Evidencebased education Developing as a health professional educator: pathways and choices Richard Hays School of Medicine, Keele University, UK Conferences may be attended, journals and books can be read When health professionals graduate and start to practise, the last thing on the minds of most is tackling any further academic training outside their own field. Instead, their focus will be on maintaining their competence and currency amid rapidly evolving knowledge and technology-based skills. However, many health professionals are expected to become involved in teaching undergraduate or postgraduate students in their own or a related health profession. If time allows, many will be interested, but they are likely to need some knowledge, skills and practical experience that are not part of mainstream development among health professionals. Increasingly, education providers require their clinical teachers to undertake some form of basic teacher training. Once that has been completed, those with a real interest in teaching and learning will be asking such questions as What else is available? and What will it do for me? Finding answers to these questions is not necessarily easy, as there are many possible pathways to take, depending on what the individual health professional wants to achieve. This paper attempts to guide the choices of those with more academic interests in medical education, and to facilitate their career enhancement and enjoyment. AIMS: WHERE DO I WANT TO GO? This is probably the most important question to answer, as pathways can diverge quite early. If the answer is simply to remain as a predominantly clinical professional with some teaching and assessment roles, these needs are easily met by attending standard teacher training programmes. This is also the most flexible pathway, as programmes can be accessed at a range of institutions, conferences may be attended, journals and books can be read: all of these in any sequence and over any time frame. This is a 46 Ó Blackwell Publishing Ltd 2007. THE CLINICAL TEACHER 2007; 4: 46 50
common starting point for many educators in the health professions. If a more formal role in teaching and learning is being considered, then the pathway will require certificated proof of achievement, ideally an academic qualification, and this may lead to a role such as placement co-ordinator, teaching or assessment coordinator, etc. This pathway is more complex, as there is a wide variety of postgraduate coursework programmes that can fulfil these needs, depending on specific interests and the time available. If an individual wants to be able to answer intriguing questions, contribute to the education evidence base, and take higher leadership roles, then the third pathway involves acquiring research skills training. This is even more complex, as there are many research training routes. Here we can exclude the group of health professionals with early, strong academic interests, as they have probably already completed honours bachelors and even doctorallevel degrees, generally in basic science or clinical research. The discussion in this paper is aimed at those who develop an academic interest that is applied to professional practice (in this case, education practice), perhaps because they have encountered questions in educational practice that do not appear to have satisfactory answers through any of the usual sources. This is a different pathway from that of the early research interest group; it has been described as the ultimate in self-directed learning, but it is not necessarily an easy route to take. The question may be posed: How relevant to medical education is educational research? The answer, as with clinical practice, is that educational practice should be informed by research evidence. Much depends on what one wants to do. If the desire is to focus on developing teaching and assessment skills while remaining predominantly a clinician, then education research training may not be important. However, if there is a desire to contribute to the evidence base, then being able to find answers to interesting questions will require educational research skills. Educational research often requires the use of qualitative methods. Career development can happen by chance, but doing some planning is wise. The next steps to take depend on individual aims, but there is always enough flexibility to alter one s track and head towards a different objective at a later date. OBJECTIVES: WHAT DO I WANT TO LEARN? Once the general career aim has been decided, the next step is to consider specific learning objectives concerning the content and skills to be acquired. Is the focus on core knowledge and skills, more advanced skills, or how to conduct research and add knowledge? Are there specific issues or questions that have arisen from current involvement with students? A typical question might be, Why is it that my approach with learners appears to work well with some, and poorly with others? Does the problem lie with me, the learner, or something else? There is likely to be a course somewhere that will provide a combination of theory, evidence and experience that can guide professional development along the chosen career pathway. Should the pathway involve research training, a decision needs to be made about the depth of research training that will be sought. One useful tool in considering learning objectives is a list of individual entry criteria originating from the Higher Education Academy. 1 These six criteria are summarised in Table 1. They may not appear to map all that well to the hierarchy of health professional teacher training, though there are some easy translations. For example, criteria 1, 2, 3 and 4 are often part of teacher training and more formal coursework programmes, while criteria 5 and 6 are more clearly research-related roles. Those intending to take on more senior education roles need to demonstrate achievement across all six criteria. METHODS: CHOOSING A COURSE Certificate level There are many courses and programmes to choose from at this level, reflecting different aims, different content and different geographical regions. It is wise to read course materials carefully to determine which course is the most appropriate. Most course providers have websites giving Table 1. Criteria for individual entry to the Higher Education Academy 1. Design and planning of learning activities and/or programmes of study 2. Teaching and/or supporting student learning 3. Assessment and giving feedback to learners 4. Developing effective environments, and student support and guidance 5. Integration of scholarship, research and professional activities with teaching and supporting learning 6. Evaluation of practice and continuing professional development There are many research training routes Educational practice should be informed by research evidence Ó Blackwell Publishing Ltd 2007. THE CLINICAL TEACHER 2007; 4: 46 50 47
Career development can happen by chance, but doing some planning is wise level training, the precise content and sequence of topics being determined by the course organiser. This may mean slightly less freedom to choose one s topics for study, but if the aim is to achieve professional recognition for the time and energy invested, it is worthwhile seeking out a postgraduate certificate course that includes the desired topics. Most course providers have websites detailed information. Readers in the UK with education interests should find the booklet Degrees of difference 2 useful a report of an investigation into postgraduate medical education courses available in UK institutions. The key messages from the report are that not all courses are the same; course titles can be misleading; and both cost and quality vary. The most appropriate course to meet individual needs might not necessarily be found at either the nearest or the most prestigious institution, and its price may be a poor guide to either quality or relevance. Geography is less of an issue in this age of fast internet access, but be wary of poorly designed programmes that rely entirely on distance learning (often called flexible delivery). Most people learn through interaction, so courses studied completely alone at a distance can be boring and not very useful. Courses with some group involvement, ideally in regular local or residential block sessions, provide the most interactive group learning environment. Teaching skills development needs practice under supervision, and feedback. In most education programmes, students may learn as much from working together as they do from their lecturers. The wide range of courses available can be grouped into several categories that conform to an academic hierarchy. The first level is that of ad hoc seminars or workshops addressing specific, practical topics of core interest. For clinical teachers, these can include: how to provide feedback to learners; clinical or bedside teaching skills; how to be an Objective Structured Clinical Examination (OSCE) examiner; or how to develop or assess learning portfolios. This is the level of most formal teacher training courses run by universities. In addition, each year there are international medical education conferences, such as the Association for Medical Education in Europe, the Association for the Study of Medical Education s annual science meeting and the Ottawa conference series, which offer a wide range of interesting learning opportunities from beginners through to experts. These are well worth including in study leave plans. Activities at this level generally do not provide formal academic recognition, but allow attendees to put together an individualised programme that can be very satisfying as well as enhancing clinical teaching ability. Postgraduate certificate level This usually involves a more formalised programme of individual modules that may resemble closely (or even reiterate) topics and sessions already covered in first- Postgraduate diploma level A postgraduate diploma is just an expanded version of the postgraduate certificate, as it includes more of the same and retains its focus on practical core knowledge and skills. It is usually delivered in modular form. The status of the award is slightly higher, but study at this level is still not regarded as being particularly academic. It does represent, though, another step forward. The next level: master s degree or research training This level is where some differentiation occurs. One branch of career development is simply to increase the academic status of the practical, topic-based courses discussed above to that of a coursework master s degree. This is considered to be the entry level academic qualification for those seeking a more academic career. Because of this potential, master s degree courses almost always include some modules that explore core topics to a more advanced level, going beyond practical topics to the level of principles and application in other contexts. There will also be some modules that focus on more advanced levels of educational practice, such as curriculum design, writing/scoring assessment items, and evaluation. This level will be helpful to those who want to be programme leaders in curriculum and assessment design and management. The other branch at this level is to begin formal research training by combining master s level 48 Ó Blackwell Publishing Ltd 2007. THE CLINICAL TEACHER 2007; 4: 46 50
version is a doctorate by publication. These doctorates are of variable quality: some institutions will award a publication-based doctorate on the basis of a handful of published papers, while others require a substantial collection of 20 40 published papers, generally with a consideration of their impact. Published-paper doctorates often require no formal research training, and instead reflect a more experiential research development pathway. The semantics and hierarchy of doctoral level degrees is beyond the scope of this paper. Each year there are international medical education conferences PUTTING IT TOGETHER coursework modules with research training and some level of research project. Research training modules are available for quantitative and qualitative research methods, both of which are relevant to educational research. These modules will provide an overview of research methodology, and are useful for exploring research opportunities and testing one s interest in research. The level of required research activity can range from synthesising a literature review to writing a research proposal, through to undertaking a small to medium-sized research project and, where possible, reporting this in an academic manner (as a conference presentation or journal paper). For those with less of an interest in educational research, undertaking a smaller project can still be an interesting and more independent approach to personal and professional development, particularly if it is on a topic for which there is no study module available. The more substantial the research project, the more time is involved and the greater will be the commitment to a more academic endpoint. The doctorate The widely perceived ultimate in academic qualifications is the doctorate. However, again, there is wide variation in the nature, relevance and status of doctoral level qualifications. Doctorates are traditionally about more advanced research training based on a substantial research project, although in reality they indicate achievement at a reasonably advanced level in a narrow range of research methods. Coursework doctorates are increasingly available, offering higher-level versions of coursework master s degrees, but with little or no formal research training. Another Those who elect to follow the path of creating a personallychosen, self-paced and satisfying development pathway that does not confer formal recognition can still become both knowledgeable and skilled; qualifications are not important to everybody. However, should there be any consideration of a later academic career, it is wise to construct the development pathway in a way that achieves both satisfaction and formal credit. The step-wise process of certificate diploma master s level study can allow credits in topics of personal interest to be combined over time, although course rules need to be checked carefully: there may be constraints around subject or module choices, and some credits may expire after a few years. The most flexible route generally involves making a choice from a wide range of self-paced modules that can be tackled in any sequence. Embarking on a research degree is a big step that needs careful consideration. The best research topic is one that comes from an individual s own experience, as this is more likely to produce an outcome relevant to personal educational practice and beyond. This ownership of the topic also provides greater personal investment and commitment Good research takes time Ó Blackwell Publishing Ltd 2007. THE CLINICAL TEACHER 2007; 4: 46 50 49
Writing for publication is initially challenging, but can be rewarding to a time-consuming process. Good research takes time: time to develop ideas into an answerable research project; time to explore the literature and current research; and time to reflect and ensure that the findings are relevant. Time out of professional practice is almost essential for larger projects, so consider carefully the implications for income, and the impact on both professional colleagues and family members. Resources to carry out the project plan are important, as the research may demand materials and input of time from specialist advisers. Seek advice early from potential supervisors, and select the supervisor carefully, as this is a key relationship that may have to survive some disagreements. One advantage of the usually part-time enrolment in research training is that the longer time frame allows for breaks between periods of study, thus enabling a more balanced personal and professional life. Professional development can also be expensive. Some may have access to study leave provision to cover the time commitment, but we live in an increasingly user pays world as far as course fees and project costs are concerned. Tax relief may be available where development is linked more clearly to job requirements, and research supervisors may be able to provide advice on available project grant schemes. One advantage of research activity connected to professional work is that employers may value the result and pay for the project. Finally, remember that research does not end when the report is written. Try to publish results that add something to the knowledge base of the educator community. Submit an abstract to an international medical education conference and aim to write a paper for an academic journal. Writing for publication is initially challenging, but can be rewarding. 3 WHAT NEXT? The endpoint of any professional development programme is really the beginning of the next. Some will return to full-time clinical practice as improved educational practitioners with increased knowledge and skills in student supervision. Others will actively seek combined careers that are based in clinical practice, but also include formal involvement as teachers and assessors for universities or other programme providers. Some, particularly those with master s or doctoral level degrees, may choose more formal academic careers and become professional leaders. The higher the level of training, the wider the choice, leading to increased professional satisfaction and the possibility of role changes. 4 REFERENCES 1. Higher Education Academy. Criteria for individual entry. Available at: http://www.heacademy.ac.uk/documents/cm3mar06irem6_ierpaper.doc (accessed October 2006). 2. Allery A, Brigley S, MacDonald J and Pugsley L. Degrees of difference: an investigation of masters and doctorate programmes in medical education. Edinburgh: ASME, 2005. 3. Baur L, Elliott E, Keena V and Peat J. Scientific writing: easy when you know how. London: BMA Professional Division Publications, 2002. 4. Baron R, McKinlay D, Martin J and Ward B. Master s degree-accredited professional education and development courses for GPs in the North Western Deanery 1997 2002: impact on effectiveness, retention and recruitment to additional roles. Education for Primary Care 2006;17: 147 154. 50 Ó Blackwell Publishing Ltd 2007. THE CLINICAL TEACHER 2007; 4: 46 50