A realist evaluation of faculty development in UK medical schools
Background\ud The central mission of every medical school is education, however most teachers have not received formal teacher training. Hence there is an expectation that faculty development (FD) with planned programmes to prepare faculty members for their role in teaching will be integral to medical school life. The widespread investment in FD is predicated on the belief that it enhances the effectiveness of teaching but the evidence is limited.\ud \ud Aim\ud To carry out an in-depth exploration of FD in UK medical schools and evaluate the effectiveness of FD on teaching. The realist framework with its principle of explanatory causation was chosen to find out what works for whom in FD in what context, and why. This was an innovative use of the model in educational research.\ud \ud Methods\ud A detailed literature review was carried out and combined with the researchers experience and insight of FD to develop eight realist hypotheses in the form of contexts, mechanisms and outcomes (CMO). Data that would support, modify or challenge the hypotheses were then collected in three phases. Phase I was a review and scoring of data on medical school FD webpages using a webpage scoring index. Phase II was observation and informal interviews of two cohorts of educators attending a FD course followed by detailed interviews of 12 educators (six from each cohort) six months later. Phase III was interview of FD coordinators and educators at eight medical schools. Quantitative and qualitative data were collected.\ud \ud Data analysis\ud Quantitative data were analysed by descriptive methods, slope diagrams, bi-axial constructs and statistical analysis with Fisher’s exact test. Qualitative data were analysed by categorising and connecting strategies followed by summarising the relevant data under each hypothesis to check if the hypothesis was supported, modified or refuted.\ud \ud Findings\ud The literature review revealed a paucity of publications on FD in the UK, however the 30 medical schools webpages reviewed showed data on FD activities. Data from all three phases were used to identify and explain the contexts (participatory approach/reflective practice, needs identification, supportive setting and standardization of medical teaching) that facilitated FD mechanisms (engagement, motivation, positive perception and professionalization).These led to the outcomes of improved confidence, competence, credibility and career progression.\ud \ud Conclusion\ud Four realist theories of FD were identified (engagement, motivation, positive perception and professionalization) confirming the effectiveness of FD both in the short and long term and important recommendations for all FD stakeholders (educators, FD developers, universities and policy makers). In addition, I also made recommendations for future medical education researchers who choose the realist evaluation model.
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