Does Student-Led Faculty Development Have A Place in Health Professions Education?

This article was migrated. The article was marked as recommended. Background: Instructors at health sciences universities typically transition directly from the clinical to academic setting, limiting their ability to formally develop proficiency in the science of teaching. We assess the effectiveness of a student-led faculty development course and faculty perceptions of the program. Methods: Faculty from a clinical graduate program participated in a longitudinal student-led faculty development course. The course was offered in four separate 90-minute modules led by a student facilitator. Faculty completed course evaluations after each module, a knowledge assessment before and after the course, and a comprehensive evaluation upon completion of the course. Descriptive statistics were used to explore the effectiveness of the course and faculty perceptions. Results: Faculty (N=5) exhibited increased knowledge in teaching and learning principles after the course (p < 0.01). The highest-rated area on the module evaluations was the relevance of the topics to the participants’ roles as instructors (4.31 ± 0.22). The lowest-rated area was pace of the modules (3.55 ± 0.62). The final course evaluation results showed that faculty rated the overall curriculum delivery very high (4.20 ± 0.46). Overall, faculty rated the student’s instructional quality at or above what they would expect from a peer faculty member (3.80 ± 0.72). Faculty expressed that the most valuable parts of the curriculum were applicable content, the introduction to evidence-based learning and teaching concepts, and the group discussions. Conclusions: A student-led faculty development course improved faculty knowledge of learning, teaching, and assessment principles.

Results: Faculty (N=5) exhibited increased knowledge in teaching and learning principles after the course (p < 0.01).The highest-rated area on the module evaluations was the relevance of the topics to the participants' roles as instructors (4.31 ± 0.22).The lowest-rated area was pace of the modules (3.55 ± 0.62).The final course evaluation results showed that faculty rated the overall curriculum delivery very high (4.20 ± 0.46).Overall, faculty rated the student's instructional quality at or above what they would expect from a peer faculty member (3.80 ± 0.72).Faculty expressed that the most valuable parts of the curriculum were applicable content, the introduction to evidence-based learning and teaching concepts, and the group discussions.
Conclusions: A student-led faculty development course improved faculty knowledge of learning, teaching, and assessment principles.

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Introduction
A key role of faculty at health sciences universities is to teach trainees, whether that instruction occurs in the classroom setting, clinical environment, or both.Even though instructors have developed competency in their clinical specialties, they are rarely given the opportunity to develop formal proficiency in the sciences of teaching, learning, or assessment.This lack of formal training has led many academic institutions to establish teaching and learning centers which provide pedagogical training for faculty through lectures, workshops, and observation opportunities (Center for Teaching Excellence).Studies have shown that the more resources institutions dedicate to faculty development, student learning outcomes and faculty satisfaction and engagement improve (Gansemer-Topf and Schuh, 2003;Sherer, Shea and Kristensen 2003).In addition, a recent systematic review and meta-analysis confirms the effectiveness and positive impact of faculty development initiatives in healthcare institutions (Bilal, Guraya and Chen, 2017).For these reasons, national accreditation bodies have recently revised their Common Program Requirements to include a requirement for faculty to be involved in faculty development initiatives at least annually (Accreditation Council of Graduate Medical Education).
Students are crucial stakeholders in the quality of teaching at health sciences universities, but are often excluded from faculty development efforts, despite their critical role in completing course and instructor assessments.Although literature regarding student participation in faculty development initiatives is limited, there have been reports describing efforts to incorporate student feedback in ongoing professional development activities (Holdsworth, 2013) and to enlist students to teach instructors how to use technology (Lang, Craig and Casey, 2017).However, the extent to which students can effectively train instructors in evidence-based teaching practices and develop ideas on how to implement them has not been examined.Given their frequency of encounters with instructors, and their role on the receiving end of instruction, students may be able to play a critical role in the faculty development process To further explore these issues, we developed and implemented a student-led modular, longitudinal faculty development course for health professions education faculty.We sought to explore the feasibility and effectiveness of the course and to gather reactions from both the student and faculty regarding the credibility and impact of the student-led endeavor.

Development of curriculum
The course was organized into an introductory presentation and four subsequent 90-minute modules, taught over the course of five months.An overview of each module and associated goals and objectives are provided in Table 1.Delivery formats for each module can be found in Table 2.

Development of Assessment Tools
After the content of the course was developed, a knowledge test (Appendix 1) was completed by each faculty participant.The test consisted of twenty questions, five questions per module.This same test was taken by the faculty when the course was completed.
An evaluation was also completed by the faculty directly after each module.A five-point (1=very poor; 5=excellent) scale was used to rate indicators of module quality including the quality of the instructor, the relevance of the material, the pace of the module, and the effectiveness of the presentation.A five-point scale (1=not relevant at all; 5=crucially relevant) was also used to rate the relevance of each topic in the module to the faculty's roles as instructors.Three open-response questions allowed the faculty to express their opinions related to what would change in their teaching because of what they had learned, what topics needed further clarification, and any other comments they had about the module.
Participants also submitted an 18-item course evaluation after the course.Ten items pertained to the effectiveness of the curriculum delivery based on best practices in teaching and peer coaching (Huston and Weaver, 2007;Siddiqqi, Jonas-Dwyer and Carr, 2007;Skeff, 1992)using a 1 ("strongly disagree") to 5 ("strongly agree") Likert scale.Faculty also completed five items related to the student's curriculum delivery and presentation skills as compared to performance expectations of faculty facilitators, using a Likert scale ranging from 1 ("significantly worse than what I'd expect from a peer faculty member") to 5 ("significantly better than what I'd expect from a peer faculty member").Finally, faculty were asked to provide their opinions via open response format about the most valuable part of the curriculum, ways in which they had applied concepts and strategies in their roles as an educator, how having a student facilitator for the material impacted their willingness or ability to apply the concepts, what advice they would have for others pursuing a student-led faculty development program, and any other comments about the curriculum.

Analyses
Changes on the knowledge test were analyzed using basic descriptive statistics and a paired-samples t-tests.The results of the post-module course evaluations were compared to determine which modules were rated the highest and lowest, and which indicators of module quality were rated the highest and lowest.Thematic content analyses were used to identify potential themes in the open response items.All data were analyzed using SPSS version 24.0 (IBM; Chicago, IL) using an alpha of p<0.05.This project was deemed Quality Improvement, and thus IRB approval was not required.

Participants
All faculty members (N=5) with core responsibilities in the orthotics and prosthetics (OP) program participated in this study.The average number of years since completing OP training was 6.40 (AE 4.32), since being in an academic OP program was 4.40 (AE 2.60), and since being faculty at this institution was 3.8 (AE 1.91).

Knowledge Test
The mean score on the pre-test was 9.20 AE 1.02 (n = 5).The highest baseline scores were seen in the learner and assessment areas, whereas the lowest scores were in the questions pertaining to culture and methods.The mean postcourse score was 13.40 (AE 0.92), an improvement of 4.20, or 21% (p < 0.01) from the pre-course test.

Module Evaluations
Table 3 contains the ratings of each of the four modules, organized by indicators of module quality and relevance.The average overall rating for the modules was 4.10 (AE0.15).

Course Evaluation
Results of the final course evaluation are displayed in Table 4. Overall, faculty rated the curriculum delivery very high, with an overall mean of 4.20 (AE 0.46).Faculty ratings comparing the student instructor's performance to the expected performance of a peer faculty instructor had an overall average of 3.00 (AE 0.40).Faculty rated the student lower than what they would expect of a faculty instructor on only two items ("displayed confidence in instruction" and "discussed topics of relevance to your roles"), with all other items at or above what they would expect from a faculty instructor.
Themes from the open response items are displayed in Table 5.As shown, faculty overall had positive responses to curricular elements and methods of application.There was variability in faculty responses to having a student lead the Values shown as means (standard deviations) 1 = very poor, 5 = excellent; 1 = not relevant at all; 5 = crucially relevant.
course, ranging from it having no impact on their willingness to apply what they learned, to perceptions that the student has less expertise in this area because of their level of training and lack of empathy for faculty constraints.

Discussion
Overall, the faculty in our study found the content very relevant, the module delivery very effective, and the environment safe and collegial.The scores on the knowledge test improved by an average of 21% after course completion.Some faculty had made small changes in their teaching by the end of the course, and most suggested that they would be making changes based on the course content in the future.Additionally, the faculty reported that the most valuable parts of the curriculum were applicable content (the relevance of the content was the highest rated indicator in the module evaluations), the introduction to evidence-based learning and teaching principles, and the group discussions.In sum, our findings suggest that a student-led faculty development course can achieve some of the same positive outcomes as other successful faculty development initiatives.Despite the overall positive outcomes of the student-led curriculum, a few faculty voiced concerns about having a current student lead the initiative, pointing out potential awkwardness or credibility issues.Work in Australia aimed at creating opportunities for faculty and student dialogue to enhance teaching efficacy has documented similar phenomena (Holdsworth, 2013).Specifically, some teachers found the process of having students engaged in conversations about teaching effectiveness confronting and even avoided participation in student-led sessions."Thus, anyone seeking to pursue a student-led faculty development initiatives may be wise to proactively address these issues, or develop processes to combat barriers to buy-in among faculty.
Limitations of our study include a small sample size, including faculty from a single institution, and reliance on a newly developed curriculum and customized knowledge test.Future work should explore these phenomena with a larger sample to expand the generalizability of these findings.Additionally, the longitudinal nature of the curriculum delivery may have introduced confounders that could have impacted the relationships we explored.Directions for further research in this area may include students and faculty preparing and/or co-teaching a similar course, teaching such a course over a shorter period, and using other metrics to assess the effects of the course, such as pre/post instructor evaluations from students.

Conclusions
This study demonstrated that student participation in faculty development can be beneficial to enhance baseline understanding of the science of teaching and learning, but measures may need to be taken to obtain political buy-in and ensure appropriate communication of intentions.Module 3 Questions 1. Cramming for an examination is an example of _______________ practice.2. Practicing more than one type of problem or subject in a study session is referred to as ________________________. 3. "Elaboration" refers to which of the following learning methods?(circle all that apply) a. Writing a summary of new material in one's one words b.Researching new material after class to learn more about the topic c.Relating new material to life outside of class d.Teaching the new material to someoneelse 4. Allowing students to attempt to solve a problem before they are taught how to solve it is an example of __________________. 5.All of the following are reasons that desirable difficulties should be incorporated in the learning process in and out of the classroom EXCEPT: a.They require students to exert more effort to learn b.They make learning more durable c.Students need to be in a calm, pleasant state for optimal learning d.They decrease a false sense of mastery of material Module 4 Questions 1. True or False: Summative assessment refers to cumulative evaluations used to measure student growth after instruction.2. Which of the following are true of effective formative assessment?(circle all that apply) a.It provides instructors with feedback on how to make the learning process easier b.It reveals a student's understanding of the material rather than ability to repeat facts c.It helps students see their progress d.It provides instructors with feedback regarding how to improve teaching and learning 3. Research suggests that tests should be administered _________ frequently to provide maximum benefit for learners.a.More b.Less 4. True or false: Feedback is most beneficial when provided in a positive -negative -positive format.5. Good and well-timed feedback ______________ the positive effects and _______________ the negative effects of multiple-choice testing.

Bonnie Taylor University of Texas Health Science Center -San Antonio
This review has been migrated.The reviewer awarded 3 stars out of 5 The problem as stated explicitly refers to the need for clinical instructors to gain knowledge in effective pedagogy, but also implies a need for gaining experience.The faculty development course as described appears to give benefit to the participants for increasing knowledge concurrent with similar benefit to the student instructors in skill-building.This interpretation of the problem appears to support the stated research purpose: "We sought to explore the feasibility and effectiveness of the course."In education, as in medicine, expertise matters: effectiveness of teaching is somehow related to expertise in the clinical (classroom) environment, is it not?If the selected intervention was indeed novel, perhaps the authors would consider including further description of how the student-teacher-experts (or proficients) were selected and prepared for the experience.This might provide the reading audience some indication of the feasibility for implementing such a course design, and would give readers further information for interpreting study findings.
Competing Interests: No conflicts of interest were disclosed.

Subha Ramani
Harvard Medical School, Brigham and Women's Hospital This review has been migrated.The reviewer awarded 4 stars out of 5 I enjoyed reading this paper that presents a slightly new twist on faculty development.I agree that as the principal stakeholders, students should have a role in teaching faculty how to teach.This is a well designed small study and well written manuscript.Throughout the paper, I had no trouble following the aims, methods, evaluation and implications.Neatly done.I agree with the limitations that the sample was very small, this could be a pilot which leads to a larger study.This can be done at multiple institutions which have faculty development programs to strengthen the implications.I would also recommend that the next phase should involve some revisions to the curriculum:-students and faculty co-teach so each can view the other's perspective and learn from each other-The modular content is fine.Under culture, I would like to see the institutional culture, psychological safety and institutional mindset addressed.Under methods, I hope that participants are not only learning about how to gather evidence, but also application of evidence to a variety of teaching methods (large group, small group, case based, clinical, simulation, technology etc).I did not see workplace assessment and hope the assessment module includes that.-Evaluation of the curriculum currently includes Level 1 and 2 of Kirkpatrick pyramid with some self-reports of intended behavior change.In the next iteration, this can be more formally assessed by students / peer coaches etc.Well done and I hope the authors continue this work and teach the rest of the health professions education world.
Competing Interests: No conflicts of interest were disclosed.

Table 1 .
Content of the Four Course Modules

Table 2 .
Learning Strategies Used in Respective Modules

Table 4 .
Final Course Evaluation

Table 5 .
Final course evaluation open response items "Faculty and student should co-teach." Gansemer-Topf, A. M. and Schuh, J. H. (2003)Instruction and academic support expenditures: An investment in retention and graduation.Great to see an initiative where students instruct their teachers.This article addresses the bidirectional nature of teaching and learning, issues of power, psychological safety, and cultural expectations.By culture, I mean the culture of medical education and how the practice of medicine has established roles about what is traditionally expected of teachers and students.In this well-written article, the authors have established and explained the need for this research.The intervention is described sufficiently to see the linkages among the measuring instruments and methods used to evaluate and study it.The low sample size limits the statements that the authors can make about the generalisability of the results, however, there are other gems in the results.As expected, faculty learned as shown by the pre-and post-testing.While these results are not surprising, the interesting findings are in relation to "student credibility" as teachers.This gap in 'expectations of who is a teacher' held by faculty and in 'confidence to teach' reported by students merits further investigation.I look forward to seeing the next steps these authors pursue regarding this interesting topic.I have two suggestions that the authors may wish to consider to improve the article.In the abstract, a p-value stated would be enhanced by explaining other features of the difference pre-and post-test.(Pleaseseeread the following article about reporting p-values: Wasserstein RL, Lazar NA.The ASA's statement on p-values: context, process, and purpose.The American Statistician.2016Mar7;70(2):129-33.).There are missing data in Table4because the percentages shown do not total 100.Please consider stating the category/descriptor for the missing data and present those data too.The complete set of results will help the reader make better sense of the results that are reported.For helpful suggestions about presenting results in conventional tabular format, please see guidelines such as https://www.apastyle.org/.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ACGME Common Program Requirements (2018).Accreditation Council of Graduate Medical Education.Available at: Reference Source (Accessed: October 5, 2018).Bilal, Guraya, S. Y. and Chen, S. (2017) The impact and effectiveness of faculty development program in fostering the faculty's knowledge, skills, and professional competence: A systematic review and metaanalysis.Saudi Journal of Biological Sciences.Reference Source Center for Teaching Excellence.Using Class Time Well.Available at: Reference Source Accessed: December 4, 2018.© 2019 Taylor B.
This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.