Needs assessment for faculty development at an Egyptian medical school: a triangulation approach

INTRODUCTION

Faculty members are the mainstay of any health profession education system, and their roles and responsibilities are dramatically evolving in response to the ongoing major changes in the healthcare system, medical education, scientific research, and society. Medical faculty are now expected to be excellent teachers, innovative researchers, competent clinicians, successful managers, and inspirational academic leaders.^1,2 However, faculty have been minimally prepared for many of these roles, particularly teaching; it has been wrongly assumed that faculty, being expert in content (what to teach), are effectively capable of teaching (how to teach).³ Therefore, increasing attention has been placed worldwide on the design and implementation of time-efficient programs to continually enhance the capabilities of medical faculty in teaching as well as other development areas. This has been called faculty development (FD).^2,4

FD has been systematically introduced to Egyptian public universities since only the beginning of the 21^st Century. Between 2002 and 2008, the Egyptian government and World bank implemented the higher education enhancement project (HEEP) initiative for improving the quality and efficiency of Egyptian higher education. One of the main six HEEP subprojects was the faculty and leadership development project (FLDP), which worked for enhancing Egyptian faculty competencies in areas of teaching, scientific research, management and leadership, and group communication and interaction. FLDP resulted in the establishment of the National center for faculty and leadership development as well as a faculty and leadership development Center (FLDC) at each public university.^5,6 The impact assessment of FLDP was moderately satisfactory, and its training activities have remained in operation funded by the Egyptian government and universities.^7,5

Successful FD requires a systematic design, implementation, and evaluation approach that aligns the goals of individual faculty and institution. Awareness of the specific development needs of target faculty is central to planning current and relevant FD programs with effective use of limited institutional resources.⁸ According to the compass model for FD planning and self-determination theory, planning for FD should consider the interplay between intrinsic (autonomous) and extrinsic (controlled) motivational factors. Intrinsic inputs reflect the competencies of individual faculty and their interest areas, while extrinsic inputs represent institutional strategies and available resources. Thus, needs assessment for FD should align individual and institutional goals; surveying target faculty for perceived development needs is an invaluable component in a sound needs assessment process but is not the whole process itself.^9,10

Benefits of the needs assessment are not limited to its results (specifying target needs and factors affecting them, align individual and institutional goals, and providing baseline information for program evaluation) but extend to the process itself through creating a sense of ownership leading to higher faculty engagement, motivation, and early buy-in of FD programs with increased likelihood of positive behavioral change.^2,11 Learners, in general, tend to adopt new behaviors if interventions are planned according to a needs assessment.¹² The most commonly used data collection methods for needs assessment are survey, interview/focus group, observation, and secondary data; each of which has its own strengths and weaknesses. Therefore, it is a good practice to use more than one method.^2,13

To the best of our knowledge, there has been no published needs assessment for medical FD in Egypt. The present study aims to explore the perceived development needs of medical faculty at Sohag University in order to inform contextualized/situational and efficient FD planning. The importance of this study extends beyond its local context to include potentially replicable approach and future research insights.

METHODS

The present study followed a sequential mixed-methods research design with data-triangulation, in which the quantitative component preceded the qualitative component. The study was conducted from June to December 2019 at Faculty of Medicine, Sohag University (FOM-SU). FOM-SU is located in Southern Egypt and has been established since 1991. It has a total of 32 academic departments and corresponding educational programs with 794 full-time faculty members. As of 2018/2019 academic-year statistics, there were 2193 enrolled undergraduate students.¹⁴ Eligible participants for this study were full-time faculty at FOM-SU, including professors, associate professors, assistant-lecturers and demonstrators. We excluded faculty who were not on-job at FOM-SU either during study timeframe or for more than three months in the last year.

Authors employed a triangulation approach, using multiple data collection methods: reviewing documents, web-based survey, and semi-structured interviews.

Reviewing documents

After obtaining approval from FOM-SU administration, we reviewed relevant records and documents including the most-recently prepared self-study (ver-2019).

Web-based survey

Authors developed a survey (needs assessment for faculty development survey; NAFDS) based on literature review and following the guidelines for conducting survey and interview research. Published surveys have discrepancies in defining FD construct in terms of focusing on certain FD needs domains (e.g., teaching, research, and/or leadership and career development) but ignoring others (e.g., discipline-specific development); moreover, delivery, scheduling, advertising, and motivation preferences are not consistently included.^2,8,15-24 Since proper and consistent construct interpretation is the basis for survey development and validation, authors interviewed 27 faculty members to explore understanding and conceptualization of FD construct; this emphasized all FD domains described in the literature including discipline-specific development.^23,24 Accordingly, FD was defined in this study as “the range of planned activities that institutions utilize to continuously promote faculty in their essential roles: teaching/learning, research/scholarship, leadership/administration, career development, and discipline-specific activities”. Survey development included validation with seven external experts, cognitive interviews with 14 prospective participants, and pilot testing.

The final NAFDS used in this study was formed of seven sections with a total of 74 items, including six open-ended questions to give participants a free expression space. The first section “demographic and educational experience” contained seven items. The second section “satisfaction with FD programs” contained seven items: number of previously attended FD programs; extent of satisfaction (in terms of topics, trainers, instruction, venue, scheduling) using a five-point Likert scale (1, very dissatisfied……5, very satisfied); and an open-ended question. The third section “perceived FD needs” contained 36 items covering 6 areas (educational strategies; managing learning/ teaching session; assessment/ support/ feedback; research/scholarship, leadership/ management/ career development; and discipline-specific development). The extent of need for individual items was rated using a seven-point Likert scale (1, not at all needed……7, extremely needed). The fourth section “delivery and scheduling” contained seven items; each of the fifth “advertising and motivation” and sixth “interest in participating as faculty/trainer” sections had three items; and the last section contained an open question for further comments.

Authors designed this survey using Microsoft forms (https.forms.office.com). Following ethics and administrative approvals, we obtained the e-mail addresses of faculty members from FOM-SU records. Authors sent an e-mail to the target faculty explaining the purpose and significance of the study as well as the internet address link of the survey. The invitation e-mail confirmed voluntary and anonymous participation. Informed consent was assumed based upon the return of the completed survey as per the included consent statement. Besides e-mails, we tried to enhance participation through announcing on faculty official website and social media (Facebook, Twitter, and Instagram) as well as WhatsApp text messages. In addition, authors sent weekly reminders during the six-week survey data collection duration.

Semi-structured interviews

Findings from the survey and documents review informed semi-structured interviews. Interviews were based on the same survey areas but with explanatory questions for in-depth understanding of participants’ opinions and perceptions. Authors interviewed a convenient sample of 14 faculty members, considering gender (nine males and five females), department (eight from clinical and six from academic), and academic rank (three professors, three associate professors, four lecturers, and four demonstrator or assistant lecturers). Interviews (approximately 60 minutes for each) were either in-person or by telephone and were digitally recorded and exactly transcribed. Two researchers carefully read and coded the transcripts inductively and developed preliminary coding for organizing themes. They paid attention to details with extracting representative excerpts. The whole research team frequently met to discuss and refine the developing themes and enhance rigor.

Ethical consideration

The present study was approved by the Research Ethics Committee of FOM-SU and was carried out in accordance with the principles contained within the 1964 Declaration of Helsinki and as revised in 2013. Informed consent was obtained from all participants for inclusion in the study.

Statistical analysis

Data were analyzed using IBM SPSS® software version 20. We used descriptive statistics (frequency, percentage, mean, and standard deviation), correlation test (relationship between continuous variables), Student’s-t test (two groups of continuous variables), ANOVA (more than two groups of continuous variables), MANOVA (effect of categorical variables on groups of continuous variables), and Chi-square test (difference between categorical variables). Given the many comparisons, we employed a stringent alpha level (p<0.1) in order to control for potential spurious results. Cronbach’s alpha coefficient was used to assess the internal reliability of the satisfaction and perceived FD needs scales.

RESULTS

Response rate and demographics of participants

A total of 434 out of 793 target faculty completed the survey with a response rate of 54.7%. The response rate was higher among basic sciences (68%) compared with clinical (50%) departments. Regarding academic rank, lecturers had the highest response rate (84.5%) followed by demonstrators/assistant lecturers (50.3%), associate professors (38.7%), and professors (33%). The demographics and educational experiences of participants are provided in Table 1. The mean age was 37.4±6.7 years, and the male to female ratio was 1.4:1. Two-thirds of participants were from clinical departments, and most (80.6%) were junior faculty (demonstrator/assistant lecturers and lecturers). More than half participants had experiences in large and small group as well as clinical teaching; however, only 5.9% experienced distant/online teaching, and only three faculty had a formal degree in medical education.

Multiple selection permitted.

Satisfaction with current FD programs

Participants reported attending a few FD programs in the last five years (median 4, range 0-25) with overall neutral satisfaction (Table 2). Faculty with lower rank (demonstrator/assistant lecturers and lectures) and from clinical departments were less satisfied than those with a higher rank (associate professors and professors) and from basic sciences departments.

Perceived FD needs

As shown in Table 3, all areas and items of FD were ranked as moderately to extremely needed. The top-ranked area/item was the discipline-specific need. This is followed by the research/scholarship area, whose all five sub-items were among the top 10-ranked items of the whole scale. Other top 10-ranked needs items were student support and feedback, time management, information technology and computer skills, and presentation skills.

The age of participants, duration as academician, and number of attended FD programs were found to have statistically significant but weak positive correlation with only assessment/support/feedback area (Table 4). It is also evident that FD needs areas, except discipline-specific, have a statistically significant moderate positive correlation with one another.

*Total number of participants is 434. #29 out of 32 departments were represented (no participants from parasitology, cardiothoracic surgery, and vascular surgery departments). ¶Multiple selection permitted.

Cronbach’s alpha of the satisfaction scale = 0.846

On the other hand, multivariate analysis showed that gender, department, and academic rank have a statistically significant effect on perceived FD needs (Table 5). Males perceived higher needs particularly for managing teaching/ learning, assessment/ support/ feedback, and research/scholarship areas. Participants from basic sciences departments perceived higher needs for educational strategies, managing teaching/learning, assessment/ support/ feedback, and leadership/ management/ career development areas. Associate professors perceived the highest needs for managing teaching/ learning, assessment/ support/ feedback, research/scholarship, and leadership/management/career development areas.

Delivery, scheduling, and advertising preferences

As shown in Table 6, the most desired learning format was interactive workshops (60.8), and more than half participants preferred online methods either alone or blended with other face-to-face activities. Participants generally preferred online methods (E-mails, Faculty website, social media) for receiving announcements about FD programs, and one-third desired to receive phone texts. To enhance participation in FD programs, nearly half respondents recommended compulsory FD programs; others preferred alternative incentives (Figure 1).

Interest in taking part as a faculty/trainer

Nearly 10% of respondents desired to join the newly established medical education department on a full-time basis, and one-third preferred part-time participation (Figure 2). Gender, department, and academic rank have significant effects on faculty interests. Males and clinicians were more interested in taking part as a faculty/trainer. Professors were more interested to join department as full time, whereas demonstrators/assistant lecturers and lecturers were more interested in part-time job; Both professors and associate professors were more interested in working as trainers (Table 7).

*P<0.01 (two-tailed).

* Two-tailed test. SS, type III sum of squares; MS, mean square

* Multiple selection permitted

Interviewing faculty was helpful for clarification and deeper understanding of the survey results. Representative comments of interviewed faculty are provided in Table 8.

DISCUSSION

In this work, we studied the perceived FD needs at an Egyptian medical school using a triangulation approach for data collection. The findings of the present study are fundamental for planning effective medical FD programs at FOM-SU and are insightful for other national and international settings; the used methodology can be replicable in other settings.

The purpose and scope of needs assessment must be guided by a clear conceptual framework, the purpose and scope of prospective FD programs, and institutional strategies and resources.^2,16 Exploratory interviews during developing the survey in this study revealed that medical faculty at Sohag University conceptualize discipline-specific development as an essential part of FD construct. This area has commonly been overlooked in the literature on FD and its needs assessment with the notion that faculty are usually hired based on their discipline (content) expertise; hence, FD should focus on other areas. Indeed, most published FD studies addressed teaching, research, and leadership/administration aspects.^8,15-22 However, the essence of FD is continually supporting all roles of faculty members dedicated to meeting the goals, mission, and vision of the institution.³

Teaching, research, and social service (including healthcare), which form the core mission of any medical school, require discipline (content) expertise. Faculty may be expert “now” in their discipline; however, with the rapid change, medical schools must support continuous professional development so that faculty will not lag behind in the future.²⁵

* Two-tailed test

The survey response rate (54.7) in this study is considered satisfactory. The response rate in similar studies ranged from 9.4% to 81.9%.^8,15-20 Given the number of the target population (793), a response rate of 54.7% should be adequate under stringent conditions.²⁶ However, non-respondents (whatever the reasons) remain a source of bias; this is an inherent concern in any study with voluntary participation.^13,24 Indeed, the web-based survey may miss some potential participants who are not familiar with technology, which may contribute to the lower response rate among older faculty (professors and associate professors) in the present study.²⁶

Participants in the present study perceived moderate to extreme need for all FD areas. This is consistent with the findings of previous studies.^15,18,20,21 The highest FD priorities in this study were given for discipline-specific and research. In contrast, most previous studies showed that teaching and assessment domains are the top perceived FD needs.^8,15-22 This difference could be attributed to the wider scope of FD in our study in contrast to previous studies, which mainly focused on teaching and less commonly scholarship and administration/leadership domains. For example, Adkoli.et al used only competencies of clinical educators which are centered on teaching.²⁰

The high perceived needs for FD in discipline-specific and research fields could be explained in light of Maslow’s theory of motivation, according to which humans take care of their basic needs (e.g., safety) first before seeking higher levels (e.g., self-actualization).²⁷ The high perceived need to discipline-specific development may be attributed to socioeconomic factors. Most medical faculty at our locality have additional private clinical or laboratory work to improve their income. In addition, being expert and up-to-date in discipline is highly respected by faculty, physicians, and society. On the other hand, the importance of development in research is well evident and fueled by the academic promotion system, which is mainly based on publications, as well as social environment, in terms of high academic and public respect to researchers with high publication records.^28,29 Faculty have also become more aware of the importance of teaching development given the driving forces from national accreditation authority.³⁰ However, teaching has been minimally appreciated at the levels of faculty, institution, and academic promotion standards. The lack of rewarding may explain why teaching came next after discipline-specific and research development needs.^3,16,17,29

Of note, faculty may not accurately perceive their need for certain important development areas. This is not due to ignorance, but simply because they do not have the required expertise, information, or time to precisely analyze their needs. Indeed, literature shows that most faculty may still consider themselves to be excellent teachers and may not realize their need for improving teaching skills; they regard teaching as a ‘natural talent’ that cannot be learned and only appreciate their own teaching needs when they participate in a relevant FD program. Therefore, FD planning should not only follow customer-approach but also requires considering institutional strategies and maybe external analyst.^2,29

Compared with clinicians, faculty from basic sciences departments perceived higher development needs particularly for teaching and management areas, which may be attributed to the highly demanding work of clinicians.²⁹ Moreover, there were differences in perceived development needs across the career stage. Previous studies also reported differences in perceived FD needs in relation to several factors, such as gender, discipline, academic rank, and duration as an academician.^17,18,22 For example, full professors were reported to have less interest in FD activities than lower ranks.^17,22 Studies showed that junior faculty prioritize teaching needs, whereas faculty members of higher ranks are more interested in research and management/leadership.^16,17 According to adult learning principles, adults become ready to learn things they need to cope with real-life situations during moving from a developmental stage to another over time.¹² Therefore, it is important to consider planning specific programs targeting faculty at different career stages so that timing learning experience to match developmentally specific tasks and needs.^2,4

Interactive workshop was the most preferred instructional method in this study. Likewise, most respondents in previous studies desired workshops and microteaching sessions.^15,19,20 Individualized consultation, which was desired by 13.1% in this study, was the most preferred method in McLeod et al, study.¹⁹ Adult learning principles illustrate that adults have the self-concept of handling their own decisions, including learning, and they need to be treated by others as being capable of self-direction “learners’ self-concept”.¹² In addition, adults have rich experiences that they need to be respected by others. Therefore, preferences go to experiential techniques that explore, activate, and build on learner’s experiences, such as discussions and problem-solving activities, compared with transmittal techniques, such as traditional lectures.^2,12 However, still a proportion of adults prefer traditional instruction (like nearly a quarter of our study participants); this happens particularly when little is known about the subject. A person with a high degree of personal autonomy may choose to learn in a highly teacher-directed instructional session because of convenience, speed, or learning style.¹⁰

Of note, more than half participants preferred web-based methods. Online and blended formats were also preferred by nearly half participants in McLeod et al, study.¹⁹ These methods may offer a convenient alternative to certain faculty who have difficulty in attending face-to-face activities.²⁹ It is interesting that about 10% of participants desired learning community. Building learning community helps foster collaboration and effective relationship as well as notion to community of practice; this increases the chance of knowledge transfer and positive behavioral and cultural change.³¹ It is recommended that FD programs should employ multiple instructional methods rather than the “one-size-fits-all” approach.^2,29

Proper scheduling is important and can make the difference between the success and failure of an FD program. Preferences are generally related to professional, economic, social, and lifestyle factors of the target population. The preference of participants in this study tended towards short sessions during workdays. This is consistent with the findings of similar studies. In Shah et al study, 79% of respondents desired half-day training and 61.4% preferred weekdays rather than weekends.¹⁵ Most participants in Schönwetter et al, and McLeod et al, studies preferred half-day workshops during workdays.^16,19 In a national survey of FD in US teaching hospitals, 80% of activities were half-day workshops.³² Limited time is a major barrier for participation in face-to-face activities; blending with web-based methods may be a convenient strategy.²⁹ FD programs that extend over time give an opportunity for cumulative learning, practice, feedback, and social networking; this yields more positive behavioral outcomes than one-time events.^4,25

The current study revealed a high controversy among faculty on the policy of “compulsory” FD; attending a certain number (usually six) of FD programs is mandated for every academic promotion at Egyptian universities. This debate was also described by other studies. For example, some participants in Adkoli et al, study recommended making an institutional policy for mandatory participation in FD programs, while others discouraged this idea and favored other alternatives. Adult learning principles explain that adults need to be aware of why they need to learn something prior to undertaking to learn it; they will do their best when commit to learning something on their own.¹² In light of the self-determination theory, compulsory programs are a type of extrinsic motivation that is associated with a sense of pressure and anxiety; related learning is likely short-lived and poorly integrated into long-term behavior. The feeling of being forced to attend without perceived benefit but for mere formality precipitates frustration.¹⁰

However, faculty may not perceive their need for certain important development areas (discussed above). Therefore, institutional efforts should be directed towards helping faculty become aware of their development need (e.g., by challenging their self-perception), so that they will undertake learning of their own, rather than only focusing on obligatory regulations.^29,33 Previous studies described other important types of institutional support to motivate participation in FD programs, such as financial incentives, career advancement, allowing release time, and sponsoring medical education fellowships and educational projects.^15,20 A Pakistani study reported that developing a rewarding system for recognition of excellence in teaching, research, and professional development markedly enhances participation in FD activities.³⁴ Developing an organizational culture that supports and rewards continuous quality improvement in all domains of faculty responsibilities is critical to the success of FD.^2,3

Recruitment and preparation of faculty developers is an important process. 47% of respondents showed their interest in joining the prospective medical education department. This is comparable to Adkoli et al, study, in which 37.6% of respondents were willing to join the medical education center.²⁰ Academic promotion regulations, which require discipline-related research and publication, limited the interest in joining the newly established medical education department on a full-time basis to professors. Although FD literature acknowledges the importance of program trainers and developers, little information has been reported about their educational background, years of experience, and specialty.^1,31 This is a subject for future research.

The present study has some limitations. First, survey is not an objective method and has inherent flaws of response and social desirability bias. Given the limitations of any individual data collection method, we employed a triangulation approach that is probably the best-known strategy to enhance credibility and quality. Second, some participant’s categories showed an un-equal response rate, which may over- or under-represent some opinions. Last, this is a single-center study; the findings may not necessarily reflect other settings given the contextually situated nature of qualitative research. However, transferable lessons and meanings can be derived from our study, and the approach can be easily replicated in other settings. It would be interesting to compare the findings of this study with that of other Egyptian, Arab, and worldwide universities to generate useful insights for health profession FD at the national, regional, and international levels.

CONCLUSION

The present study demonstrates a potentially transferrable model for conducting FD needs assessment, informed by theory and context, using a triangulation approach. This study provides important information on the perceived FD needs at an Egyptian medical school, which are not only useful for planning FD programs at this particular institution but also insightful for other settings. Needs assessment is central for planning more effective and economically sound FD programs within the complex structure of today’s health profession education institutions.

Note: The electronic survey (NAFDS) is available through contacting the corresponding author.

ACKNOWLEDGEMENTS

This study was a part of an educational project in Ain-Shams University-Middle East North Africa-FAIMER Regional Institute (ASU-MENA-FRI) program (https://menafri.faimerfri.org/). The authors thank professors Amal Hashish, Samar Abdelazeem, Soha Ashry, and Zinab Abdelhafiz (ASU-MENA-FRI faculty) for their insightful and kind support and feedback. We also thank Nahed Mekky and Hisham Elkholy (officers at Faculty of Medicine-Sohag University) for their invaluable technical assistance.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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