The emphasis on resident competencies advocated by the Accreditation Council for Graduate Medical Education and other medical educators1 has brought new focus on the teaching competencies of our faculty. The expectation that teaching faculty possess a minimum level of teaching competency has been under discussion at our institution. In our recent (2008) peer-reviewed workshop at the Association of American Medical Colleges, we found that, among the 28 participants, no school was providing faculty development for competence in teaching. As increasing public scrutiny focuses on the medical professions, medical educators will be asked to be more accountable for training programs they are involved in and the teaching skills they possess.2
We are applying principle-based core teaching competencies at our institution across all specialty disciplines. We believe that having a set of core principles related to teaching competencies has many benefits. During the discussion in the aforementioned workshop, these benefits were further identified and defined, including clarifying teaching expectations for faculty, more directed development of assessment methods, increased accountability, and enhanced focus of faculty development efforts.
The knowledge base of competency in teaching can be assessed through written assessment, while the practice and application of the competencies are better evaluated through the use of objectively structured teaching exercises and peer observations.3 A mandated requirement of a minimum level of competence for all faculty members actively teaching continues to be a challenge, but perhaps formal documentation of participation in a faculty development program as indicated on the curriculum vitae may be an important first step; this is already required by many institutions.4 Clear definitions of teaching competencies provide a framework and language for system-wide standardization in any faculty development system. For example, teaching competencies could help define the focus of a faculty member's portfolio; influence resource allocations, recognition, and award incentives; and help enhance promotion efforts. Establishing widely accepted principles for teaching competencies further formalizes the validity and importance of teaching of medical trainees and would improve the quality of teaching.
Effective teaching attributes of clinical teachers have been described,5 although teachers and learners may disagree about what constitutes such attributes.6 Griffith et al7 showed that the quality of teaching improves student learning. The Stanford Faculty Development Program is well known for its behavioral teaching framework and validation of specific teaching behaviors.8 Academic competencies have been described for family medicine teachers9 and for internal medicine residents.10 Hesketh et al11 suggest an outcomes-based framework to define teacher competencies. An outcomes-based approach focuses more on the product than the process, and emphasizes learner outcomes as well as faculty outcomes for faculty development courses. Core teaching principles can guide teachers as they teach to whatever outcomes are set in the curriculum: the principles are applicable to all teachers.
We are proposing 7 principle-based teaching competencies (table).12–14 A principle is defined as “an accepted or professed rule of action or conduct,” “a fundamental, primary, or general truth from which others are derived,” or “a fundamental doctrine or truth.”15 Therefore, principles are core tenets that should be acceptable to all medical educators. Such principles provide the foundation from which other divergent perspectives can be developed, but the principles remain as the key basis for expectations. Principles can be informed by previous scholarly work, or principles can have such a strong degree of face validity that there is general, communal agreement on them (eg, “do no harm” in clinical medicine). Medical schools can develop their own set of principle-based teaching competencies and design faculty development programs that train faculty in these areas. Based on our review of previous scholarly work and our collective experience as medical educators, we have arrived at the following competencies as core for our program. Faculty should be competent in: developing a climate conducive to learning; methods of actively engaging learners; assessing a learner's knowledge, skills, and attitudes; facilitating the learner's educational goals; providing feedback to learners; having self-awareness of their own teaching competencies; and fostering self-directed and lifelong learning. Each of the 7 major competency categories has more specific capabilities associated with them that more clearly define the category and provide a means of assessing teacher competence.
Based in learning theory, we suggest that these principles apply to all learners (eg, student, faculty member) and learning venues (eg, small group, lecture). The expectations of the faculty teacher should remain the same. Some faculty may use these teaching principles naturally without having prior training or faculty development, based on knowledge of social learning theory and on their observations of effective teaching over the years. We suggest that our framework allows for a more comprehensive accountability for faculty competence in teaching.
The competencies listed in the table are deliberately defined as observable behaviors. Teaching skills are directly translatable to behavior; therefore, it is relatively easy to measure competency in skill areas. Knowledge of teaching can be “observed” through written or oral recitation of pertinent knowledge. Attitudes have been historically harder to “observe” when it comes to assuring and documenting that competency has been achieved and will continue to be a challenge. Yet, defining knowledge, skills, and attitudes remains relevant to determining measures and outcomes. We are proposing these principle-based competencies as the framework for further defining the desired outcomes and measures for specific learning/teaching contexts.
All 7 teaching principles should be incorporated into an overall teaching strategy. Our teaching faculty is encouraged to create an educational environment that is stimulating, motivating, safe, and conducive to learning. The ability to exert the appropriate amount of pressure for a particular learning activity, finding the optimum degree of stress that is enhancing learning rather than negating it, is an important competency. Both the teacher and learner should have the freedom to express doubt, uncertainty, and their own limitations. These characteristics create an educational climate that promotes learning.16 If one of the goals of teaching is to promote learning, facilitating the learner's positive perception of the learning environment is essential.17
Faculty should be able to actively engage learners.5 Learners who are disengaged or disinterested are not likely to learn in an effective or efficient manner. Within the lecture format, teaching need not be a one-way transfer of information.18,19 Involving learners in the activity can make the learning more relevant and effective, a characteristic that is especially relevant to adult learners. Action plans for further learning experiences are important to emphasize at the end of a learning activity. This de-emphasizes learning activities as isolated events and implies teacher availability and interest for further exploration.14
Competent faculty should be able to assess a learner's knowledge, skills, and attitudes. In order to help a learner improve, faculty should know how to determine the learner's level of competence with specificity in these 3 domains. This evaluation should be done through direct observation, supplemented by ancillary evaluation techniques such as active questioning, written examinations, objective structured examinations, and self-evaluation by the learner. Teachers can use a variety of questioning and nonquestioning techniques to engage their learners on a cognitive level.20,21 Determining the appropriate level of supervision is an essential skill for faculty, both for the sake of the learner and for patient care and safety. Knowing the difference between formative and summative evaluation, and possessing the ability to complete and use these assessments in a meaningful, constructive way, is a core competency for teaching faculty.
In defining the educational goals for their learners, faculty should be attuned to individual learning needs while meeting the specific requirements for professional training. This competency means that faculty should be able to express clear goals with learners, involve learners in prioritizing goals, and find the optimal learning opportunities to meet such goals. Competency-based medical education does not abrogate the responsibility of an individual teacher to establish and express goals for the learner. Actively engaging learners in establishing mutual goals can be accomplished with tools such as learning contracts.22
Many have described the importance of feedback skills for medical educators.23,24 Learners improve when faculty are competent in providing them with effective feedback. High-quality feedback should be timely, specific, descriptive, and related to learners' goals.25 Faculty should understand the characteristics of effective feedback and be able to provide feedback that results in improved learner performance. Giving appropriate feedback should be a fundamentally accepted competency for all faculty physicians.
Competent faculty should cultivate self-awareness of their own abilities and limitations. Without such awareness, improvement may be difficult. Faculty should be open to reviewing their teaching evaluations frequently, and subsequently determining areas for self-improvement. This competency requires the skill of self-reflection.26,27 The importance of reflective practice is gaining attention for teachers as well as medical practitioners.28 Faculty should know how to demonstrate and model professional and ethical behaviors, including self reflection, for their learners. We videotape each faculty member who participates in an objective structured teaching exercise station and we ask them to reflect on their interaction and their selected teaching strategies.
Because medicine is an ever-changing and growing profession, we believe that the faculty should be competent in fostering lifelong learning.29,30 The medical knowledge explosion requires physicians and all health care professionals to be committed, self-directed learners. Teachers should know how to encourage learners in developing such skills and in dealing with many uncertainties in clinical medicine. Faculty has the opportunity and responsibility to actively role model lifelong learning practices.
In summary, the shift in medical education toward learner competency will increasingly focus our attention in the direction of teacher competency. Recent efforts to support faculty teachers through academies have begun.31 However, academies may also focus on broader issues such as curricular reform, reward systems, and educational scholarship. We believe a set of principle-based teacher competencies provides an important framework to focus efforts in faculty development and improving faculty teaching skills. We hope our perspectives will promote local and national dialogue around this topic, as well as provide direction for future scholarly activity.
