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Country Paper

A need and necessity for faculty development : the role of


medical education units in the Indian context

Tejinder Singh1, Payal Bansal2, Monika Sharma3

Introduction Medical Education Units can play a critical


role in faculty development and thus
India contributes significantly to the world’s contribute to educational improvement and
disease burden. At the same time, the reforms in a major way.
Indian health care and medical education
are facing systems and standards Need for faculty development in
challenges. education

With the highest number of medical Until recently in contemporary medical


colleges in the world, and an education, teachers used to teach as they
unprecedented growth of medical were taught. No formal training programs
institutions occurring in the past two for teachers existed. It was believed that
decades, there is a marked shortage of ‘good’ clinicians may be ‘good’ teachers
teachers. Additionally, although recent and time and experience polish teaching
advances in medicine have been methodologies as well. Though this has
understood and adopted by medical and changed in many parts of the world, in
other health science institutions, the same India, even today a large number of the
is not true for methods and strategies in academic faculty joining medical schools
medical education. Curricula need to be are not really trained to teach - one of their
better aligned with health needs and basic responsibilities. Hence, introducing
changing methodologies. Developments in teachers to the principles of teaching and
the field of medicine and allied health learning is essential.
sciences need to be adopted and
assessment systems need to be Efforts for sensitizing the teachers to
modernized. These are critical in order to teaching have become more organized
maintain educational standards and, as a into activities that fall under the term
result, quality of graduating doctors ‘faculty development’. The term ‘faculty
produced by the system. development’ has been traditionally used
to describe the activities undertaken by
There is an urgent need for educational academic staff in educational institutions
leaders to come forward with strategies to and implies that some individual
overcome this crisis in medical education intellectual and professional growth will
and initiate reforms at the earliest. take place as a result of these programs.
Simply stated it includes all activities taken
The key to successfully initiating and up by the faculty in an institution targeting
implementing these and other reforms is their all round development, personally or
educational capacity building through professionally and finally implying the
faculty development. growth of the institution. More recent
descriptions include institutional growth as
well, and most definitions of faculty
1
Professor and Head of Paediatrics, Vice Principal, development in literature reflect the role of
Director, CMCL FAIMER Regional Institute, the institution in the process in form of free
Christian Medical College, Ludhiana 141008, India
time or fees (Jolly, 2002).
2
Associate Professor in Medical Education
Maharashtra University of Health Sciences, Pune The key question is how we develop
India medical ‘teachers’? There are very few
3
papers describing faculty development
Assistant Professor in Paediatrics, programs in medical education and there
Christian Medical College, Ludhiana 141008, India
is no conventional framework for doing so.
Most medical teachers feel that their lack

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vol. 2, no. 1, 2008
of knowledge of teaching skills and lack of • Creation of a senior-junior mentoring
availability of formal training in teaching relationship where a senior faculty
hinders their growth as teachers. For member can guide the junior faculty
clinicians, the additional clinical member about the intricacies of
responsibilities impinges on the teaching
importance and time they may give to the
• Provision of institutional funding for
actual teaching they undertake
research in the field of medical
(MacDougal & Drummond, 2005).
education
There is no encouragement or recognition • Promotion of a culture of teaching to a
for medical teachers. The range of level where teaching is recognized as
activities in medical teaching are diverse much as clinical research
and the additional emotional aspect of the • Rewarding teachers who excel in
teaching makes the training of doctors to teaching
be teachers a complex process. All these
make the designing and implementation of • Recognizing the scholarly attributes of
a faculty development program difficult. teaching
• Participation of teachers in international
Doctors train themselves to be teachers by collaborations through BEME (best
observing their role models and use their evidence in medical education)
own insight in developing their own
teaching methodologies. Training medical Besides enabling the teachers to develop
teachers to teach and to be able to reflect their basic skills in teaching, evaluation
upon and analyze their teaching strategies and making suggestions to the curriculum,
is thus an important aspect of faculty faculty development also includes the
development. Like other formal training responsibility of enhancing the
programmes, there is a need to develop management, administrative and
and actively promote a formal programme leadership skills of teachers as most of the
towards achieving excellence in medical medical teachers are required to take on
teaching. various roles, including that of an
administrator, a leader, a mentor for
Ramani (2006) suggests the following juniors and students and a facilitator for
guidelines to help medical teachers excel learning. The whole process of faculty
at teaching; development, though apparently individual
centred, finally aims at the development of
• Having concrete teaching-learning the institution as a whole.
outcomes planned for teachers to help
them plan what they teach It is not difficult to assume that this task of
faculty development is unlikely to be
• Using best evidence in medical successful without an organized effort.
education, similar to evidence based The key to implementation of any faculty
medicine used in clinical practice, development programme is the
where teachers have access to establishment of a Medical Education Unit.
educational research to guide them to
the applicability of the recent changes While such organized units are an integral
in teaching-learning methodologies part of most western medical schools, the
• Organization of education based importance and utility of such an
journal clubs establishment is still being realized and
poorly implemented in India.
• Organized faculty development
programmes to create an environment History and status of faculty
for learning for the teachers development programmes in India
themselves
It is necessary to understand the situation
• Evaluation of teaching to help the of health and educational infrastructure in
teachers know how they teach India. The number of medical schools in
• Evaluation of the impact of teaching India has almost doubled in the last 20
methods on the learners years (Supe & Burdick, 2006). This growth
has been largely in response to the
growing population and health needs.

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This exponential growth has resulted in a colleges in Manipal, Mumbai, Ludhiana,
fall in the teacher student ratio. The Belgaum, Bangalore and Visakapatnam.
economic growth in urban areas has made The Medical Council of India (MCI)
the private sector a more attractive option initiative in this direction in the year 1999
for medical professionals (Duggal, requires every medical college to have a
2006).This has further compounded the medical education unit (Medical Council of
teacher shortage. Though recommended India, 1997). Although this directive has
by the Medical Council of India, the resulted in a fast paced establishment of
training in educational techniques is not medical education units all over India, their
compulsory for medical teachers in India. ‘function’ is far from satisfactory in most
There is still no formal policy on teacher institutions.
training. Additionally, we have not kept
pace with the newer trends in medical FAIMER (Foundation for Advancement in
education and that research in medical Medical Education and Research),
education exists is virtually unknown to Philadelphia, is a non-profit organization of
most medical teachers. ECFMG (Educational Commission for
Foreign Medical Graduates), USA that
The World Health Organisation (WHO) supports faculty development in education
recognized the importance of training through fellowships. It has a unique
medical teachers as early as 1965 and curriculum in that it combines basic
suggested creation of three levels of education principles, teaching skills,
training - the specialists in education, the leadership and research skills, as well as
leaders in the field of education who could networking with fellow educators from all
integrate the science of educational over the country and international experts
research into institutional programs and in its programme. Presently, it is being
the educational practioners who would be offered in collaboration with three regional
trained in the basic skills of classroom or centres at Christian Medical College,
clinical teaching. Ludhiana, GS Medical College, Mumbai
and PSG Institute of Medical Sciences,
In 1969, it set up centres for development Coimbatore and has successfully taken
of medical education at the University of these activities to a large group of medical
Illinois and University of Southern teachers in India in a very short period of
California, which served as International time (Burdic et al., 2007).
Teacher Training Centres. Regional
Teacher Training Centres (RTTC) and Role of medical education units
further National Teacher Training Centres
(NTTC) were set up in some medical What role can education units play in the
colleges, including a few in India. The first medical education system? With
such centre was set up at the Jawaharlal increasing awareness among patients and
Institute of Post Graduate Medical expanding medical frontiers, societal
Education and Research (JIPMER), in expectations from doctors have increased
Pondicherry, India in 1976. These considerably in recent times. Medical
programs were supported by WHO grants curricula have become more complex.
until 1984 and subsequently by the Newer methods of curriculum delivery are
government of India until 1999. being innovated and adopted, as are new
Subsequently, three more centres were assessment methods. Skills such as
set up in India. However, most of the change management are needed due to
NTTC centres ceased after government the rapid advancements and
funding was discontinued. Of the four corresponding systems changes. Medical
institutions, the JIPMER, Pondicherry education units are therefore needed to
centre is the only one that is still have the ability to train teachers in these
functioning (Bansal & Supe, 2007). advancements.

More such faculty development initiatives The WHO has played a key role in the
were organized in the form of the Centre establishment of medical education units,
for Medical Education and Technology as described above. The earliest medical
(CMET) at the All India Institute of Medical education units established in the USA
Sciences (AIIMS), New Delhi and the were offices for research in the field. In
setting up of Medical Education units by contemporary medical education and
motivated teachers in a few medical research, the role of a medical education

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vol. 2, no. 1, 2008
unit (MEU) is varied, from research and and support staff (technical support in
teaching to nurturing a fulfilling career. The information technology). Members of this
need to concentrate on one of these roles unit may be medical educators working
of a MEU may vary in different colleges. fulltime or clinicians spending a part of
Some of the important attributes of a their time working in these units. The issue
medical education unit (Davis et al., 2005) of the structure or organization of such a
are as follows; unit is a subject of interest. Detailed
guidelines on the role of various staff
• The MEU should be able to create a
members have been provided in the
culture of educational research.
AMEE guidelines for creation of medical
• It should be able to keep the faculty education unit (Davis et al, 2005) and can
aware of the ongoing research in the be applied in the Indian context as well.
field
• It should be able to generate There can be two distinct models of
publications and resources in medical MEUs. The first model is where the MEU
education is an entirely separate unit, independently
handling everything regarding medical
• A medical education unit essentially education. This unit, comprising of highly
needs to concentrate on the teaching- focused staff can be a centre of great
learning needs of the students and activity providing rich research
hence facilitate the same contributions to the field of medical
• It should provide instructional design education. However, as it does not include
clinical faculty as staff of the unit, the
• It should focus on newer learning relevance of its activities is a matter of
technologies such as simulation and debate.
e-learning
• It should develop guidelines for The other model is the ‘hub and spoke’
student evaluation and curriculum patterned model. This model has a core
development group that manages the work of the
medical education unit and has
• It should provide on the job training or representation from all the teaching
formal courses for teachers departments. This helps in carrying the
Medical education units can be information and resources generated by
instruments in nurturing the careers of the medical education unit into practice of
faculty interested in the field of medical each of the teaching departments. The
education, who could in turn become core group members can also engage in
educators to guide the rest of the faculty. activities such as teaching the rest of their
Organized units can also be service departmental faculty in teaching
providers, helping other colleges in setting methodologies (Singh, 2008).
up faculty development programmes and
curriculum evaluation or designing. A MEU The second model is similar to the one
can provide a forum for learning the suggested by Mehta, in a paper presented
principles of ethics and professionalism in at a national workshop in 1996 (as quoted
clinical practice and in research and in 11). This model recommends having a
support the teachers to understand the MEU with representation from various
relevance of research in the field of fields of medicine with most of the
education and the skills of scientific members working part-time. 5-6 members
writing. In addition to training medical who could devote at least 2 hours per
teachers in teaching, a medical education week to medical education and one main
unit should be able to consider innovations member (= the unit leader), who is trained
in curriculum design, assessment methods in medical education, who spends at least
and newer advances in technology and 6 hours per week to the activities of the
their application to medical education and unit. This kind of difference in approach to
establish research and scholarship in the continued professional development has
field. also been recognized earlier (Verma &
Singh, 1995).
Organizing a medical education unit
While structuring a MEU, several other
A medical education unit may be staffed factors may also need to be considered
by varied personnel - clinicians, educators with respect to the needs and organization

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within a medical school and its relation to Bhuiyan, P.S. & Rege, N.N. (2001) Evolution of
Medical Education Technology Unit in India. Journal
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of Postgraduate Medicine, 47 (1), 42-44.
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the status enjoyed by any other teaching Capacity Building in Medical Education and Health
department or should it be a unit providing Outcomes in Developing Countries: the Missing Link.
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educational activities, rather than leave it
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