The expected results of faculty development programs in medical professionalism from the viewpoint of medical education experts
Nikoo Yamani, Mahsa Shakour, Alireza Yousefi
Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Submission||16-Nov-2015|
|Date of Decision||16-Dec-2015|
|Date of Acceptance||25-Jan-2016|
|Date of Web Publication||23-Feb-2016|
Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Background: Despite the great emphasis on teaching professionalism in universities, creating changes in one's professional behavior is a serious challenge in medical education. In this regard, one cannot ignore the role of faculty members. The present study was set to investigate the opinions of medical education experts about the expected results of faculty development programs regarding teaching and learning professionalism. Materials and Methods: The study was carried out in two phases including content analysis study and Delphi. In the first phase, 10 medical education experts participated in the study. Data gathering was carried out using semi-structured interviews. Codes were analyzed using classic content analysis method. In the second phase, a six-member focus group and Delphi with 23 experts from across the country participated, and themes from the previous phase were confirmed and finalized. Results: Analysis of the content of the interviews in the first phase and discussing in the focus group and Delphi showed two main themes: 1) direct results and 2) indirect results with six subthemes. Direct results included three subthemes of creating role model faculty members, scientific improvement, improving professionalism, and inspiring the students; indirect results included three subthemes of change in educational environment of the university, change in the university system, and effects on the society's culture. Conclusion: Faculty development in professionalism can contribute to university faculty members to become better role models and inspire their students, peers, and even the society. Therefore, improving professional behavior in university faculty members can have direct and indirect effects on improving the society due to their crucial role.
Keywords: Faculty, medical education, medicine, professional, staff development
|How to cite this article:|
Yamani N, Shakour M, Yousefi A. The expected results of faculty development programs in medical professionalism from the viewpoint of medical education experts. J Res Med Sci 2016;21:11
|How to cite this URL:|
Yamani N, Shakour M, Yousefi A. The expected results of faculty development programs in medical professionalism from the viewpoint of medical education experts. J Res Med Sci [serial online] 2016 [cited 2022 Nov 26];21:11. Available from: https://www.jmsjournal.net/text.asp?2016/21/1/11/177370
| Introduction|| |
One of the characteristics expected from all graduates in medical sciences is appropriate professional behavior. Professionalism is an important part of the contract between society and medical experts, stating that not only must the decisions be correct, but they need to be professional and benefit the patients as well.  According to Cohen (2007), professionalism is a way for acting and behaving upon certain norms, and according to Haferty (2006), professionalism in medicine must be based on knowledge, skill, moral codes, and dedication in providing medical services. 
One of the important topics for discussion in many medical universities is professionalism. Various studies on professional behavior show that professionalism is an important topic in medical education. For example, a quick look at medical education journals in recent years shows that articles on teaching professionalism are among these with the highest number of citations.  Most prestigious universities have designed and implemented appropriate curriculums for teaching professionalism along with such studies and have used continuous education programs in order to improve professionalism in their students and faculty members. 
Despite the great emphasis on teaching professionalism in various universities around the world, creating changes in one's professional behavior is a serious challenge in medical education.  In this regard, one cannot ignore the role of faculty members.  One of the important factors regarding professionalism is the capability of faculty members as role models acting as a professional model while teaching professional behavior to their students.  Additionally, the teaching method used for medical students is another topic for discussion.  Many faculty members are unable to articulate the attributes and behaviors characteristic of health workers as professionals and do not serve as effective role models. They have not mastered teaching and evaluation methods. As a result, in both cases, it is necessary to provide the faculty members with appropriate information and design and implement suitable faculty development programs in order to achieve the determined goals. However, in medical science universities of Iran, this is often ignored, and the lack of appropriate studies and plans is especially obvious in teaching professionalism in medical education.
We supposed that it is possible to have faculty development programs for professionalism to teach clinical teachers, how to be professional, act in professional manner, and how to teach professionalism to the students. It is obvious that before implementation of any development program, it is necessary to determine the expected goals of the program to gain the necessary support for the initiation and implementation of the development program. Therefore, the current study set to determine the expected results of faculty development programs in teaching and professional behavior based on medical education experts' points of view.
| Materials and methods|| |
This study was carried out in two phases. The first phase was a qualitative and content analysis study; the second phase was qualitative study and we used focus groups and Delphi to reach a consensus among experts. The aim of the study was to investigate the expected results of faculty development for teaching professionalism based on the opinions of experts. The study was done in Isfahan University of Medical Sciences, Isfahan, Iran in 2015. Ten experts as participants were selected among high-ranking managers and faculty members in various Iranian medical sciences universities and Ministry of Health and Medical Education who had at least 5 years of medical teaching experience in Iranian medical science universities. Attempt was made to select experienced medical teachers who were managers and experienced in teaching and faculty development. Given the fact that in qualitative studies acquisition of deep and useful information is a basis for the study, purposive sampling method was used to select experts with higher experiences regarding the subject of the study.  The participants were selected based on their experience and ability to express their experiences. Because in qualitative studies, the main focus is the quality of gathered information instead of the sample size, the purposive sampling progressed until the required information saturation was achieved.  Data gathering was carried out using semi-structured interviews which are of the main methods of information gathering in qualitative studies.  Researchers contacted the participants and met them at a location agreed upon, after setting up an appointment. The main questions were "Is faculty development for professionalism practicable? What are the expected results for faculty development on teaching and learning professionalism?"
In order to ease the interview process, interviews were not fully open and not fully structured so as to maximize efficiency and response. The interviews were semi-structured, and some of the questions were completed and edited during the study. The interviews were recorded and transcribed verbatim after obtaining informed consents from research participants. Afterwards, the interviews were transcribed, and the information was extracted, and then coding and analysis were carried out using classic content analysis method which is a content analysis performed without sufficient theoretical information.  Accordingly, at first, related words were extracted from the text, and then the related concepts were determined according to the inductive method. The concepts were given suitable labels and codes and were categorized based on their differences. Categorization was carried out, based on the judgment of the researcher, and no previously defined categorization was used.
In order to determine the trustworthiness of the study, Guba and Lincoln criteria, credibility, transferability, and dependability were used.  To meet the credibility criteria, in addition to the long-term involvement of researchers in the process of data gathering, analysis, and evolution of data (taking more than 6 months); the peer review method was employed as well. In order to ensure the transferability of the study results, the details of the extracted qualitative aspects were described in a way to be used in both Iran and other countries. Additionally, based on Guion's method, triangulation method was used in data gathering, and information sources for answering the main research questions and the accuracy of the data were confirmed. Using this method, credibility and verifiability of the findings of this phase were confirmed by using Delphi and focus group. 
The second phase of the study was mostly designed in order to confirm and complete the list of expected results of faculty development programs using focus groups and Delphi. In the first part, two focus group sessions with six researchers and experts in medical education completed and corrected the results of the first phase which were then sent for Delphi session. The study environment consisted of all medical science universities of Iran using purposive sampling. The participants invited to Delphi session included 23 faculty members who were experts in the fields of medical education, ethics, or professional charter from across the country. Themes extracted in the previous phase were concentrated on and categorized by researchers and presented to the invited participants in the Delphi session. In this part, all the results of the previous phase were sent to the participants and they were asked to describe their opinions about each theme and to add any theme they thought as missing. Finally, all the opinions were gathered, and final categorization of the expected results was carried out.
| Results|| |
In this phase, interviews were conducted with ten experts in medical education, eight of which were males and two were females. All interviewed experts were employed in higher management roles and had at least 10 years of teaching experience. The analysis of the expected results data of faculty development programs in the area of professionalism resulted in two main themes and six subthemes. Two main themes included "expected direct results" and "expected indirect results." Expected direct results theme is output, outcome level one or two that have effect on attitude, knowledge, skills, and behavior; it included three subthemes of creating role model for faculty members, improving professionalism, and inspiring the students; expected indirect results theme has an effect on organization and society; it included three subthemes of change in educational environment of the university, change in the university system, and effects on the society's culture.
Expected direct results
Creating role model for faculty members
One of the direct results of faculty development in the area of learning and implementation of professionalism is the creation of role models for faculty members who can have an important role in improving the professional behavior of students and other faculty members. In this regard, one of the experts says: "The highest forms of teaching professionalism are behavior role models. If we want to teach professionalism, we have no other way except fostering faculty members in universities."
According to the participants, development in the area of professionalism is possible and can improve professional behavior. Among the codes in this subtheme, one can mention gradual improvement, preventing deterioration, and simultaneous development of faculty members. Some of the participants noted that professional behavior can be improved, but this improvement is not fast or very tangible. For example, one participant stated: "We have done a great thing if we can improve people just a little or prevent them from getting any worse." The other participant mentioned that "professionalism will be improved, of course may be not happen at the best level,…"
Inspiring the students
One of the direct results mentioned by the participants is inspiring students by faculty members with suitable professional behavior that can lead to better professionalism in the students. In this regard, one of the participants says: "We are all behavioral role models. This means all the students and interns watch us, and we are their role models. If we behave properly, they learn the right thing, and if we behave wrong, they learn the wrong."
The other participants said "…Learning of professionalism is like other competencies, the students see what teacher does, and then they do, and do again...She/he learn professionalism during the time…"
The other quotation is added.
Expected indirect results
Change in educational environment of the university
According to the participants, faculty development can have positive effects on the educational environment of the university and may improve education. Faculty development can act as a satiable step in adding professionalism to the curriculum of the students as well. Another effect mentioned was professionalism entering the speeches of faculty members that can act both as a method for improving professional behavior in the students and as a result of faculty development programs. One of the participants stated: "The result is that professionalism involves in normal speech patterns of faculty members, i.e., when faculty members talk to each other, they state their opinions about a particular behavior or action as being professional or unprofessional, or conducting it assumed as against professionalism. These words enter their daily speech little by little."
Change in the university system
The university system is a combination of related things or parts that form an educational institution, an institution of higher learning authorized to grant academic degrees. According to the participants, faculty development in the area of professionalism can be effective in improving a university system and implementing theoretical knowledge about ethics and evaluation of behaviors in the university. In this regard, one of the participants said: "Hopefully, we are moving toward acting, based on the criteria we use to evaluate others."
Effects on the society's culture
According to the participants, the effects of development in professionalism can be more compared with university and faculty members and can indirectly affect the society as a whole. Faculty members and students contemplating based on these rules can play important roles in the betterment of the society and "… this professional behavior can be a prelude to social change" or according to one of the participants: "If we manage to improve people (faculty members), our final output will be that more worthy students that can do better jobs … and the final goal will be improvement of the society."
In the second phase, the results obtained from the previous phase were introduced to the focus group. After analyzing the expected results, the subtheme of "improvement in science of professionalism," not mentioned in the interviews, was added to the main theme of direct results of the development. Then, all expected results were investigated using the Delphi method. Twenty three experts participated in the Delphi phase including 10 women and 13 men; seven individuals were assistant professors and 15 were associate professors. The average teaching experience of the participants was 22 years, and their average management experience was 13 years.
Based on the Delphi results, three of the expected results were grammatically corrected, and 100% of the participants agreed with the results while adding three new suggestions. One of the participants stated that creating role model faculty members, improving professionalism among faculty members, and improving professional behavior in the society are more important than other expected results.
Finally, by evaluating the opinions of the participants in the Delphi phase, small changes were made in the main themes and subthemes, and the results were finalized. The final list of expected results of faculty development programs in teaching and learning professionalism included two main themes and seven subthemes [Table 1].
|Table 1: Expected results of faculty development programs in teaching and learning professionalism|
Click here to view
Except for the above categorization, the researchers suggested another categorization according to place-action. In this categorization, the subthemes are categorized into three main themes. The main themes are 1) society, 2) university, and 3) teachers. The following subthemes are considered for university: "Inspiring the students," "improvement in science of professionalism," "change in organizational culture," and "change in environment of the university." Two subthemes are assumed for teachers: "Creating proper role models between faculty members" and "improving professionalism." Moreover, faculty development programs in professionalism are effective to the "society's culture." The main themes and their situations are shown in [Figure 1].
| Discussion|| |
According to medical education experts, faculty development in the area of teaching and learning professionalism can have important results. This development means that, first of all, faculty members themselves need to follow rules of professionalism and know how to teach professionalism to others. This development not only affects the faculty members themselves, but can additionally affect others as well.
One of the themes emphasized in spreading professional behavior is having a role model faculty member because being a role model is the most effective method of teaching professional behavior. A role model faculty member is different from a mentor; a mentor provides advice and shows the right way,  while a role model faculty member is someone with characteristics that we want to have or is in a place we want to be. A role model faculty member can inspire behavioral norms, attitudes, and proper behavior in the students.  A role model faculty member can consciously and unconsciously teach professional behavior to the students and can be effective in teaching informal curriculum that includes unscheduled education.  A role model faculty member is additionally effective in transferring hidden curriculum that includes all activities and teachings that happen outside the formal curriculum  and is learnt through behaviors and attitudes of faculty members.  Given the fact that hidden curriculum is known to be the most powerful tool for transferring professional behavior to students,  along with teaching the formal curriculum, a role model faculty member can be effective in transferring informal and hidden curriculum, especially when it comes to professional behavior.
For countries such as Iran where there is no codified curriculum for teaching professionalism in all universities, the role of faculty members will be even more important. For example, the results of a study in Iran shows that more than 40% of interns believe that the effect of role model faculty members in teaching professional behavior is very high.  Therefore, training role model faculty members can be a suitable method for teaching professionalism. In addition, given the fact that one of the best strategies for training role model faculty members is informing the faculty members about their role as models for students,  it is necessary to have a suitable program for this purpose that can be namely the faculty development program.
One of the themes was "Improving professionalism." According to the participants, a faculty member trained the principals of professionalism and provided with suitable conditions for the development that can improve the professionalism among all other faculty members of the university. Faculty members that participate in the faculty development programs in the area of professionalism can play a leading role in their own departments  and can in turn improve professionalism among all other faculty members. Accordingly, if all faculty members participate in these development programs, the results would be a faculty with high levels of professionalism that can improve the organization as a whole.
According to the participants, faculty development in the area of professionalism can be effective in changing the educational environment of the university because faculty members are an important part of every university. Therefore, development of faculty members in the area of professionalism can create a professional environment in the university.
The other theme in this study was "Change in environment of the university." In the educational environment of the university, most teachings in the area of professionalism are conducted through hidden curriculum. As there is a hidden curriculum for students, there is a hidden curriculum for faculty members as well, with peers acting as indirect sources of learning.  There are many studies about hidden curriculum and its effects on students, but there are fewer studies on hidden curriculum for faculty members. Hidden curriculum of organizations  and organizational culture  can affect the behaviors of faculty members, and according to Hafler, it is possible for faculty development programs to help understand and develop hidden curriculum and organizational culture. On the other hand, behaviors of faculty members as part of the organization can affect the organization as a whole.  Therefore, faculty development programs in the area of professionalism can promote professional behavior among members of the organization that will cause a general improvement in the university's environment, which in turn, leads to improvement of its members. This causes a feedback loop as a result of faculty development programs that causes these programs to get stronger over time and improves the educational environment of the university as well. This result is confirmed by Cue Simone's study. She pointed out that in an organization, a positive climate helps to promote humanity and organizational growth. 
A faculty member in a university is in a position that can create positive changes in students and train competent workers that can have a positive effect on the society as a whole.  Therefore, development of all faculty members in the area of ethics can have indirect effects on the society and can improve a university as an organization as well. A university is an educational organization that has a crucial role in the improvement of citizens and creating social justice,  hence, improvement of universities can improve the society. According to the participants, improvement of university and society is one of the indirect effects of faculty development in the area of professionalism.
Another expected result regarding faculty development programs is the improvement in the science of professionalism. According to Paton, a suitable curriculum can improve the organization's knowledge and needs to be considered during evaluations.  In addition, the participants in this study believed that the process of faculty development in the area of professionalism can improve the science of professionalism. In addition, given the fact that the conductors and participants in these development programs were faculty members, these programs may have high scientific levels and may be have proper opportunities for scientific production.
One of the limitations of this study was the limited time of faculty members, resulting in incomplete data and each phase lasting for more than 6 months. It is recommended to conduct a similar study with respect to the process of implementation of the development programs.
| Conclusion|| |
Faculty development in the area of teaching and learning professionalism can have valuable results as a new program among faculty development programs for medical science faculty members in Iran. Predicting the results of these development programs can be effective in creating motivation in faculty members' participation and gaining the necessary support for implementation of these programs. According to the experts, faculty development in the area of professionalism can create role model faculty members for students, peers, and the society as a whole. Therefore, improving professional behavior of faculty members can have direct and indirect effects due to the role of faculty members and universities in the society. In addition, scientific background of participants and conductors of these programs can improve the knowledge of professional behavior. Thus, and given the abovementioned results and despite the difficulty in implementation of faculty development programs, the value of these programs is apparent, and managers of higher education need to have proper plans for implementation of faculty development programs.
This paper is the result of an approved PhD thesis in Isfahan University of Medical Sciences (IUMS) (no. 393500). The authors wish to thank the vice-chancellor on research in Isfahan University of Medical Sciences who supported this study and also wish to thank all participants, Medical Education Board members for their excellent cooperation, and other experts for their great help in conducting this research.
Financial support and sponsorship
Conflicts of interest
The authors declare no conflicting interest.
| Authors Contribution|| |
MSh: writing proposal, data gathering, data analysing, writing report. NY: Editing and analyzing. AY: consulting.
| References|| |
Kirk LM. Professionalism in medicine: Definitions and considerations for teaching. Proc (Bayl Univ Med Cent) 2007;20: 13-6.
Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. Defining professionalism in medical education: A systematic review. Med Teach 2014;36:47-61.
Azer SA. The top-cited articles in medical education: A bibliometric analysis. Acad Med 2015;90:1147-61.
Goldstein EA, Maestas RR, Fryer-Edwards K, Wenrich MD, Oelschlager AM, Baernstein A, et al
. Professionalism in medical education: An institutional challenge. Acad Med 2006;81:871-6.
Donetto S. Medical students′ views of power in doctor-patient interactions: The value of teacher-learner relationships. Med Educ 2010;44:187-96.
Harris GD. Professionalism: Part I - Introduction and being a role model. Fam Med 2004;36:314-5.
Swick HM, Szenas P, Danoff D, Whitcomb ME. Teaching professionalism in undergraduate medical education. JAMA 1999;282:830-2.
Biabangard E. Research Methods in Psychology and Educational Sciences. Tehran: Doran; 2005. p. 303.
Burns N, Grove KC. Understanding Nursing Research. 4 th
ed. Philadelphia: WB Saunders; 2001.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88.
Lincoln Y, Guba E. Naturalistic Inquiry. Newbury Park, CA: Sage Publications; 1985. p. 290-300.
Lichtman M. Qualitative Research in Education: A User′s Guide. London: Sage; 2010. p. 290.
Cruess SR, Cruess RL, Steinert Y. Role modelling-making the most of a powerful teaching strategy. BMJ 2008;336:718-21.
Paice E, Heard S, Moss F. How important are role models in making good doctors? BMJ 2002;325:707-10.
Lempp H, Seale C. The hidden curriculum in undergraduate medical education: Qualitative study of medical students′ perceptions of teaching. BMJ 2004;329:770-3.
D′eon M, Lear N, Turner M, Jones C; Canadian Association of Medical Education. Perils of the hidden curriculum revisited. Med Teach 2007;29:295-6.
Cohen JJ. Professionalism in medical education, an American perspective: From evidence to accountability. Med Educ 2006; 40:607-17.
Saberi A, Nemati S, Fakhrieh AS, Heydarzadeh A, Fahimi A. Education of medical professionalism and the role of educators of Guilan University of Medical Sciences, Iran, according to its residents. Strides Dev Med Educ 2013; 10:100-6.
Steinert Y, Cruess S, Cruess R, Snell L. Faculty development for teaching and evaluating professionalism: From programme design to curriculum change. Med Educ 2005;39:127-36.
Hamstra SJ, Woodrow SI, Mangrulkar RS. Feeling pressure to stay late: Socialisation and professional identity formation in graduate medical education. Med Educ 2008;42:7-9.
Abbasi E, Zamani-Miandashti N. The role of transformational leadership, organizational culture and organizational learning in improving the performance of Iranian agricultural faculties. High Educ 2013;66:505-19.
Hafler JP, Ownby AR, Thompson BM, Fasser CE, Grigsby K, Haidet P, et al
. Decoding the learning environment of medical education: A hidden curriculum perspective for faculty development. Acad Med 2011;86:440-4.
De Simone S. The affective component of workplace in organizational behavior studies. AIJCR 2014;4:38-43.
Kalanick K. Educational Pathways: A Faculty Development Resource. 1 st
ed. United States: Delmar Cengage Learning; 2007. p. 368.
Harkavy I. The role of universities in advancing citizenship and social justice in the 21 st
century. Educ Citizen Soc Justice 2006;1:5-37.
Stufflebeam DL, Shinkfield AJ. Evaluation Theory, Models, and Applications. San Francisco, California: Jossey-Bass; 2007. p. 264.