Challenges for medical educators: Results of a survey among members of the German association for medical education

Abstract

Background: Despite the increasing interest in medical education in the German-speaking countries, there is currently no information available on the challenges which medical educators face. To address this problem, we carried out a web-based survey among the members of the Association for Medical Education (Gesellschaft für medizinische Ausbildung, GMA).

Methods: A comprehensive survey was carried out on the need for further qualifications, expertise and the general conditions of medical educators in Germany. As part of this study, the educators were asked to list the three main challenges which they faced and which required urgent improvement. The results were analysed by means of qualitative content analysis.

Results: The questionnaire was completed by 147 of the 373 members on the GMA mailing list (response rate: 39%). The educators named a total of 346 challenges and emphasised the following areas: limited academic recognition for engagement in teaching (53.5% of educators), insufficient institutional (31.5%) and financial support (28.4%), a curriculum in need of reform (22.8%), insufficient time for teaching assignments (18,9%), inadequate teacher competence in teaching methods (18.1%), restricted faculty development programmes (18.1%), limited networking within the institution (11.0%), lack of teaching staff (10.2%), varying preconditions of students (8.7%), insufficient recognition and promotion of medical educational research (5.5%), extensive assessment requirements (4.7%), and the lack of role models within medical education (3.2%).

Conclusion: The medical educators found the biggest challenges which they faced to be limited academic recognition and insufficient institutional and financial support. Consequently, improvements should be implemented to address these issues.

Introduction

In recent years, medical education has increasingly become a focal point of political interest across Germany. Initiated to a substantial degree by the change in the Medical Licensing Regulations in 2002 [1], many medical curricula for student education in Germany were reformed, the postgraduate degree program “Master of Medical Education – Germany” was established (MME-D; [5], [14]), and the GMA Prize for Young Educators of the Association for Medical Education (GMA) was founded [9]. At the same time, the number of GMA members grew from 338 members in 2004 to over 900 members in 2012.

Interest in medical education is also growing from an international perspective. For instance, an initiative for the “revitalisation of academic medicine” was launched [20], and well-known international medical scientific journals are increasingly publishing contributions on themes of medical education [20], [3], [2], [6]. Data on expertise, the need for further qualifications, and the challenges faced by medical educators have recently been presented in an international web-based survey [10]. Accordingly, educators from 76 countries see their expertise as lying mainly in the area of general methodology and didactics, in the implementation of communication training, instruction for self-guided learning, as well as in the area of assessments. The need for further qualification was identified particularly in the areas of teaching-related research methodology, the use of new media, and curriculum development. Limited academic recognition and insufficient financial support, restricted faculty development, a lack of protected time for teaching, and insufficient support by the institutions were considered as particular challenges [10].

These international data are broadly in line with the results of a recently published, comprehensive survey for the Germany-speaking area [7], which presented the results of the closed questions of the questionnaire study described in the current work. Only the need for further qualification in the area of assessments tended to be evaluated more highly in the German-speaking area; the need for further qualification in the area of computer-assisted learning, by contrast, was rated as lower. As yet, no data are available regarding the greatest challenges faced by medical educators in the German-speaking area. Therefore, in the current work, the results of an open question asking members of the Association for Medical Education to name the three greatest challenges, which were gathered in the framework of a comprehensive questionnaire study [7], are presented.

Methods

Development of the web-based questionnaire

The questionnaire, which formed the basis of the data collection in the framework of the presented study, was conceived in five focus group sessions, each consisting of four to six participants (all with many years of experience in medical education). Furthermore, five interviews with people who were actively involved in teaching were conducted in order to check the comprehensibility of the questionnaire. In the next stage of development, the questionnaire was pilot-tested on 30 medical educators who were able to access it via a Web-link, with the aim of checking its comprehensibility and web-based functionality. The definitive, web-based version of the questionnaire consisted of 34 closed questions and one open question. It took approximately 20 minutes to complete. The results of the first 34 closed questions on expertise, need for further qualification and the general conditions for committed educators have already been published elsewhere [7]. In the current work, we present the qualitative analysis of the responses to the open question regarding the central challenges for educators.

Distribution of the questionnaire

The link to the web-based version of the questionnaire, together with an information letter, was sent out by email. This email was forwarded by the secretary’s office of the GMA to the GMA mailing list (n=373) in spring 2006. A reminder email was sent 4 weeks later. There were no further emails or telephone calls.

Participants

In spring 2006, the mailing list of the GMA consisted of GMA members and visitors to the GMA congress in autumn 2005. The GMA represents medical educators in the German-speaking area (http://www.gesellschaft-medizinische-ausbildung.org). The participants are identical to the target group of the survey by Huwendiek et al. [7].

Qualitative analysis

In response to the open question regarding central challenges, the participants were able to indicate the three most important challenges in their opinion in the form of free text. Two authors (SH and CN) independently identified themes of the participants’ free-text responses, defined thematic categories on the basis of the free-text responses, and in a second step sorted the categories that had emerged according to the principle of qualitative content analysis [17]. Consensus was reached through discussion between the two authors and comparison. The relevance and consistency of the analysis was checked by the team of authors. The percentage of mentions of the categories was determined, and for each of the thematic categories, exemplary citations were selected in order to illustrate the categories in terms of their contextual meaning.

Results

Participants

Fully completed questionnaires were received from 147 (39%) of the members of the GMA mailing list. Table 1 (Tab. 1) shows the characterisation of the survey participants (cf. [7]).

Table 1. Characterisation of the survey participants (n=147).

Challenges for educators

In total, 346 free-text comments were made by 147 participants. Figure 1 (Fig. 1) shows the percentage distribution of the main thematic categories regarding the main challenges mentioned by the participants according to the undertaken content analysis. Tab. 2 (see attachment 1 ) provides a descriptive definition for each of the thematic categories that emerged. Moreover, exemplary and characteristic citations of the participants are given for each thematic category in Tab. 2 (see attachment 1 ).

Figure 1. Percentage of survey participants who cited challenges in the corresponding categories.

Discussion

The current web-based, cross-subject and cross-faculty questionnaire study among the educators of the GMA shows that the central challenges for educators of the German Association for Medical Education are seen as lying particularly in the necessity of academic recognition, and institutional and financial support.

The main challenges expressed by the study participants are also reflected in international experiences and demands. For instance, Golub [6] and Jones [12] called for more funding and institutional support for educators. Reed and colleagues [18] determined in their study that most of the published projects from the area of medical education research were either not funded at all or else were clearly under-financed. The barely existent funding of medical education criticised in this survey can equally be interpreted as an expression of a lack of academic recognition. In an international survey which posed the same question, problems in terms of academic recognition and institutional and financial support were also seen by the educators as the main challenges [10]. Differences between the challenges in Germany and the challenges faced worldwide are particularly apparent with regard to academic recognition. For instance, over 53% of the participants of the present survey cited the limited academic recognition of their teaching assignments as a main challenge. By comparison, in the international survey, this lack of recognition was not criticised quite as frequently (40%). The fact that commitment in the area of education is not academically recognised is not only a problem in medicine but also in other subject areas in Germany. For instance, in her article “Mentalitätswechsel! Perspektiven für Lehrbeauftragte“ [Mentality change! Perspectives for educators] [19], Teichmann criticises the gulf in reputation between research and teaching. According to Teichmann, only if this situation changes and a mentality change occurs in universities, meaning that research and teaching actually become equal components of an academic career, will the attitude towards teaching and educators change ­ and only then will universities be equipped for the increasing competition for students.

Further challenges in the framework of the current survey were seen particularly in the cost-intensive areas, such as a generally limited institutional and financial support, lack of time for teaching assignments and lack of teaching personnel. Moreover, a need for improvement is seen in the didactic qualification of educators. To tackle this problem, in the last few years, numerous courses have been developed, e.g. in the framework of the Centers for Didactics in Higher Education [4], [15]. In the habilitation regulations of many medical faculties, participation in such courses is now mandatory. For those who wish to qualify themselves further beyond these courses, there is an opportunity to gain qualifications such as the Certificate of Advanced Studies in Higher Education of Baden-Württemberg or a postgraduate Master of Medical Education [5], [13], [11]. A central theme of the Master’s study programs is also the ability to conduct educational research. Precisely in this area, further qualification programs like those that already exist in biomedical areas [16] are urgently needed, as academic recognition will also depend essentially on the future academic achievements in the area of education.

The characterisation of the participants of the present survey shows that the examined group constitutes a specific and selected target group which possesses a high degree of experience in the area of medical education. For instance, the surveyed participants spend an average of 44% of their work time on medical education and have already been active in medical education for many years. Moreover, 9% of the participants have completed comprehensive further training in medical education in terms of a Master of Medical Education, and over 60% have already published at least one original work in the area of medical education as first author. For this reason, the examined sample is certainly only representative to a limited degree for all of those who are active in education, for whom the teaching activity does not take up a comparable amount of time. In order to characterise this group of educators who are involved in education to a lesser extent, further investigations are necessary.

The results of the study highlight the need to recognise the achievements of medical educators to a greater extent and the requirement of greater funding for educational projects. First steps in this direction have already been taken in the last few years: The GMA prize for young educators has been awarded since 2006 [9], the GMA prize for student educators has been awarded since 2010 [14], and also since 2010, the Ars legendi Faculty Prize for Medicine of the Stifterverband für die Deutsche Wissenschaft [Association for the Promotion of German Science] (http://www.stifterverband.org/wissenschaft_und_hochschule/lehre/ars_legendi_fakultaetenpreis/medizin/index.html) has been awarded, bestowed with 30,000 Euro. Moreover, faculty-internal education prizes have been established in numerous faculties. Overall, the establishment of a foundation to fund innovative teaching and educational research projects in medicine would be a further useful and important step.

Acknowledgement

We thank the Association for Medical Education (Gesellschaft für Medizinische Ausbildung, GMA) for permitting us to use their mailing list, and all participants of this survey for their support.

Competing interests

The authors declare that they have no competing interests.