Faculty development in family medicine education: what is needed?

Faculty development in family medicine education: what is needed?

Brian Johnson¹, William Edward Cayley^2,&, Bich-May Nguyen³, Paul Larson⁴, Maria del C Colon-Gonzalez⁵, Christine Gibson⁶, Ann Evensen⁷

 

¹Contra Costa Family Medicine Residency, University of California-San Francisco Northern California Faculty Development Fellowship, USA, ²Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, USA, ³Department of Family and Community Medicine, Baylor College of Medicine, USA, Memorial Family Medicine Residency, USA , ⁴Department of Family Medicine, University of Pittsburgh, USA, ⁵Department of Family and Preventive Medicine, University of Texas Rio Grande Valley, USA, ⁶Department of Family Medicine, University of Calgary, USA, ⁷Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, USA

 

 

^&Corresponding author
William Edward Cayley, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, USA

 

 

 

 

In 2009 the World Health Assembly resolved that primary care health systems should include family physicians and academic and government leaders in Sub-Saharan Africa have advocated for a larger Family Medicine pipeline [1-3].

 

New Family Medicine residencies in low-income countries are expanding and often are started with the assistance of faculty from higher-income nations. Several countries have developed residency curricula to train new medical school graduates or re-train practicing physicians as Family Medicine practitioners [4-7]. These residencies aim to prepare locally-trained, competent family physicians who will meet the nearly universal lack of post-graduate trained primary care specialists working in underserved areas of their countries. One significant challenge of these new programs is to find family medicine-trained faculty and to adequately prepare them for educational excellence and leadership [3]. Promising senior residents are encouraged to remain in their programs as faculty. However, they may not have had the benefit of formal training in teaching and curriculum development.

 

Faculty development has been a central part of Family Medicine since the early years of the specialty. Initially focusing simply on teaching in primary care medicine [8], faculty development in Family Medicine has broadened to include “research, administration and career management” [9] and organisational and leadership development skills [10]. Two reviews have highlighted the wide diversity of faculty development programs that have evolved [8,11]. These reviews also highlight the need for faculty development efforts to be flexible and adaptable to changing needs, demands and contexts. This flexibility is illustrated well even in countries where Family Medicine is an established discipline and where the depth and breadth of faculty development programs vary considerably [8].

 

We conducted a literature search for published articles describing faculty development in countries where Family Medicine is an emerging specialty. Several studies have described the international development of Family Medicine. Additionally, there is a small but growing body of literature addressing needs for faculty development. A survey at a medical school in Singapore found clinical faculty felt a need for further knowledge in lecture, small group, and clinical teaching, and in teaching house officers and medical officers. Objective structured clinical examination (OSCE) and assessment of professional behavior were two items in which participants wanted much higher knowledge [12]. A faculty needs assessment conducted in India indicated interest in the areas of curriculum design, instructional delivery, student assessment and educational management [13]. A survey of medical educators in China found significant interest in research, management, and especially medical education, with particular interest in learning via educational collaborations or international study [14]. Published descriptions of faculty development interventions include: a workshop series in Nepal focusing on teaching-learning methods, media, microteaching and evaluation techniques [15], a training workshop on effective teaching methods, feedback, knowledge assessment, and time management conducted in Iran [16], a series of faculty development workshops conducted in Saudi Arabia [17], and an overseas training program to specifically support family medicine faculty development for educators from Egypt [18].

 

Nonetheless, few studies have described clear faculty development competencies and curricula to maintain and support Family Medicine educators. There is a particular lack of information about faculty development in Sub-Saharan Africa. De Villiers and Hellenberg have described the evolution of family medicine in South Africa, including the challenges of establishing the role and value of the discipline in a low-resource country and the reorientation of Family Medicine teachers, trained in a biomedical paradigm, to a patient-centered approach [19,20] Furthermore, Family Medicine in Nigeria is described as encompassing family care dynamics, primary medical care, and facility-based care either in clinics or in hospitals [21]. While these papers provide descriptors of Family Medicine and the challenges to developing a clear Family Medicine identity in Africa, they do not identify faculty development competencies.

 

It has been argued that the African situation is distinct enough from the “industrialized world” that the commonly articulated characteristics of Family Medicine may not provide the appropriate training model for African contexts [22,23]. Efforts to develop a uniquely African approach to family medicine have been growing in recent years [24-26]. We acknowledge that the sub-saharan African region includes many countries with diverse cultures and needs, and one solution is not likely to be sufficient to meet the needs in diverse contexts. Efforts so far have focused on workforce development and trainee education and there is no published literature specifically assessing faculty development needs of African Family Medicine educators.

 

The scarcity of information on faculty development in areas where Family Medicine is a developing specialty points to the need for further research to both clarify specific, locally relevant faculty development priorities. We will soon report on results of a completed qualitative needs assessment of current faculty in family medicine from countries in sub-Saharan Africa. Once local priorities have been identified it may inform the development of new locally appropriate faculty development programs. Understanding what current and future Family Medicine faculty need to improve their teaching skills may be instrumental to maintaining morale, promoting the specialty, and strengthening the primary care workforce in these countries.s

 

 

The authors declare no competing interest.

 

 

All authors have read and agreed to the final manuscript.

 

 

1. Flinkenflögel M, Essuman A, Chege P, Ayankogbe O, De Maeseneer J. Family medicine training in sub-Saharan Africa: South-South cooperation in the Primafamed project as strategy for development. Fam Pract. 2014;31(4):427-36. PubMed | Google Scholar


2. Sixty-second World Health Assembly: Primary health care, including health system strengthening. World Health Assembly. 2009; 62(12):1-3. Google Scholar


3. Moosa S, Downing R, Essuman A, Pentz S, Reid S, Mash R. African leaders' views on critical human resource issues for the implementation of family medicine in Africa. Hum Resour Health. 2014;12 (1):2. PubMed | Google Scholar


4. Abyad A, Al-Baho AK, Unluoglu I, Tarawneh M, Al Hilfy TK. Development of family medicine in the middle East. Fam Med. 2007;39(10):736-41. PubMed | Google Scholar


5. Roberts RG, Hunt VR, Kulie TI, Schmidt W, Schirmer JM, Villanueva T, Wilson CR. Family medicine training - the international experience. Med J Aust. 2011;194(11):S84-7. PubMed | Google Scholar


6. Christianson CE, Bistrovsky VF, Kogut BM. Family medicine in the Russian Far East. Fam Med. 2007; 39(10):742-5. PubMed | Google Scholar


7. Sanders J. A family medicine training program in the Republic of Georgia: incorporating a model of chronic disease management. J Am Board Fam Med. 2007;20(6):557-64. PubMed | Google Scholar


8. Sorinola OO, Thistlethwaite J. A systematic review of faculty development activities in family medicine. Med Teach. 2013;35(7):e1309-18. PubMed | Google Scholar


9. Bland CJ, Schmitz CC, Stritter FT, Henry RC, Alieve JJ. Successful faculty in academic medicine: Essential skills and how to acquire them. 1990. New York. Springer. Google Scholar


10. McLean M, Cilliers F, Van Wyk JM. Faculty development: yesterday, today and tomorrow. Med Teach. 2008; 30(6):555-84. PubMed | Google Scholar


11. Sheets KJ, Quirk ME, Davis AK. The Family Medicine Curriculum Resource Project: implications for faculty development. Fam Med. 2007;39(1):50-2. PubMed | Google Scholar


12. Amin Z, Eng KH, Seng CY, Hoon TC, Sun GP, Samarasekera DD, Huak CY, Rhoon KD. A multi-institutional survey on faculty development needs, priorities and preferences in medical education in an Asian medical school. Med Educ Online. 2009;14:16. PubMed | Google Scholar


13. Singh T, Moust J, Wolfhagen I. Needs and priorities of faculty development for medical teachers in India: a Delphi study. Natl Med J India. 2010;23(5):297-301. PubMed | Google Scholar


14. Guo Y, Sippola E, Feng X, Dong Z, Wang D, Moyer CA, Stern DT. International medical school faculty development: the results of a needs assessment survey among medical educators in China. Adv Health Sci Educ Theory Pract. 2009;14(1):91-102. PubMed | Google Scholar


15. Baral N, Paudel BH, Das BK, Aryal M, Das BP, Jha N, Lamsal M. An evaluation of training of teachers in medical education in four medical schools of Nepal. Nepal Med Coll J. 2007;9(3):157-61. PubMed | Google Scholar


16. Ebrahimi S, Kojuri J. Assessing the impact of faculty development fellowship in Shiraz University of Medical Sciences. Arch Iran Med. 2012; 15(2):79-81. PubMed | Google Scholar


17. Elzubeir M. Faculty-led faculty development: evaluation and reflections on a distributed educational leadership model. Saudi J Kidney Dis Transpl. 2011;22(1):90-6. PubMed | Google Scholar


18. Lie DA, Boker JR, Lenahan PM, Dow E, Scherger JE. An international physician education program to support the recent introduction of family medicine in Egypt. Fam Med. 2004;36(10):739-46. PubMed | Google Scholar


19. de Villiers PJ, de Villiers MR. The current status and future needs of education and training in family medicine and primary care in South Africa. Med Educ. 1999;33(10):716-21. PubMed | Google Scholar


20. Hellenberg D, Gibbs T. Developing family medicine in South africa: a new and important step for medical education. Med Teach. 2007;29(9):897-900. PubMed | Google Scholar


21. Inem AV, Ayankogbe OO, Obazee M, Ladipo MM, Udonwa NE, Kofo Odusote. “What Constitutes The Domain of Family Medicine in West Africa”. Nigerian Medical Practitioner. 2004;45(2):33-37. PubMed | Google Scholar


22. Downing R. African family medicine. J Am Board Fam Med. 2008;21(2):169-70. PubMed | Google Scholar


23. Yankogbe O, Ndimande J, Dahlman B, Bevins W. Streamlining the family medicine movement in Africa with general practitioners, medical officers, private general practices, faithbased (mission) hospitals and public and / or private partnerships. African Journal of Primary Health Care & Family Medicine. 2010; 2 (1) Accessed 26 April 2016. PubMed | Google Scholar


24. Pust R, Dahlman B, Khwa-Otsyula B, Armstrong J, Downing R. Partnerships creating postgraduate family medicine in Kenya. Fam Med. 2006;38(9):661-6. PubMed | Google Scholar


25. Philpott J, Cornelson B, Derbew M, Haq C, Kvach E, Mekasha A, Rouleau K, Tefera G, Wondimagegn D, Wilson L, Yigeremu M. The dawn of family medicine in Ethiopia. Fam Med. 2014;46(9):685-90. PubMed | Google Scholar


26. Mash RJ, de Villiers MR, Moodley K, Nachega JB. Guiding the development of family medicine training in Africa through collaboration with the Medical Education Partnership Initiative. Acad Med. 2014; 89(8 Suppl):S73-7. PubMed | Google Scholar