Competency-based faculty development: applying transformations from lessons learned in competency-based medical education.

Faculty development in medical education is often delivered in an ad hoc manner instead of being a deliberately sequenced program matched to data-informed individual needs. In this article, the authors, all with extensive experience in Faculty Development (FD), present a competency-based faculty development (CBFD) framework envisioned to enhance the impact of FD. Steps and principles in the CBFD framework reflect the lessons learned from competency-based medical education (CBME) with its foundational goal to better train physicians to meet societal needs. The authors see CBFD as a similar framework, this one to better train faculty to meet educational needs. CBFD core elements include articulated competencies for the varied educational roles faculty fulfill, deliberately designed curricula structured to build those competencies, and an assessment program and process to support individualized faculty learning and professional growth. The framework incorporates ideas about where and how CBFD should be delivered, the use of coaching to promote reflection and identity formation and the creation of communities of learning. As with CBME, the CBFD framework has included the important considerations of change management, including broad stakeholder engagement, continuous quality improvement and scholarship. The authors have provided examples from the literature as well as challenges and considerations for each step.

Dans l'enseignement médical, le perfectionnement du corps professoral se fait souvent de façon ad hoc et non dans le cadre d'un programme structuré en fonction des besoins individuels définis sur la base de données. Dans cet article, les autrices, qui ont toutes une vaste expérience en matière de perfectionnement du corps professoral (PCP), présentent un cadre pour le perfectionnement fondé sur les compétences (PCPFC) visant à renforcer les effets du PCP. Les étapes et les principes de ce cadre reflètent les enseignements tirés de la formation médicale fondée sur les compétences (FMFC), dont l'objectif fondamental est de former les médecins de façon à ce qu'ils puissent répondre aux besoins de la société. De manière analogue, le cadre PCPFC viserait à mieux former le corps professoral pour qu'il puisse répondre aux besoins éducatifs. Les éléments centraux du cadre comprennent la définition des compétences pour chacun des rôles que les enseignants remplissent, la création de programmes de formation structurés et axés sur le développement de ces compétences et l'élaboration d'un programme d'évaluation ainsi qu'un processus pour soutenir de manière individualisée l'apprentissage et la croissance professionnelle des enseignants. Le cadre présente des idées sur les modalités des formations de PCPFC, sur l'environnement dans lequel elles interviennent, sur l'utilisation du coaching pour promouvoir la réflexion et la construction d'identité et sur la création de communautés d'apprentissage. Tout comme la FMFC, le cadre du PCPFC répond aux importants enjeux liés à la gestion du changement, y compris l'engagement des parties prenantes, l'amélioration continue de la qualité et la recherche. Les autrices proposent des exemples tirés de la littérature scientifique et passent en revue les défis et les points importants à considérer pour chaque étape.

Developing Faculty Developers: An Underexplored Realm in Professional Development.

ABSTRACT: As faculty developers enter the field and grow in their roles, how do they keep up with ongoing changes and ensure that their knowledge remains relevant and up-to-date? In contrast to most of the studies which focused on the needs of faculty members, we focus on the needs of those who fulfill the needs of others. We highlight the knowledge gap and lack of adaptation of the field to consider the issue of professional development of faculty developers more broadly by studying how they identify their knowledge gaps and what approaches they use to address those gaps. The discussion of this problem sheds light on the professional development of faculty developers and offers several implications for practice and research. Our own piece of the solution indicates that faculty developers follow a multimodal approach to the development of their knowledge, including formal and informal approaches to addressing perceived gaps. Within this multimodal approach, our results suggest that the professional growth and learning of faculty developers is best characterized as a social practice. Based on our research, it would seem worthwhile for those in the field to become more intentional about the professional development of faculty developers and harness aspects of social learning in that process to better reflect faculty developers' learning habits. We also recommend applying these aspects more broadly to, in turn, enhance the development of educational knowledge and educational practices for the faculty members these educators support.

Activity and participation experiences of people with disabilities in Ethiopia.

Background: Ethiopia, as a State Party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has committed to upholding the rights of people with disabilities in Ethiopia. There is little evidence, however, reflecting the impact of this commitment on the lived experiences of people with disabilities in Ethiopia. Objectives: This study sought to uncover how the experiences of participation and activity shape the enactment of rights for Ethiopians with disabilities as enshrined in the UNCRPD. Method: Analysis of 25 qualitative interviews with people with disabilities and family members living in Ethiopia used a reflexive thematic analysis approach to arrive at central themes. Results: People with disabilities in Ethiopia experience marginalisation, distress and practical challenges in both routine daily activities and participation in broader social roles and opportunities. These experiences affect their ability to claim many of the rights afforded by the UNCRPD. Conclusion: Despite legislative efforts to bring about change in Ethiopia, people with disabilities continue to live on the social margins. A meaningful change will require substantial allocation of needed resources by the Ethiopian government to support national-level programmes and policy change. It is critical that people with disabilities and their families are engaged in receiving relevant support, and serve as change leaders. Contribution: This study illustrates how marginalisation, distress and practical challenges in daily activities and social participation arise and are sustained for people with disabilities in Ethiopia. The findings can help to inform the country's efforts to enact the rights of Ethiopians with disabilities as enshrined in the United Nations Convention on the Rights of Persons with Disabilities.

Developing a Curriculum for Addressing the Opioid Crisis: A National Collaborative Process.

BACKGROUND: The burgeoning use of opioids and the lack of attention to the safe prescribing, storage, and disposal of these drugs remains a societal concern. Education plays a critical role in providing a comprehensive response to this crisis by closing the training gaps and empowering the next generation of physicians with the knowledge, skills, and resources needed to diagnose, treat and manage pain and substance use. Curricular Development: The Association of Faculties of Medicine of Canada (AFMC) developed a competency-based, bilingual curriculum for undergraduate medical students to be implemented in all Canadian medical schools. The authors describe the principles and framework for developing a national curriculum. The curriculum design process was situated in the Knowledge to Action theoretical framework. Throughout the development of this curriculum, different stakeholder groups were engaged, and their needs and contexts were considered. CONCLUSION: The curriculum ensures that consistent information is taught across all medical schools to educate future physicians on pain management, opioid stewardship and substance use disorder.

Activity and participation experiences of people with disabilities in Ethiopia

Ethiopia, as a State Party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has committed to upholding the rights of people with disabilities in Ethiopia. There is little evidence, however, reflecting the impact of this commitment on the lived experiences of people with disabilities in Ethiopia. Objectives: This study sought to uncover how the experiences of participation and activity shape the enactment of rights for Ethiopians with disabilities as enshrined in the UNCRPD. Method: Analysis of 25 qualitative interviews with people with disabilities and family members living in Ethiopia used a reflexive thematic analysis approach to arrive at central themes. Results: People with disabilities in Ethiopia experience marginalization, distress and practical challenges in both routine daily activities and participation in broader social roles and opportunities. These experiences affect their ability to claim many of the rights afforded by the UNCRPD. Conclusion: Despite legislative efforts to bring about change in Ethiopia, people with disabilities continue to live on the social margins. A meaningful change will require substantial allocation of needed resources by the Ethiopian government to support national-level programs and policy change. It is critical that people with disabilities and their families are engaged in receiving relevant support and serve as change leaders. Contribution: This study illustrates how marginalization, distress and practical challenges in daily activities and social participation arise and are sustained for people with disabilities in Ethiopia. The findings can help to inform the country's efforts to enact the rights of Ethiopians with disabilities as enshrined in the United Nations Convention on the Rights of Persons with Disabilities

Activity and participation experiences of people with disabilities in Ethiopia

Ethiopia, as a State Party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has committed to upholding the rights of people with disabilities in Ethiopia. There is little evidence, however, reflecting the impact of this commitment on the lived experiences of people with disabilities in Ethiopia. Objectives: This study sought to uncover how the experiences of participation and activity shape the enactment of rights for Ethiopians with disabilities as enshrined in the UNCRPD. Method: Analysis of 25 qualitative interviews with people with disabilities and family members living in Ethiopia used a reflexive thematic analysis approach to arrive at central themes. Results: People with disabilities in Ethiopia experience marginalisation, distress and practical challenges in both routine daily activities and participation in broader social roles and opportunities. These experiences affect their ability to claim many of the rights afforded by the UNCRPD. Conclusion: Despite legislative efforts to bring about change in Ethiopia, people with disabilities continue to live on the social margins. A meaningful change will require substantial allocation of needed resources by the Ethiopian government to support national-level programmes and policy change. It is critical that people with disabilities and their families are engaged in receiving relevant support and serve as change leaders. Contribution: This study illustrates how marginalisation, distress and practical challenges in daily activities and social participation arise and are sustained for people with disabilities in Ethiopia. The findings can help to inform the country's efforts to enact the rights of Ethiopians with disabilities as enshrined in the United Nations Convention on the Rights of Persons with Disabilities

Oncology training programmes for general practitioners: a scoping review.

INTRODUCTION: Due to the increasing global burden of cancer and the shortage of trained medical oncologists, training General Practitioners (GPs) in Oncology (known as GPOs) has been proposed as a means to potentially ease some burden on medical oncologists with heavy workloads, especially in low-and-middle-income countries (LMICs), by task-sharing and task-shifting. We undertook a scoping review to identify and characterise the existing training programmes and curricula for GPOs globally. DESIGN: We searched three major electronic databases: EMBASE, Medline/PubMed and Education Source for articles that described a medical oncology training programme for GPs. All study types were eligible in this review. We followed a two-stage standardised screening process using two independent reviewers to evaluate the eligibility of the articles. RESULTS: Five peer-reviewed articles were included in our review and grey literature scans identified an additional seven GPO training programmes for a total of 12 programmes and their curricula. All of the included studies were from high-income countries. The duration of programmes varied from comprehensive programmes structured over 2 years (n = 2) to shorter duration medical oncology training activities (n = 2), a short, 1.5-day workshop and a 10-hour course. In the grey literature, GPO training programme durations ranged from 2 weeks to 13 months. A mixture of delivery methods was employed including didactic lectures and clinical rotations. CONCLUSION: This scoping review identified a small number of heterogeneous studies and grey literature sources that described and/or evaluated medical oncology training programmes for GPs. The information synthesised here can be used to foster the collaboration needed for the continued development of GPO programmes that could help address the problem of lack of workforce to meet the rising burden of cancer, especially in LMICs.

Viewing faculty development through an organizational lens: Sharing lessons learned.

INTRODUCTION: Faculty Development (FD) plays a key role in supporting education, especially during times of change. The effectiveness of FD often depends upon organizational factors, indicating a need for a deeper appreciation of the role of institutional context. How do organizational factors constrain or enhance the capacity of faculty developers to fulfil their mandates? METHODS: Using survey research methodology, data from a survey of FD leaders at Canadian medical schools were analyzed using Bolman and Deal's four frames: Symbolic, Political, Structural, and Human Resource (HR). RESULTS: In the Symbolic frame, FD leaders reported lack of identity as a FD unit, which was seen as a constraining factor. Within the Political frame, developing visibility was seen as an enhancing factor, though it did not always ensure being valued. In the Structural frame, expanding scope of practice was seen as an enhancing factor, though it could also be a constraining factor if not accompanied by increased resources. In the HR frame, a sense of instability due to changing leadership and uncertainty about human resources was seen as a constraining factor. CONCLUSION: While broadening the mandate of FD can generally be considered as positive, it is imperative that it is appropriately resourced and accompanied by recognition of FD as a valued contributor to the educational mission.

Problem-solving strategies used in anatomical multiple-choice questions.

BACKGROUND AND AIMS: Multiple-choice questions (MCQ) in the anatomical sciences are often perceived to be targeting recall of facts and regurgitation of trivial details. Moving away from this assumption requires the design of purposeful multiple-choice questions that focus on higher-order cognitive functions as opposed to rote memorization. In order to develop such questions, it was important to first understand the strategies that students use in solving multiple-choice questions. Using the think-aloud protocol, this study seeks to understand strategies students use in solving multiple-choice questions. Specifically, it seeks to uncover patterns in the reasoning process and tactics used when solving higher and lower order MCQ in anatomy. The research also provides insights onto how these strategies influence the student's probability of answering questions correctly. METHODS: Multiple-choice questions were created at three levels of cognitive functioning based on the ideas, connections, extensions (ICE) learning framework. The think-aloud protocol was used to unravel problem-solving strategies used by 92 undergraduate anatomy students as they solved multiple-choice questions. RESULTS: Sixteen strategies were identified through the oral and written think-alouds that students used to solve MCQ. Eleven of these have been described and supported by the literature, while the rest were utilized by our students when solving MCQ in anatomy. Domain-specific strategies of visualizing and recalling had the highest use. Personal connection was a strategy that allowed students to achieve success in all ICE levels in the oral think-alouds and in the I and E levels in the written think-alouds. CONCLUSIONS: This research argues that it is upon us as educators to make learning visible to our students, specifically through the use of think-alouds. It also raises awareness that when educators facilitate the process of students making personal connections, it aids students in new knowledge being integrated effectively and retrieved accurately.

The design and evaluation of a master of science program in anatomical sciences at Queen's University Canada.

The purpose of this study was to describe the design and evolution of a unique and successful Master of Science program in anatomical sciences at one Canadian post-secondary institution and to evaluate its long-term impact on student learning. This program prepares students to teach anatomy and design curricula in the anatomical sciences and is structured around three pillars of competency-content (disciplinary knowledge and transferable skills), pedagogy, and inquiry. Graduates of the program from the last ten years were surveyed, to better understand the knowledge, skills, and habits of mind they have adopted and implemented since completion. Interest was taken in identifying aspects of the program that students found particularly beneficial and areas that needed to be further developed. Based on the findings, this program has been a highly valuable experience for the graduates especially in helping them develop transferable skills, and grow as individuals. The hope is that other institutions that have similar programs in place or are considering developing them would benefit from this description of the program design and the sharing of the lessons learned.

Crossing boundaries: the design of an interdisciplinary training program to improve care for the frail elderly.

The Technology Evaluation in the Elderly Network (TVN) was funded in July 2012 under the Canadian Networks of Centres of Excellence program. This article highlights the development and preliminary evaluation of the TVN Interdisciplinary Training Program. This program is based on an experiential learning approach that crosses a multitude of disciplines including health sciences, law, social sciences, and ethical aspects of working with the frail elderly. Opportunities within the program include mentorship, interdisciplinary online collaborative projects, external placements, academic products, pre-grant submission, trainee-driven requirements, Network meetings, online modules/webinars, and most importantly active involvement with patients, families, and their support systems. The authors have 120 trainees from approximately 23 different disciplines including law, ethics, public policy, social work, and engineering engaged in the program. Based on our evaluation this program has been perceived as highly valuable by the participants and the community.

Potential therapeutic applications of phosphodiesterase inhibition in prostate cancer.

OBJECTIVE: Phosphodiesterases (PDEs) play a role in controlling cyclic nucleotide action, including cyclic guanosine monophosphate (cGMP). Previous studies have ascribed a protective role of cGMP signaling on hypoxia-mediated cancer progression. Herein, we determine their potential role in hypoxia-mediated chemoresistance and immune escape. MATERIALS AND METHODS: Phosphodiesterase assays were used to measure PDE activity in prostate cancer cell lines (DU145, PC3). Immunoblots were performed to determine the presence of PDEs in human prostate tissue samples. The effect of PDE inhibition on hypoxia-induced chemoresistance (compared to normoxic controls, 20% O2) was determined using clonogenic assays. Flow cytometry was used to determine the effects of PDE inhibition on surface MHC class I-related chain A (MICA), a natural killer (NK) cell-activating ligand. A mouse model was used to evaluate the in vivo effects of PDE inhibition on the growth of human prostate cancer cells. RESULTS: PDE5 and PDE11 were the most prominent PDEs in the cell lines, representing between 86 and 95% of the total cGMP-specific PDE activity. Treatment of DU-145 cells with a PDE inhibitor significantly reduced the hypoxia-associated acquisition of resistance to doxorubicin, with a mean 51% reduction in surviving fraction compared to controls (p < 0.001, ANOVA). As well, PDE inhibition completely reversed (p = 0.02, ANOVA) hypoxia-induced shedding of the immune stimulatory molecule, MICA, and attenuated the growth of human prostate tumor xenografts in an NK cell-competent murine model (p = 0.03, Wilcoxon, Mann-Whitney). CONCLUSIONS: These results suggest a rationale for future studies on the potential therapeutic applications of PDE inhibitors in men with prostate cancer.