A Case Study of a Teacher Development Training Programme for ...

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CASE STUDY

A Case Study of a Teacher Development Training Programme for Newly Qualified Foundation Year Doctors Simon Tso,1,2 Douglas Corrigall,1 Kristopher Bennett1 & Eleanor Wood1 1

Homerton University Hospital NHS Foundation Trust, Homerton Row, E9 6SR, UK Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

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Abstract

Corresponding author: Dr Simon Tso, 12 Renolds Close, Coventry, CV4 9GB, UK Email: [email protected], Phone: +44 (0) 7432 140 552 © 2014 S.P. Forrest, The Higher Education Academy

Newly qualified Foundation Year 1 doctors (FY1s) have a professional duty to teach and they should be supported in their development into clinical teachers. A survey of Homerton University Hospital FY1s identified 13% (2/15) of respondents rated ‘strongly agree’ or ‘agree’ to the statement ‘I am confident about my teaching skills’. All 15 respondents rated ‘strongly agree’ or ‘agree’ to the statement ‘I want more help to develop my teaching skills’. Homerton Hospital trainee doctors developed a teacher development programme to address the unmet teacher development needs of FY1s. Developed in 2012, the Homerton Teacher Development Training Programme is an annual training event at the Homerton Hospital providing teaching-skills training for FY1s. It is delivered in three stages over a two-to-three year period with a clear pathway for progression of training. Programme evaluation highlighted FY1s wanted continuous professional development in teaching skills. Participants who have undertaken teaching skills training in medical school also perceived our training programme as beneficial. This suggests there is potential scope for undergraduate–postgraduate collaboration with joint development of teacher training programmes potentially facilitating a smoother medical student transition from learner to teacher. We believe teacher development programmes can help trainee doctors ease their transition from learner to teacher. Faculty

HSCE, Vol 0, Issue 0 (Month 2014) doi:10.11120/hsce.2014.00043

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Teacher Development for Newly Qualified Doctors

and money to undertake teacher development courses as they are not entitled to study leave or a study leave budget that would have helped them to take time off work and pay for course fees. These are the challenges to FY1s accessing teacher development training that we have observed, which echoed with the findings from the British Medical Association report entitled Doctors as Teachers (British Medical Association 2006).

development of doctors identified as having an aptitude for teaching will further develop their skills and may increase the hospital’s teaching capacity. Keywords: faculty development, teaching, foundation doctor

Background Newly qualified Foundation Year 1 doctors (FY1s) are in their first postgraduate year of training in the United Kingdom. The General Medical Council of United Kingdom states that doctors involved in teaching must develop the skills, attitudes and practices of a competent teacher (General Medical Council 2009). FY1s should be supported by their employer in their professional development into clinical teachers, which is an important aspect of their postgraduate training.

In 2012, we conducted a survey to establish the teacher development needs of Homerton FY1s. A convenience sample of 15 FY1s responded to the survey. We found none of the respondents possessed a formal teaching qualification, minorities of respondents were confident about their teaching skills and all respondents wanted more help to improve their teaching skills (see Table 1).

Sir John Temple’s Time for Training medical education report is driving the national agenda to promote a trainee-led approach to the development and implementation of training innovations that will affect their future careers (Temple 2010). Trainees developed the Homerton Teacher Development Training Programme to address their teacher development needs. It is designed to fit into FY1s’ busy work schedules. FY1s receive one-to-one personalised teaching skills training with the aim of developing participants into teachers and, where appropriate, faculty members and local programme leaders. Homerton trainee doctors who have already received teaching skills training delivered the training programme. The programme has been a yearly training fixture at the Homerton Hospital since 2012 and is provided at no cost to participants and delivered at no direct cost to the hospital. We present findings from our programme evaluation.

Context There are ample opportunities for FY1s to develop teaching competencies through participation in organised teaching programmes (Qureshi et al. 2013) and ad-hoc teaching activities. However, service provision priorities may reduce opportunities for senior doctors to supervise and feedback on FY1s’ teaching activities. There is wide variation in the provision of workplace teacher development training for FY1s. Structured training programmes to develop FY1s into faculty members for a named educational programme (Pattison et al. 2012, Qureshi et al. 2013) are not widespread, inadvertently restricting access to those willing to commit themselves to a faculty role. Generic training programmes that do not require FY1s to commit to a faculty role exist, but they are offered on a limited scale. Many FY1s could not afford the time

Table 1 Survey of Homerton University Hospital Foundation Year 1 doctors about their teacher development needs.

N = 15

Neither agree nor Strongly Disagree Agree disagree agree

Strongly disagree

Incomplete/invalid response

I like teaching

40%

47%

7%

7%

0%

0%

I am confident about my teaching skills

0%

13%

53%

20%

13%

0%

I feel fairly well prepared for my current teaching role

7%

40%

27%

13%

7%

7%

Medical school has taught me how to teach

13%

13%

20%

47%

7%

0%

I know what is a lesson plan

0%

73%

13%

13%

0%

0%

I know what are the key items to be included in a lesson plan

0%

33%

40%

27%

0%

0%

I want more help to improve my teaching skills

73%

27%

0%

0%

0%

0%

© 2014 S.P. Forrest, The Higher Education Academy


Tso et al.

Innovation – The Homerton Teacher Development Training Programme This optional training programme is delivered at the Homerton Hospital in three stages (see Table 2) providing FY1s with continuous professional development in teaching skills over a two-to-three year period. Stage 1 is the Teaching Skills Workshop providing FY1s with teaching skills training in line with national training guidelines (General Medical Council 2009, UKFPO 2013). It is a one-day near-peer blended learning programme providing one hour of one-to-one direct contact time with trained faculty members who are doctors in their second postgraduate year of training, or above, in seniority. Participants gain an overview about the theoretical and practical aspects of teaching. Participants will have prepared and returned a lesson plan (see Supplemental Document). 20 minutes are allocated for facilitators to provide structured

feedback on participants’ lesson plan design and delivery of a 20-minute observed teaching session. Ten minutes are allocated for facilitators to complete the participants’ work-based electronic portfolio teaching assessments. Participants are encouraged to apply their reflective learning into future practices. Stage 2 is the faculty member training programme. It is a one and a half days blended learning programme to develop participants’ skills in giving feedback and learning guidance in preparation for their role as faculty members. Participants develop a basic understanding of the theories and practicalities behind teaching and giving feedback by completing a minimum of three London Deanery faculty development e-learning modules on teaching skills (London Deanery 2012). These open access learning materials are relevant to the training programme and can be accessed via the Internet from work or home.

Table 2 The three stages of the Homerton Teacher Development Training Programme, made up of five training components: a) Introduction, b) Theory, c) Preparation, d) Direct Observation of Practice, e) Reflective Learning.

Stage 1: Workshop Training Programme

Stage 2: Faculty Member Training Programme

Stage 3: Local Programme Leader Training Programme

Duration

One-day blended programme.

One and a half days blended programme.

Over a two-to-three year period.

Entry criteria

Foundation Year 1 doctors.

Doctors who have completed stage 1 training.

Doctors who have completed stage 2 training.

a) Introduction

Read the workshop participant handbook with reading materials about the workshop and lesson planning. (~1 hour)

Attend a tutorial about the workshop, how to give feedback on lesson plans and how to facilitate the workshop. (~0.5 hour)

Demonstrate understanding of the organisational structure through completion of the faculty member training programme.

b) Theory

Read the recommended reading materials from the London Deanery Faculty Development E-Learning modules on teaching skills. (~2 hours)

Complete a minimum of three London Deanery Faculty Development E-Learning modules on teaching skills. (~3.5 hours)

Complete a further three London Deanery Faculty Development E-Learning modules on teaching. (~3.5 hours)

c) Preparation

Write a structured lesson plan. Feedback given. (~2 hours)

Shadow experienced educators facilitating workshop and contribute to discussion. Feedback given. (~3 hours)

Observe experienced organisers in the organisation, delivery and evaluation of workshops.

d) Direct Observation of Practice

Deliver a 20-minute teaching session according to lesson plan. Feedback session lasting 20 minutes. Work-based assessment completed. (1 hour)

Facilitate a minimum of two workshops to a satisfactory level and provide feedback on lesson plans. Feedback given. (~3 hours)

Play an active role in the organisation and evaluation of a workshop programme. Facilitate workshops over a one-to-two year period to a satisfactory level. Feedback given.

e) Reflective Learning

Apply reflective learning into future practice.

Apply reflective learning into future practice. Faculty peer support given.

Apply reflective learning into future practice Faculty peer support given.



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Stage 3 aims to develop local programme leaders and nurture participants’ educational leadership and organisational skills over a one-to-two year period. Participants would have completed stage 2 training and played an active role in curriculum development, organisation and/or evaluation of stage 1 of the training programme. Participants would be in the position to deliver stage 2 training and be supported in leading a local programme after completion of training.

factor). Many experienced difficulties obtaining feedback from observers and learners about their ‘on-the-job’ teaching activities, as evidenced by the following feedback:

Stage 1 training programme evaluation

Their perceived lack of preparedness and workplace support for teacher development training was in conflict with the need to fulfil a teaching role:

We evaluated our stage 1 training programme by means of post-intervention interviews with all 15 participants who took part in the 2012 workshops. The one-to-one interviews were conducted using the following standardised questions:

How did you find your experience of the workshop?

What do you think about the structure of the workshop programme?

Would you like to change anything about the workshop?

Is there a need for mandatory teacher development training for Foundation Year 1 doctors?

Audio recordings were transcribed verbatim. The transcripts were analysed adhering to the six-step approach of thematic analysis studies (Braun & Clarke 2006). All authors agreed with the coding and achieved consensus on the themes that have emerged from the data.

Results The stage 1 training completion rates were as follows: 71% (15/21), 53% (8/15) and 73% (8/11) of registered participants completed the stage 1 training programme in 2012, March 2013 and October 2013 respectively.

Perception of own teaching role Participants recognised that teaching is an integral part of their role as a FY1, seeing teaching as a requirement, an expectation or a competency. Most of their teaching activities were informal ad-hoc teaching tasks.

The desire to become better teachers All participants wanted to become better teachers. Their motivation to improve their teaching skills can be categorised into internal and external factors. Many doctors lacked confidence in their own teaching skills (internal factor) and perceived the undergraduate curriculum did not adequately prepare them for their teaching role (external © 2014 S.P. Forrest, The Higher Education Academy

. . .you do get an opportunity to teach students but you will never get feedback from them. It’s very difficult to get (feedback) from doctors because they are being busy with other patients or another situation.

You are expected to be able from day one to teach. Whether you like it or not you will be teaching as a doctor.

Stage 1 training programme evaluation Participants described the educational environment of the workshop as ‘non-threatening’ and ‘non-judgemental’. The 20-minute time restriction imposed on participants’ observed teaching time was perceived as helpful in honing their time management skills, although some participants felt this did not accurately reflect their actual teaching practices. Participants reflected upon the feedback they received on their teaching practices and consequently considered ways to enhance their future teaching performance: I found the process (write a lesson plan) very useful and will probably use it as a method again before I do another teaching. All participants perceived the workshops as beneficial and indicated that they would recommend it to their peers. Some participants felt teacher development should become a compulsory part of their training as a FY1 and some advocated that there should be a series of workshops to enable continuing development of teaching skills. Some participants reported difficulties in finding colleagues to provide temporary work cover so that they could undertake the workshop: . . .if we had . . .workshop timetabled into future teaching session it would really be beneficial. Then we could be taught how to teach and then go away and be encouraged to do teaching session and then come back. Because now I have all this feedback and I wish I could do it again and incorporate your (workshop facilitator) feedback and see if I improve.


Tso et al.

Discussion Swanwick (2008) described the drivers for faculty development in postgraduate medical education as the professionalisation of medical education, increasing accountability and the pursuit of excellence in teaching. Trainee doctors must be accountable for their own teaching practices and should be supported to develop their teaching skills. Our training programme attempted to address the unmet teacher development needs of Homerton trainee doctors. Most participants expressed that they had learnt something new and planned to incorporate their new skills into future practices. Providing teacher training opportunities at various stages of trainee doctors’ training programmes would enable continuous professional development of their teaching skills. We found that participants who had undertaken teacher skills training in medical school also perceived our training programme as beneficial, thus, suggesting there is scope for undergraduate–postgraduate collaboration with joint development of teacher training programmes potentially facilitating a smoother medical student transition from learner to teacher. We advocate that research should be conducted to investigate the impact of teacher development programmes on the knowledge, skills and behaviours of learners being taught by such programmes.

Limitations This is an uncontrolled study with a small volunteer sample. Volunteers may be more self-conscious and less confident about their teaching skills than non-attendees, resulting in selection bias. This could offer an explanation as to why one doctor has rated ‘disagree’ to the statement ‘I like teaching’ in the survey. The training non-completion rate was high and this may be accounted for by FY1s’ clinical

References Braun, V. and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3 (2), 77–101. British Medical Association (2006) Doctors as teachers, p5. General Medical Council (2009) Tomorrow’s doctors. Available at www.gmc-uk.org/education/ undergraduate/tomorrows_doctors.asp (accessed 1 October 2013).


commitments, scheduled and unscheduled leaves and lack of motivation to attend training. FY1s at Homerton Hospital have weekly protected teaching time. This could be used to allow doctors to attend the workshop and improve workshop uptake and attendance rates. Although the generalisability of our findings is limited, we believed that there is a genuine demand from FY1s for teacher development training.

Conclusion The transition from learner to teacher can be a challenging one. All doctors who participated in the Homerton Teacher Development Training Programme wanted more teacher development training. We believe teacher development programmes can help trainee doctors ease their transition from learner to teacher. Faculty development of doctors identified as having an aptitude for teaching will further develop their skills and may increase the hospital’s teaching capacity.

Acknowledgements The Homerton University Hospital NHS Foundation Trust provided the workshop venue and administrative support. Magdalena Tosun assisted with the organisation of the training programme. The London Deanery developed the open access e-learning teacher development materials that were featured in our teacher development training programme. At the time this manuscript was written, the responsibilities of the London Deanery have been taken over by three Local Education Training Boards.

Supplemental Document Sample lesson plan Written lesson plan feedback

London Deanery (2012) Faculty development e-learning modules for clinical teachers 2012. Available at www.faculty.londondeanery.ac.uk/ e-learning (accessed 12 December 2012). Pattison, A.T., Sherwood, M., Lumsden, C.J., Gale, A. and Markides, M. (2012) Foundation observation of teaching project – a developmental model of peer observation of teaching. Medical Teacher 34 (2), 136–142. Qureshi, Z., Ross, M., Maxwell, S., Rodrigues, M., Parisinos, C. and Hall, H.N. (2013) Developing junior


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doctor-delivered teaching. The Clinical Teacher 10 (2), 118–123.

Available at www.mee.nhs.uk/pdf/JCEWTD_Final% 20report.pdf (accessed 2 October 2013).

Swanwick, T. (2008) See one, do one, then what? Faculty development in postgraduate medical education. Postgraduate Medical Journal 84, 339–343.

United Kingdom Foundation Programme Office (UKFPO) (2013) Foundation Training Programme Curriculum 2012. Available at www.foundationprogramme.nhs.uk/pages/home/ curriculum-and-assessment/curriculum2012 (accessed 13 July 2013).

Temple, J. (2010) Time for training: a review of the impact of the European Working Time Directive on the quality of training. Medical Education England.

