Elmberger Agnes, Björck Erik, Nieminen Juha, Liljedahl Matilda, Bolander Laksov Klara
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.
BMC Med Educ. 2020 Dec 9;20(1):497. doi: 10.1186/s12909-020-02407-8.
Faculty development is important for advancing teaching practice in health professions education. However, little is known regarding how faculty development outcomes are achieved and how change in practice may happen through these activities. In this study, we explored how clinical educators integrated educational innovations, developed within a faculty development programme, into their clinical workplaces. Thus, the study seeks to widen the understanding of how change following faculty development unfolds in clinical systems.
The study was inspired by case study design and used a longitudinal faculty development programme as a case offering an opportunity to study how participants in faculty development work with change in practice. The study applied activity theory and its concept of activity systems in a thematic analysis of focus group interviews with 14 programme attendees. Participants represented two teaching hospitals, five clinical departments and five different health professions.
We present the activity systems involved in the integration process and the contradiction that arose between them as the innovations were introduced in the workplace. The findings depict how the faculty development participants and the clinicians teaching in the workplace interacted to overcome this contradiction through iterative processes of negotiating a mandate for change, reconceptualising the innovation in response to workplace reactions, and reconciliation as temporary equilibria between the systems.
The study depicts the complexities of how educational change is brought about in the workplace after faculty development. Based on our findings and the activity theoretical concept of knotworking, we suggest that these complex processes may be understood as collaborative knotworking between faculty development participants and workplace staff through which both the output from faculty development and the workplace practices are transformed. Increasing our awareness of these intricate processes is important for enhancing our ability to make faculty development reach its full potential in bringing educational change in practice.
教师发展对于推进卫生专业教育中的教学实践至关重要。然而，关于如何实现教师发展成果以及这些活动如何促使实践发生改变，我们知之甚少。在本研究中，我们探讨了临床教育工作者如何将教师发展计划中开发的教育创新融入其临床工作场所。因此，本研究旨在拓宽对教师发展后临床系统中变革如何展开的理解。
本研究受案例研究设计启发，将一个纵向教师发展计划作为案例，该案例提供了一个机会来研究教师发展参与者如何应对实践中的变化。本研究在对14名项目参与者进行焦点小组访谈的主题分析中应用了活动理论及其活动系统概念。参与者来自两家教学医院、五个临床科室和五个不同的卫生专业。
我们展示了整合过程中涉及的活动系统以及在工作场所引入创新时它们之间出现的矛盾。研究结果描述了教师发展参与者与工作场所的临床教师如何通过反复协商变革授权、根据工作场所的反应重新构想创新以及作为系统之间临时平衡的调和等过程进行互动，以克服这一矛盾。
本研究描述了教师发展后工作场所教育变革实现方式的复杂性。基于我们的研究结果以及活动理论中的节点工作概念，我们建议这些复杂过程可被理解为教师发展参与者与工作场所工作人员之间的协作节点工作，通过这一过程，教师发展的成果和工作场所实践都得到了转变。提高我们对这些复杂过程的认识对于增强我们使教师发展在实践中充分发挥其带来教育变革潜力的能力非常重要。
