Introduction

This is the era of rapid globalisation linked with knowledge revolution, economic and triple bottom line accountability coupled with relentlessly exciting advances in groundbreaking medical breakthrough discoveries. The quality and character of the medical students and more importantly, the desired learning outcomes of medical schools and the types of medical school graduates (i.e. future medical doctors) are under scrutiny. And this is rightfully so.

Didactical teaching and rote-learning of yore are inadequate to prepare medical students for the patients’ needs and expectations today. The rate of electronic as well as biomedical technological advances make the acquisition, management and critique of information increasingly pivotal. Yet this dynamic state must be comfortably juxtaposed with a core pool of ‘fixed’ and familiar knowledge. So how is the medical faculty going to rise to these new needs? Are these needs more or less uniformly recognised? Are the conviction and consensus critical within the medical fraternity strong enough to overcome the administrative and financial scepticism: ‘If it ain’t broken, don’t fix it’?

Challenges and Issues

In considering the evidence for the efficacy of faculty development in medical teaching, one ought to bear in mind that the heterogeneity of faculty development programmes poses a challenge to their evaluation. These programmes can be a one-time (few hours’) course, several days of conference, several months or even one- to two-year fellowships.

Another challenge to evaluating the literature on faculty development in medical teaching is the heterogeneous models of teaching and learning. As Wilkerson and Irby (1998) pointed out, behavioural theory was the dominant model of teaching and learning in the 1970s. Learning was perceived as a change in behaviour from drill, practice and feedback. Hence, faculty development focused on teaching behaviours then. The 1980s saw a move towards the cognitive theory in which learning was viewed as an active construction of meaning. Faculty development then focused on engaging learners and understanding learning styles. The primary focus and desired outcome then were attitudes to teaching questionnaires. Come 1990, the model slanted towards the social learning theory in which learning was viewed as socialisation into a new knowledge community. The focus was on a role model and on outcomes like peer reviews, reflective statements and teaching portfolios.

However, these categorisations are artificial. In reality, the practice is fluid and medical teaching encompasses some of each domain—behaviours, attitudes and knowledge of learning styles, role modelling and reflection. Therefore a positive or negative result based on the outcomes of one model may not necessarily apply to the outcomes of other models.

Another issue is that of selection bias. For most of these faculty development programmes, the participants were motivated faculty who voluntarily sought to develop their teaching skills. Whether these motivated individuals would have improved their teaching without the development programmes is yet unknown.

Importance and Significance of Faculty Development

There is emerging evidence that better teaching results in more learning. Faculty development may also have other less defined benefits—it sends the message clearly to both faculty and learners, the value placed on teaching by funding it. In addition, the experience and encounters of a teacher which can inspire students and colleagues cannot be completely captured in measurable outcomes. All these contribute towards building and nurturing a community of learners through an integrated multidisciplinary approach so pivotal in ensuring holistic medical care for patients.

The best teachers change not only the factual base of students but also the perceptual filter through which they view and process knowledge by teaching self-renewal and rekindling intellectual passion. All clinicians etch the images of clinical teachers who have left an enduring legacy in their hearts and minds. Since medical teaching is characterised by such a close mentorship-apprenticeship kind of relationship, how can we not invest in leaving an enduring legacy?

The other significant trend is that of having to keep up with the changing demands and evolving needs of patient and medical care. These shifts are brought about in part by globalisation, more knowledgeable patients and revised healthcare funding with pressures exerted by an aging population that is further exacerbated by a shrinking birth rate.

The rate of biomedical advances and the cracking of the human genotype provide a huge potential for genetic engineering. This, coupled with the increasing sophistication in stem cell research and application, not only offers exciting potential for medical therapy, but also opens a Pandora’s box of ethical issues. It is therefore imperative that the medical school produces students who are not just scientifically and clinically competent but also rooted in sound human, medical and research ethics. The desired learning outcome must take into consideration the capabilities of being flexible, nimble, collaborative and introspective. The active and reflective learner is part of the desired outcome.

Life, death and dignity are increasingly urgent issues that need to be grappled with as medical practitioners face the world’s aging population. A good teacher must be able to demonstrate and show the ropes of decision making processes or at least stimulate the search for the various aspects to be considered.

Conclusion

An increased recognition of the value of faculty development means more resources and attention will be dedicated towards the development of medical faculty’s teaching skills. This is most appropriate because the pervading long-held belief towards medical education seems to be ‘if it ain’t broken, don’t fix it’. It is time to challenge the philosophical intent and relevance of the belief in light of the challenges and issues facing the medical profession.

Reference

Wilkerson, L. & Irby, D.M. (1998). ‘Strategies for Improving Teaching Practices: a Comprehensive Approach to Faculty Development’. Academic Medicine. Vol. 73, No. 4, pp. 387–396.