Shifting to team-based faculty development: a programme designed to facilitate change in medical education

ABSTRACT

The value of traditional faculty development programmes has been questioned regarding its effectiveness in transforming clinical education. Rather than training faculty separately from their colleagues, the faculty development programme described in this paper presented an opportunity for teams of faculty to improve clinical education by developing tools grounded in medical education research. The five participating teams were interviewed in focus groups at the end of the programme and followed up with emails and phone calls three years after the end of the programme. The interview data were analysed according to conventional content analysis. Immediately after completion of the programme, all teams had managed to implement their tools, and three years later, four were still in use. The study demonstrates that critical success factors for faculty development to transform change in practice included a design focused on a stepwise, longitudinal programme; coaching of teams; management and peer engagement, and programme days that created space for reflection, development, and discussion.

KEYWORDS:

• Faculty development
• educational change
• theory practice integration
• medical education

Introduction

Students studying to become health professionals spend a considerable part of their education in clinical learning environments. Despite increasing knowledge of how learning can be facilitated in the clinical learning environment, it can be a challenge to develop clinical learning environments that support learning (Teunissen, 2015). Faculty development, also referred to as academic development or educational development, has been highlighted as a key to improving clinical education and student learning. A systematic review of faculty development initiatives in medical education (Steinert et al., 2016) identified four different types of faculty development: shorter workshops, seminar series, shorter courses and longitudinal programmes and fellowships. Over a ten-year period, there was a clear tendency towards more emphasis on the two latter formats. However, a consistent problem identified with many initiatives is the lack of evidence showing that they bring about changes in the practice of the organisation (Steinert et al., 2016).

We conceptualised the difficulties of translating what is learned in faculty development programmes into the organisation as an integration problem between theory and practice. Current research on efforts to integrate research results with practice offers an understanding of how complex the integration of research findings into health care can be (Freeman & Sweeney, 2001). These results are also valid when it comes to the integration of educational research into teaching practice (Alkin & Taut, 2003). When striving for integration between higher education theory and teaching practice, we used the three levels of challenges that we previously identified in the process of faculty development (Bolander Laksov, 2018): the role of teams, establishing ownership and obtaining legitimacy.

The role of teams

One challenge is that most faculty development programmes focus on individual learners instead of teams in the organisation. In our understanding of teams, we build on work regarding group development and the creation of effective teams (Wheelan, 1994). Basically, a team is conceptualised as a group of people who, unlike groups, share a common purpose, build on the competences of the team members and are collectively accountable for the outcome of the teamwork. Research on team development established already half a century ago that the development into a team often follow a process of several stages (Tuckman, 1965), through forming (participants are polite and strive to upheld a nice atmosphere), storming (participants start to get to know each other and feel safe enough to raise concerns and opposing views so that conflicts may occur), norming (participants start to find shared ways of doing things and create their own norms) and performing (the team has developed effectiveness in communication and work). Wheelan (2014) also points out that the organisational environment is crucial for the effectiveness of teams. This perspective is well in line with our socio-cultural research stance, which acknowledges the interaction between context and individuals for learning and development.

From an organisational learning perspective, the organisation and its environment as well as individuals, should benefit from engaging staff in faculty development programmes. The use of teams in faculty development has also been argued to have a greater and more lasting impact of faculty development efforts (Leslie et al., 2013). This needs to be reflected in the design of faculty development programmes and has been stressed by several researchers (Doppenberg et al., 2012; Leslie et al., 2013; O'Sullivan & Irby, 2011; Steinert, 2010).

Establishing ownership

It is challenging to get participants in an organisation to engage and establish ownership in relation to educational change. Ownership among faculty is a core aspect for developing a quality culture in education (Bendermacher et al., 2017). Harvey and Stensaker (2008) introduced the term ‘quality culture’ to express that educational quality is tightly linked to the culture of an organisation, and thus, to be able to promote educational change, the aim of faculty development should also include the organisational culture in terms of how quality is viewed and strived for in that same organisation. The development of change agency from a socio-cultural perspective involves the interaction between the social practice and the individuals who strive to implement change (Trowler et al., 2012). Thus, any change that people strive to implement is impacted by the social setting, its history, its ways of doing things, and impacts the opportunities for change agency for individuals who want to promote change.

Individuals who take part in faculty development often generate ideas for development, or even are asked to carry out educational development projects (Burdick et al., 2012). Unfortunately, the implementation of such projects often faces resistance. One explanation for such resistance is that leadership roles may be in conflict, that the timing of change is not right and that knowledge of change processes is not included as part of faculty development programmes (McGrath et al., 2019).

Obtaining legitimacy

The third challenge involved in faculty development is the challenge of obtaining legitimacy from practice. There is a risk that ideas that are generated from faculty development are alienated or seen as separate from the needs of the practice. As faculty development programmes generally are offered to a wide range of professionals from different (clinical) contexts, the relevance of what is learnt in the programme may vary. Consequently, the flexibility to cater for the needs of different types of learning environments may be low, and the research literature included in the programme unspecific. Since clinical teaching is often an additional and secondary task to that of providing medical care and creates a situation of competing priorities (Elmberger et al., 2018), the application of what was learned to local practice is particularly important for the integration of theory with practice.

The issue of legitimacy also relates to the organisational management. For educational development projects to have a chance to overcome local scepticism, the explicit support from management has been identified as key. However, this may prove difficult in an academic consensus-seeking culture with multiple and sometimes unclear layers of management structures (Sahlin & Eriksson-Zetterquist, 2016). Faculty development programmes thus need to find strategies to support their participants in obtaining legitimacy in the relevant management structure as well as in the workplace. One way to do this is through the alignment of pedagogical innovations with current values in the organisation as well as the system within which an innovation or change is planned (Bajada et al., 2019).

With these challenges and recommendations from research in mind, we designed a faculty development programme that targeted teams rather than individuals, that made participants in the clinical education practice engage and develop ownership through agency, and that created legitimacy for the programme participants to carry out educational development projects. This paper is an account of how the programme was designed, carried out and perceived by the programme participants. The overall aim was to gain insight into how faculty development programmes could be designed to enable the integration of theory and practice. The following research question was explored: What aspects of the programme design can inform future faculty development in terms of bringing about change in organisational practice?

Materials and methods

The methodology of this study is inspired by design-based research as put forward by the Design-based Research Collective, ‘ it blends empirical educational research with theory-driven design of learning environments [… and] is striving to foster learning, create usable knowledge, and advance theories of learning and teaching in complex settings’ (Collective, 2003, p. 5). As such, the present study was designed to generate theoretical knowledge and practical implications for faculty development through the process of designing an authentic faculty development programme.

The project is based on a socio-cultural perspective on learning, meaning that we assume that knowledge is created in interaction with the context (Säljö, 2002). From this perspective, ‘learning is always learning to do something with cultural tools (be they intellectual and/or theoretical)’ (Säljö, 2002, p. 147). People learn and develop by making use of tools and, thus, tools can also influence how people understand and interact with the world and each other. The creation of tools to support such socio-cultural learning was hence at the heart of the design of the programme.

Programme design

The aim with the faculty development programme was expressed as follows: ‘to support teams of clinical teachers to build capacity to lead educational change based on educational research in their clinical environments’. The programme thus targeted teams of participants who, within each team, worked with clinical education at the same clinic.

The programme constituted eight half-day workshops spread out over one year. Each day had a specific theme and required an assignment to be completed prior to the meetings. It started with a short introduction and ended with each team presenting their progress.

Considerable time was set aside for teams to work together and receive feedback from the programme facilitators. The focus of each of the half days is presented in Table 1 in relation to the preparation and documentation produced. All meetings were held at the centre for medical education at the university, except days 4 and 6, where one of the facilitators visited teams in their own environment.

Table 1. Content and documentations from the programme days.

Programme days	Content	Preparation and documentation
Day 1: (February)	Introduction, aim, expectations. Lecture on research on clinical learning environments. Identification of challenges the teams wanted to address. What works? What are tensions in the system? Why?	Document on what challenges the teams wanted to solve.
Day 2: (March)	Goal identification. Journal club. Sharing of relevant research findings in the problem areas that were identified by the teams on day 1. Teams identified goals in relation to the literature. These were discussed with colleagues at work.	Reading of four relevant articles per team.
Day 3: (April)	Project management models. Short lecture on change management models. Case – film as educational tool. Drafting of ideas in relation to goals identified on day 2.	Target person was drafted for the project.
Day 4: (May)	Production of tools for change in relation to goals. Separate workshop with each team in their own context.	Descriptions of tools for change.
Day 5: (August)	Implementation and evaluation. Lecture on how to implement change and evaluation of tools. Planning of implementation process of project. Mirror exercise: Each team identified their objectives, the tools that would help them achieve those objectives and signs of achievement in relation to past, present and the future. This helped them to design the process of implementation.	Mirror exercise describing past, present and future.
Day 6: (September)	Community building. Based on previous examples where participants described successful and unsuccessful change initiatives – a workshop was held on how to create a strong community around change. Separate workshop with each team in their own context.	Identify and bring three change initiatives that were more or less successful (written down).
Day 7: (October)	Evaluation. The teams designed or analysed and reflected upon the evaluations they had made, and identified further requirements.	Survey reports, interviews, notes.
Day 8: (December)	Presentation. Presentation for the public, clinic heads, colleagues, human resources department of county council invited. Location: County Council head office.	PowerPoint presentations.

With the purpose of creating legitimacy from management the programme was advertised via the human resources departments of the university hospitals in the region to the clinic heads as well as via informal networks. All clinic heads and the human resources department were also invited to the last day of the programme, where the teams would present the tools they had developed and evaluated. Another way to create legitimacy was to focus on educational leadership and evidence, as these were considered core values in the current medical discourse.

Research on learning in the clinical context was presented by the facilitators on the first day. When the teams had identified educational problems that they wanted to solve in their own clinical context, the facilitators, who all are active medical education researchers assisted with finding and identifying relevant research literature. A film expert was invited for inspiration on the third day to talk about how film can be used as an educational tool. However, the teams were free to develop any kind of tool.

The participants were presented with Meyer and Stensaker’s (2006) framework for facilitating the process of going from idea to implementation in practice, the Change Process Prescription (CPP). The process consists of (a) framing (identifying and communicating what is to be done and why), (b) participation (allowing the members of the organisation to be involved in planning), (c) pacing and sequencing (identifying how quickly and in what order different actions need to be taken), and (d) routinising and recruiting (recruiting people to take part and considering how the idea will become part of everyday work) (Meyer & Stensaker, 2006). These stages were used as a way for the teams to go from idea to implemented tool together with the mirror exercise, as designed by Engeström et al. (2013). The mirror exercise asks participants to identify problems and solutions as interdependent in the system of the past, the present and the future, and helps teams to design tools for change (Engeström et al., 1996).

Data collection and analysis

All teams were invited to, voluntarily, participate in focus group interviews at the end of the last programme day. In line with the design-based methodology, the interview guide focused on the three design principles of the programme to promote integration of theory and practice and explored the participants’ experiences of (a) working in a team, (b) reactions and ownership in the organisation, and (c) legitimacy to conduct educational change. Participants were informed of the purpose and had the possibility to withdraw from the study at any time. Fourteen participants agreed to take part and were divided into three focus groups where teams were maintained: one group consisted of one large team, one group consisted of two teams working with similar student groups, and one group consisted of two teams working with similar patient categories. The three focus groups were held by the authors in pairs. Informed consent was collected from all participants and the study was approved by the Regional Ethical Review Board in Stockholm (no: 2016/1425-31). The interviews were recorded and transcribed verbatim. The focus group interviews, which lasted between 60–90 min, were analysed according to conventional content analysis (Hsieh & Shannon, 2005). Conventional content analysis is characterised by the search of themes in the data when there are no pre-conceived conceptual structures. Two of the authors (KBL and AE) read the interviews repeatedly and separately looking for meaning units in the interview data, that were then clustered into themes. Themes were compared and discussed in the research group until consensus was reached.

Three years after the end of the programme, we contacted one member from each team by email or phone to explore whether or not projects were still up and running and if the tools were still in use. All teams responded.

Findings

Five teams from three different research-intensive teaching hospitals participated in the programme. The participants had varying degrees of teaching experience: eight participants had more than five years of experience and six participants had less. Three teams were interprofessional, with two or more professions. All teams managed to develop a tool (see Table 2) aimed to improve learning, implement and evaluate it within the timeframe of the programme. The tools developed and their impact will be reported elsewhere, but it is notable that one year after the programme, four of the five teams had presented their work at medical education conferences. Three years later, four teams are still using their tool and two teams are currently working to publish their work.

Table 2. Summary of the tools that were developed in the programme.

Team	Tool
A	An educational video resource to support teaching clinicians in providing feedback
B	A learning activity to increase students’ understanding of interprofessional ward rounds, including an educational video resource
C	A reorganisation of the clinical rotation to enable peer learning between students and teaching clinicians, creating educational teams of two students and two teachers
D	A learning activity to increase interprofessional collaboration during ward rounds, including an educational resource in the form of a checklist
E	A learning activity to train students in interprofessional communication and profession-specific tasks, including rescheduling the clinical rotation^a

^a See Ivarson et al. (2020).

The analysis of the focus group interviews with teams surfaced four themes that can inform future faculty development programme designs: (a) explorative design of the programme, (b) availability of educational research and expertise, (c) working in teams, and (d) engagement and support from working environment. The interview extracts below have been labelled with a team letter (A–E) to signify what team members said what.

Explorative design of the programme

The participants emphasised that the design of eight half days stretched over a year was necessary for giving time for development, as well as planning, implementation and evaluation of the projects. The stepwise structure where programme days built on each other was valued: ‘it was good to get inspiration from the programme days and then let the projects grow successively’. However, this was also viewed as challenging: ‘the explorative character of the programme design made it difficult to know from the start where we were going, what our goal was’. The programme leaders thus filled an important role in keeping the teams on track, ‘constantly directing us towards what the problem we wanted to solve was’.

Several of the participants reported a lack of time to work on the projects apart from a few emails and casual encounters in the workplace. Therefore, the emphasis on letting programme days be spent on actively working in the team together with the off-site visits of the programme leaders to the participants’ own workplaces were appreciated. All participants agreed that the final day where teams were given the opportunity to present their tools was motivational as they knew their clinic heads had been invited: ‘We were triggered by it [that our management was invited], that we would show them and present a product.’

Availability of educational research and expertise

The participants repeatedly emphasised the importance of the availability of educational expertise and research. To work from available research in the area of clinical learning environments was mentioned as key for creating trust both in relation to the programme managements’ expertise and the feeling of doing something important with the project.

The [programme] days offered support regarding literature and the opportunity to create different things, and actually inspired the idea for the product [tool] that now exists, so the concept is good. (Team A)

The fact that participants got access to educational experts alongside the development of their educational tool was expressed as important because it meant the participants dared to try things they would not otherwise have dared, such as producing a film. Several team members also emphasised that ‘being in a programme’ gave a certain kind of legitimacy to lead change that would not have been achievable otherwise.

… by taking a course and showing what you’ve done and […] coming back to show what you have learned, that’s expected from you, otherwise you cannot take a course. It is a bit of an unwritten rule that we have to present what we are doing … . (Team C)

From the start it has been a good design based on the research articles we got, that we broke everything down and then took some of it and followed a plan. At times you felt a bit confused, but when we did the product [the tool] in the end, you could see that it was possible to tie everything together and got a clear picture of how you had worked with the project. (Team B)

Working in teams

Despite coming from the same clinical environment, most of the teams did not consider themselves a team at the start of the programme. Rather, they viewed themselves as a group of people who were all interested in education.

We collected five, six individuals at the outset. We had not collaborated before. It was the first time we collaborated this close, and it was a challenge to get to know each other and get our team together. (Team D)

Throughout the process and the creation of the tool they experienced becoming a team, which was evident in the focus group interviews in several ways. One example was the possibility to critically discuss and challenge each other’s ideas – something that was not as straight-forward at the start of the process.

Well, you (pointing at other team member) were always late, and we had started (laughter) and that has been ongoing (laughter) but it has been interesting to follow. Then we got an explanation to your ‘lateness’ but […] and it has been fun. We have gotten to know each other, we dare to say these kind of things (laughter), that we probably wouldn’t have said on the first day. (Team D)

One team, who at times previously had worked with patients together, expressed that the collaboration around the educational tool improved their collaborative clinical work with patients.

We have developed during the process and I think we have achieved a new level of communication where we communicate much better [since] we got to know each other, and I think it will help us also when we work [clinically], not only when we teach our students. (Team E)

The participants also expressed several advantages of working with educational change as a team. Apart from expressing having more fun working on the programme assignments, the participants thought it provided more perspectives on both the problem in question and on possible solutions, and could result in a better project. This was particularly emphasised by the interprofessional teams.

We wouldn’t have gone this far with other professional categories had we done this alone. Representing a single profession and try to sell it [the tool] to your own as well as well as other [health] professions … and I think somehow, we all have our own perspective that we need to connect to [the project], so I believe it would have been difficult. (Team E)

Another important outcome of working as an interprofessional team was that it facilitated the implementation phase. ‘It is easier to get buy-in from people of the same profession’, as one team member said. Also, working as a team implied having a broader network in the workplace, where more people got engaged in the project through planned as well as unplanned meetings and discussions. Particularly, the team gave energy and support when the project was questioned and challenged by peers at the clinic. One of the teams felt that it established better conditions for the tool to be used following the programme, as ‘two of the team members are always present at the ward rounds’, and could thus be involved in ‘routinising’ the use of the tool.

Engagement and support from work environment

The conditions for participating in the programme and for working with the project differed among programme participants. The vast majority of the participants had no more time than the actual programme days to work with the programme. Having time off regular duties during the programme days was, in other words, viewed as important. The support they received from their management, such as encouragement from people in the managerial group to whom the project was presented, was felt to be a key for the project to succeed as it signalled to colleagues that this was something important, not only for the participants, but for the entire clinic.

In the management group […] I presented a suggestion for [our project] and it went really well. They were very positive. Then there were reactions from the nurses, that it would be too much [work], that they did not have the capacity for that amount of students. And then we realised, in spite of the positive reactions from the management, the importance to anchor it [our project] at different levels. (Team D)

The engagement from colleagues was also viewed as central: ‘a lot of corridor and coffee talk was done before asking people to devote engagement and time to carry out the project together’. The team’s enthusiasm was also acknowledged: ‘thinking it is fun makes it easier to engage colleagues’. However, an ongoing re-organisation splitting the team at one of the hospitals was viewed as a threat to the sustainability of using the tool.

Finally, the development of a good project, that was easy to grasp and that concerned something relevant for everyone at the clinic, made the projects, as well as the programme itself, more successful.

You can as I said feel what you do somehow, that’s what has been fun with this project, that it leads to something, to change. (Team A)

Three years later

The findings from the follow-up with the teams showed that four of the five projects were still on-going. The four teams had managed to routinise their tools, that were consistently used with teaching staff and students. Team B had developed an additional video resource, inspired by the development of the first one. Team A, C and E had started a process to publish their project as scholarly projects. Team D, however, had not been able to continue the use of their tool. According to the team member who we were in contact with, the reasons for this were a number of unfortunate events. Firstly, the team changed. One of the team members left the team half way through the project due to new work responsibilities and another team member, who had been one of the core members as she was responsible for the student nurses at the ward, changed jobs. Secondly, the ward was under a lot of pressure due to a re-organisation of work processes at that hospital. The team member argued this created a lack of motivation and space to devote to anything other than the absolutely necessary parts of the work.

Discussion

In this paper, we describe a faculty development programme designed around team participation, the development of tools for change in interaction with the workplace to establish ownership, and around an explicit focus on change implementation processes embedded in practice to create legitimacy. The analysis of the focus group interviews with the participating teams identified features that can inform future faculty development in terms of bringing about change in organisational practice. These are discussed in relation to previous research below.

A first major finding was linked to the stepwise and longitudinal design of the faculty development programme around tools. The stepwise structure with eight half-days paced over 11 months gave opportunity for reflection, collaboration and discussion with peers, although some also found the long-term perspective challenging. This is in line with Steinert et al.’s (2016) review, where a longitudinal programme design was one of the key features for programme success. Additionally, the design around Meyer and Stensaker’s (2006) change process prescriptors enabled teams to plan, implement and evaluate the changes created by their tools at their workplace within the time-frame of the programme. This approach has, to our knowledge, not been used previously in faculty development programmes, and appeared to support sustainable implementation and use of educational research in the clinical education environment.

When designing a faculty development programme in any subject or discipline, designers tend to assume an approach where all participants should follow the same process, the same literature and present the same kind of artefacts as a result of the programme, such as a report or text. This is contrary to the research showing that meaning making and motivation is based on participants’ opportunity to choose. When individuals associate feelings of autonomy, competence, and relatedness with choice, then choice is most likely to result in beneficial outcomes, such as engagement (Katz & Assor, 2007). It was clear in our study that the design around choice and development of tools was paramount to creating change capacity with the teams of teachers involved in the programme (Dabrowski & Marshall, 2018). We believe, and others have shown (Onyura et al., 2017), that the establishment of a safe environment with room for experimentation and innovation, also was key to support participants in developing their capacity to change. Spaces for experimentation and innovation has been found to be reliant on the establishment of an open climate, where mistakes and insecurity are allowed, and facilitated by expertise of the programme facilitators (Clegg et al., 2006).

A second major finding was that designing faculty development around teams has several advantages. The programme enabled development into teams according to criteria of how teams differ from groups (Wheelan, 1994) as participants emphasised teamwork provided more perspectives on problems that needed to be resolved. Particularly, interprofessional teams emphasised teamwork as a strength, something that is in line with research showing the importance of interdisciplinary teams for successful teamwork (Fields et al., 2019). Other benefits were that it facilitated the implementation process, that individuals in the team felt support from each other when the project or tool was questioned by peers, and that it became easier to sustain the use of the tools developed. An important argument for targeting teams in faculty development is that higher education, and not the least clinical education, has been described as super complex (Barnett, 2000), with competing priorities between education and clinical work (Elmberger et al., 2018). In order to bring about change in complex organisations, it is beneficial to work in teams (Wheelan, 2014). However, as was noted with team D, where one member left the team during the programme, a new team configuration can require the team to pass through the stages of team development anew. Alas, team D took longer to identify what they wanted to produce as a team and could have needed more support from the programme facilitators regarding their team development.

A surprising finding in our study was also the ‘spill-over effect’ into patient care that was reported as a result of the teamwork around the educational tool. This is an area that has not been extensively researched (Laksov et al., 2015) and thus further studies are warranted.

A third major finding is that designing for engagement of management and peers is crucial for the legitimacy of the programme participants’ work and the success of the implementations of the tools. This also became clear regarding group D’s experience of not having time or motivation to pursue the use of the tool when they were required to adapt to the new organisational structure. The support from management as well as funding and resources to implement change has repeatedly been identified as important for the success of change initiatives (Barman et al., 2014; Fields et al., 2019). In this study, it became clear that the opportunity for teams to present their work at an event where clinic heads were invited was an important motivator for the teams. Also, and in line with previous findings (Hoover & Harder, 2015), the monitoring of the teams’ project ideas with peers at an early stage in the process of designing the tool made the peers more engaged in the projects and increased the sense of ownership of the tool among colleagues. However, how to deal with ongoing organisational changes is a challenge that need to be considered.

Finally, our study shows that the programme as such created legitimacy for the participants to carry out educational development projects. Several factors contributed to this outcome. The issue of time, where participants got ‘protected time’ during the programme days made their work on the projects legitimate in relation to their colleagues at their workplaces. Additionally, the connection to the course facilitators, who were also educational researchers, contributed to building legitimacy through their expertise, as did the concluding day where clinic heads were invited for the presentations of the projects. The course thus became a tool for the participants’ legitimate engagement in the educational development projects. In line with previous findings that emphasise the bridging of the programmes and the working environment (Graham, 2012; Mårtensson & Roxå, 2016), these findings indicate that faculty development programmes should not only focus on providing theoretical knowledge for educators to develop their conceptions of teaching and learning, but can be seen as an opportunity to develop teaching and learning in practice.

The main features that can inform future faculty development in terms of bringing about change in organisational practice thus focus on stepwise longitudinal structure around development of chosen tools, by teams of teachers, possibly interprofessional, and the continuous engagement of managers and peers in the process. However, some challenges needed to be dealt with. In our continuous programme, to counteract the difficulties faced by team D, we have developed the design so that teams get a mentor – an experienced educational developer – who supports and facilitates the teamwork throughout the programme. Another development is to make explicit from the very start that participants create the content of the course, not a course where they ‘consume’ course content. The developed programme has been running for several years now.

Considerations

This study has several limitations. It was a small-scale study based on three focus group interviews. Furthermore, this was the first time the programme was run, and the participants had volunteered participation. However, after several years of running a developed version of the programme at another university, we can see that the principles of design (stepwise and longitudinal design of the programme, targeting teams, focusing on development of tools and creating management support for participation) are working well. Further, as pointed out in the discussion, key aspects of these principles have previously been highlighted in several different contexts, including both medical education as well as higher education in general, indicating that the experiences presented here also might be valuable and applicable to other institutions. Finally, three of the authors were engaged in designing and facilitating the programme. We acknowledge the potential bias that is involved in this and thus tried to counteract such an effect by involving a fourth member of the research team (AE) and by systematically and continuously critiquing our assumptions and perspectives.

Future research exploring faculty development programmes and their outcomes could benefit from gathering data from multiple sources and stakeholders, where managers or clinical colleagues can be included to investigate their experiences in relation to educational interventions at the workplace.

Conclusion

This article describes the design and outcomes of a new faculty development programme to bring about change in organisational practice. The outcomes of the study indicate that by shifting to teams clinical teachers get a greater chance to build capacity to lead educational change based on educational research in their clinical environments. The article contributes to understanding of prerequisites for team faculty development in the clinical environment. It further proposes a model for faculty development which supports an exploratory approach to the integration of educational theory and teaching practice through team coaching, the search for management support for participation, and the development of tools for change in an environment that offers legitimacy, time, space for innovation and space for reflection. Thus, we wish to argue for a less explicit line between viewing faculty development programmes as delivery of content to be applied in practice, and viewing them as a structured approach to educational change.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The faculty development programme was supported by grants provided by the Stockholm County Council [ALF project ID:20170043].