Tying the knot between faculty development and educational change in clinical settings

Clinical workplaces offer important learning experiences for the next generation of health professionals, and clinicians serving as supervisors and educators are a critical determinant of the quality of learning in these settings. However, many clinicians are unprepared for their educational roles, and the complexity and changing nature of health care present substantial challenges that threaten the quality of clinical education. As a way to address these issues, there has been increasing provision of faculty development targeting teaching clinicians. While such initiatives are often appreciated, there are questions regarding their impact on teaching practices and the inadequacy of current research approaches in addressing how faculty development may contribute to change in practice. Yet, such understandings are crucial for faculty development to enhance the quality of teaching.

The overall aim of this thesis was to explore faculty development and educational change in clinical settings. Employing a socio-cultural perspective, it breaks from traditional notions of linear knowledge transfer. Specifically, activity theory was applied to emphasise individuals as acting within social and cultural systems, and four qualitative studies were conducted. Study I explored how clinical educators’ engagement in faculty development was affected by the systems they act within. Study II explored experiences of working with educational change in clinical workplaces from the perspective of clinical educators from two different countries. Study III explored how clinical educators integrated educational innovations developed in a faculty development programme into their clinical workplaces. Lastly, Study IV identified aspects of a faculty development programme that supported participants in working with educational change in practice.

The findings suggest that the tensions between education, research and patient care in clinical settings – where the activity of education is less valued – limit clinical educators’ opportunities for faculty development and educational change. The findings further emphasise educational change as dynamic and collaborative processes that are heavily influenced by workplace context, and thus alludes to the limitations of the concept of knowledge transfer. In contrast, collaborative knotworking is suggested to more rightfully conceptualise how faculty development can contribute to educational change in clinical settings. Taken together, the findings contribute to the understanding of educational change as dynamic, interactive and influenced by the context in which it unfolds. This has implications for how to design faculty development activities that support participants in working with change in practice, thus moving towards tying the knot between faculty development and educational change in clinical settings.

List of scientific papers

I. Elmberger A, Björck E, Liljedahl M, Nieminen J, Bolander Laksov K. (2019). Contradictions in clinical teachers’ engagement in educational development: an activity theory analysis. Advances in Health Sciences Education. 24(1), 125–140.
https://doi.org/10.1007/s10459-018-9853-y

II. Elmberger A, Blitz J, Björck E, Nieminen J, Bolander Laksov K. “It’s not our job to transform people”: A multi-institutional study of clinical educators’ experiences from working with change. [Manuscript]

III. Elmberger A, Björck E, Nieminen J, Liljedahl M, Bolander Laksov K. (2020). Collaborative knotworking – transforming clinical teaching practice through faculty development. BMC Medical Education. 20:497.
https://doi.org/10.1186/s12909-020-02407-8

IV. Bolander Laksov K, Elmberger A, Liljedahl M, Björck, E. (2020). Shifting to Team-based Faculty Development: a Programme designed to facilitate change in Medical Education. Higher Education Research & Development.
https://doi.org/10.1080/07294360.2020.1841122