n.d.). International medical education directory. Retrieved 30 January 2008, from http://imed.ecfmg.org/
Freeman, J. M., & Anderson, M. (2007). Is 'lurking' a valid learning style? [Electronic Version]. On-line Classroom. Retrieved 15 March 2008 from http://www.vcu.edu/cte/resources/newsletters_archive/OC0707.pdf
Hoffman, J. (2005). How to design for the live on-line classroom: Creating great interactive and collaborative training using Web conferencing [Electronic Version]. Retrieved 15 January 2008 from http://www.brandon-hall.com/publications/lol/lol.shtml
Keegan, D., Schwenke, E., Fritsch, H., Kenny, G., Kismihók, G., Bíró, M., et al. (2005). Virtual classrooms in educational provision: Synchronous elearning systems for European institutions. Hagen: FernUniversitaet (ZIFF). Retrieved 15 January 2008, from http://www.fernuni-hagen.de/ZIFF/synchronous.pdf
MCI (n.d.). Home Page of Medical Council of India. Retrieved 6 January 2008, from http://www.mciindia.org
Moore, M. G., & Kearsley, G. (1996). Distance education - A systems review. CA: Wadsworth Publishing Company.
Supe, A. N., & Burdick, W. P. (2006). Challenges and issues of medical education in India. Academic Medicine, 81, 1076-1080.