Professional development for medical educators and clinical teachers : challenges and opportunities

Medical educators and clinical teachers are increasingly required to become involved in (and to lead) teaching, learning, assessment and supervisory activities with medical students, trainees and other health professionals. Alongside this, medical education itself is becoming more professionalised, driven by quality assurance activities in both undergraduate and postgraduate contexts. This article considers challenges and opportunities for medical educators and clinicians when engaging in professional development activities.


Introduction
The context of medical education is changing.Swanwick (2008) suggests that postgraduate medical education is moving into a new era driven by the three interlinked trends of professionalisation, increasing accountability and the pursuit of excellence.However, all those involved in clinical teaching and medical education are increasingly required to deliver high quality teaching, learning, assessment and supervisory activities with medical students, trainees and other health professionals.Medical education is becoming more professionalised, driven by quality assurance activities and requirements from professional and statutory bodies in both undergraduate and postgraduate contexts.This article considers some of the challenges for medical educators and clinicians when engaging in professional development activities and explores opportunities for medical educators and those responsible for medical students' and trainees' education and training to develop their educational expertise.The article also considers how organisations have responded to external drivers and changing expectations.

The importance of professional development
All areas of healthcare and education are moving towards more 'professionalised' systems and expectations from those involved.
Professionalisation involves developing sets of standards against which people or organisations can be measured and towards which they can strive.Professionalisation also involves the idea of continuing development and revalidation, in order to stay 'professional' (whether this is through a formal registration process or not), there may be requirements to stay current and up to date in your area of expertise.In terms of medical or clinical education, teachers need to reach a level of knowledge, skills and behaviours, which may be learned on a course or 'on the job' and which may be measured through formal assessment or more informally in practice.They should then aim to keep up to date in their area through continuing professional development activities (CPD).For medical educators, this includes a combination of staying current in terms of clinical or scientific knowledge and skills whilst also staying up to date with contemporary teaching, learning and assessment methods.Managing development in both these aspects can be very demanding particularly for clinical educators who also have to deliver the health service.However, regulatory and professional bodies increasingly require doctors and other health professionals to be able to provide evidence of professional development relating to teaching as well as clinical competence.
We move on to explore issues for medical and clinical educators using the COINNS model of professional development (McKimm et al., 2008) (Spencer, 2003;Swanwick & McKimm, 2010).
Although there are many challenges for those involved in teaching, training and assessing medical students and junior doctors, the changing face of university and postgraduate medical education has also given rise to a number of career and training opportunities.

Opportunities
In the university sector, medical education is slowly becoming regarded as a specialty in its own right, stimulating a wide range of roles and career options to support teaching, learning and assessment activities.Most undergraduate medical programmes require students to study in a blended learning model which includes face to face laboratory, classroom and lecture sessions, e-learning and simulated activities and clinical placements or apprenticeships.Other modes of learning, such as Problem Based Learning (PBL) or Team Based Learning (TBL) provide interesting opportunities for teachers to extend existing teaching skills and learn new ways of working.Other opportunities are emerging as the medical curriculum expands to include a wider range of topics such as communication skills, professionalism, medical ethics and law and research skills.As curricula become increasingly integrated, teachers with experience and interest in the social and behavioural sciences and public health are required as well as in more conventional topics.
Just as opportunities relating to subject content and teaching, learning and assessment methods are increasing, so are those relating to educational leadership.There are many leadership roles in undergraduate and postgraduate education for medical educators throughout organisations, including those at course or programme level, in relation to subject areas, clinical teaching, assessment or quality assurance.Increasingly, educational leaders need to work collaboratively between organisations, departments or professions as well as having an expertise in some area of education.The need for those in leadership roles to engage in leadership development is well-evidenced (Grint, 1999;Day, 2001;Kouzes & Posner, 2002; NHS Institute for Innovation and Improvement, 2006) to help develop skills including those of working with people, managing change and complexity, strategic management and leading teams (Degeling et al., 2003;Hayes, 2002;Northouse, 2004).
The need for sustaining a viable number of high quality clinical academics to ensure the quality of clinical education and training has stimulated a focus on recruiting and retaining clinicians who will take a lead in medical education in their specialty or with a broader remit.In some countries (e.g. the UK and US) junior doctors are being identified as potential educators and new career paths have been established (eg academic teaching fellows).
Many universities have departments of medical education which provide a focus for academic activities, including research and professional development programmes.The recent UK General Medical Council's recommendations on undergraduate medical education, Tomorrow's Doctors (GMC, 2009) suggest that medical students should be trained in basic teaching skills and be provided with opportunities to teach others.Swanwick and McKimm suggest that "although this poses the challenge of fitting yet another topic into crowded undergraduate curricula ...over time, more doctors will be formally trained to teach and they will not acquire these skills opportunistically or serendipitously" (2010, in press).
In the health service sector there is increasing recognition that it is not enough to simply assume that all clinicians have the skills, ability and willingness to deliver high quality education and supervision.The quality of supervision for example, is closely linked to the quality of patient care (Kilminster et al., 2007)

Summary
This article has provided an overview of the challenges and opportunities available to medical educators and clinical teachers who wish to develop their knowledge, understanding and skills in education.There are many activities available, ranging from local, small scale activities to international events.The international community of medical educators welcomes those from all organisations and there is a wealth of information available to support teachers, trainers and supervisors.In the 'Education in Practice' series we will explore different topics in medical education supported by case studies to highlight different approaches taken by organisations and individuals.The series is designed to provide background information and discussion on selected aspects of medical education to help support the professional development needs of medical educators.

Take a lead...
If you are more confident in your teaching skills then think about moving into an educational leadership role.This might include applying for a formal teaching or educational management position or setting up or running an educational interest group, research meeting or local event for those involved in teaching and learning (this might include trainees, students or colleagues).You may also become involved in training the trainers programmes, educational projects or research.