The Development and Validation of a Professional Development Program for Health Professional Educators in Ethiopian Higher Education Context

Abstract

Despite the presence of a common agreement on the importance of integrating professional development (PD) for instructors in higher education (HE), the level of progress made in that regard varies greatly across HE systems around the world. Part of the variation was due to the lack of comprehensive theories and guidelines that leverage efforts to integrate PD issues into HE system. Also, there is limited research regarding the development and revision of PD programs for instructors of health sciences in HE setting. The limited studies primarily lack a comprehensive or all-encompassing framework that capture the complexities of the program development and validation process. Rather, they are essentially impact evaluation studies, examining the short-term and long-term benefits of the programs under studies. This study offers a theoretical rationale and a three-step framework for PD program development and review in HE through presenting a case study of an innovative PD program in the Ethiopian public university context. A three-step approach that consists of curriculum development, an iterative research–based review, and collaborative revision and validation is recommended in this study, to promote a commitment to systematic planning and research-based review and revision in a PD of instructors in HE in Ethiopia and beyond.

Introduction

Background

The professional development (PD) of academics is a multidimensional concept, often encompassing the subject, type of process, skills targeted, and/or expected results. It includes a wide array of training, formal education, or advanced professional learning opportunities intended to help stakeholders of HE improve their professional knowledge, competence, skill, and effectiveness [1]. Seen in this way, PD is any activity that is part of a continuous and strategic effort to improve teachers’ professional skills and competencies [2]. As Nicholls [3] states, PD is taken as a means to the enhancement of the knowledge, skills, and understanding of individuals or groups in learning contexts that maybe identified by themselves or their institutions.

The systematic development of a curriculum is a collaborative engagement of teachers and administrators, among others [4]. Reviewing a curriculum or a program denotes evaluating its effectiveness after implementing it and reflecting on what the participants did and did not get out of it [5]. Similarly, revising a curriculum or a program represents a modification to the existing curriculum using data from the review process [6]. These reviews and revisions are important for enhancing the quality of PD experiences because they enable higher educators to consider the ways the curriculum interacts with actual participants [7].

While it is believed that PD is a key to educational reform and quality enhancement [8], most often, it is common to evaluate the impact of PD without clearly understanding the nature of the program and how it is developed and enhanced [9]. This means, there are no established standards for development, review, and revisions of PD practices. While the lack of standards has had an adverse effect [10], such standards are not developed, discussed, and applied in part because curriculum development is viewed as being separate from research. Existing evidence shows that there is nominal structure to support the development, review, and revision of teachers’ PD in HE [11]. A model of PD contextualized within subjects, targeting specific skills, and meeting a minimum duration might be most effective [12].

Statement of the Problem

Over the years, we have seen that HE systems around the world face three new challenges: massification, marketization, and pandemic conditions, resulting in the spread of a student-centered approach, and the growing importance of digital technologies in teaching and research in HE [13, 14]. The advantages and disadvantages of these changes are disputable. Yet, it is clear that in light of these changes, the need for professionalism on the part of academics has grown and become a necessary condition for the competitiveness for institution and an individual’s career progression [15]. Research shows that despite this expectation, academics’ participation in PD is infrequent and takes place unsystematically [16]. This study addresses the main obstacles to academics’ participation in PD, and how these obstacles are overcome in higher education institution (HEI) through a systematic process of curriculum development and revision of a particular PD program in Ethiopia.

A well-educated, flexible, and highly competent teaching force is required to handle the issue of globalization and complex social changes and to foster practices which are responsive to the educational needs of all learners. It is stated in HE Proclamation 650/2009 that preparing knowledgeable, skilled, and attitudinally matured personnel is one of the objectives of HE program [17]. Poor teachers’ competency and pedagogical skills are among the factors that affect the quality of HE [18]. To be an effective educator in addition to the subject matter expertise, there should be a need for pedagogical knowledge and skills [19].

One mechanism put in place in Ethiopian HE sector to improve the quality of HEI is introducing the higher diploma program (HDP) for instructors in HE that is aimed at developing the pedagogical skills and professionalism of teachers. HDP was launched in 2004 across HEIs in Ethiopia as an in-service faculty development system. This program was intended to enhance the pedagogical competencies of teacher educators [20, 21], both for early career academics and for senior academics [22]. Over the years, various scholars examined the potency of HDP in offering its intended purposes. The different studies conducted so far revealed some program success [23, 24] and its inherent challenges, particularly in making lessons active and increasing students’ engagement and academic achievement [25–28]. The Ethiopian HEIs are highly challenged to reshape the professional development programs and professional practices to respond to the emerging demands of customization to discipline based and using technology platforms for learning. The quality of health professional education (HPE) influences the competencies of future physicians and the quality of health care services overall [29].

Even though the current curricular shifts in the HPE had incorporated significant changes to the previous versions, these changes were not influential to overcome the deep-rooted beliefs and pedagogical practices of teachers [5]. Studies have suggested that the pedagogic shift needed of the health care system requires fundamental changes of the roles and commitments of educators [30, 31].

The introduction of new educational strategies, increased use of learning technologies, the development of new assessment tools, and the increasing complexity of the curriculum whether at the undergraduate or postgraduate level have led to the recognition that all those who teach require some pedagogical skill [32, 33]. As such, HDP customized for health professional educators has been increasingly called upon as one of the desired solutions for making the teacher’s PD enjoyable and meaningful. In line with this, in his rigorous study of a mixed-methods evaluative design, Piper [34] pointed that the HDP has been applied across a range of cluster-based in-service teacher PD programs to scale up the roles and benefits of HDP.

However, this causes pressure on educational managers and practitioners to tailor HDP for health professionals. Thus, universities and governmental bodies are now called upon to implement sustainable and efficient innovative HDP strategies. One of the primary challenges in this kind of innovative approach to instructors PD is how to design innovative solutions that are appealing and useful to the program implementers, and, at the same time, bring about transformative practices [35–37].

PD is an essential component of HE teachers that plays key roles in improving the performance of teachers, and thereby the learning of students in HE [38]. Also, it has significant implications for lifelong learning for those involved in the PD process [10]. Despite common agreement on the importance of integrating PD for teachers in universities, the level of progress made in that regard varies greatly in different countries and academic institutions. Part of the variation was due to the lack of comprehensive theories and guidelines that leverage efforts to integrate PD issues into HE system [39]. Hence, what remains unclear is how to develop and validate a PD program for university teachers and who should get involved in the process. In this study, the authors strived to clarify these issues, using a three-stage process of PD program development and review. The PD of health professional educators in HE was considered a central theme for in-depth scrutiny and broader examination due to the current increasing needs for a tailor-made PD program for HPE.

Therefore, the purpose of this study was to examine the existing HDP used in all HEIs in Ethiopia and further improve its contents, process, duration of the training, and delivery approaches. More specifically, this study answers the following basic research questions:

• How relevant are the existing contents of HDP to health professional experiences of PD in the Ethiopian HE context?

• What is the health professional educators’ response to the challenges surrounding the acceptance and implementation of the existing HDP in Ethiopian HEIs?

• How can the existing conventional HDP be improved and tailored to HPE fields in the Ethiopian HE context?

Methods

Study Paradigm

The study draws on a pragmatic paradigm, which allows using the philosophical and/or methodological approach that works best for the particular research problem that is being investigated [40]. This pragmatism is one of the underlying philosophical foundations of mixed-methods research [41], including a mix of quantitative and qualitative methods and approaches to explain a solution to a research problem. Guided by a pragmatic paradigm, this study places “the research problem” as being central to understanding the problem and applies those suitable approaches as mechanisms to respond to the questions of interest [42] (p. 11).

Study Design and Research Approach

In this study, the authors used an exploratory mixed-methods design, comprising of a survey of PD needs and a case study of program customization, review, and revisions. This exploratory mixed-methods design was found relevant as it allows using varied methods to provide a greater depth and breadth of evidence [43].

In terms of research approach, both needs assessment and cooperative approach based on focus group interviews to inquiry were applied. Needs assessment and cooperative inquiry approaches were selected because these helped to discover the felt needs and offered a unique and comprehensive form of participative research in which the stakeholder of the HDP for health professionals could use the full range of their feelings, knowledge, and experiences to reveal, discuss, and negotiate the different understanding and aspects of this HDP for health professionals in HE. While the needs assessment used gauged the felt needs of the program participants, the cooperative inquiry gave the opportunity for the participants to discuss issues and sharpen thoughts.

In this study, we used a case study design [44], taking the conventional HDP for Ethiopian HEI as a unit of analysis to the in-depth investigation of the contents, context, and process of the HDP. Focused on this, the authors first collected the health professionals’ satisfaction on the existing HDP, and analyzed the relevance of HDP to the HPE, followed by initial consultative workshops with content and pedagogical experts in order to customize the program and establish foundation. Over a period of 2 years, the researchers customized, implemented, reviewed, and revised the HDP to improve the quality of the HPE at a public university in Ethiopia.

Study Participants

For the quantitative part of this study, forty-six participants were invited to complete the SurveyMonkey, and 40 of them completed and submitted it. For the qualitative part, institution-based internal review, national consultative workshops, and revision and validation workshops were held with one hundred sixty-six (n = 166) selected participants from Ethiopian HEIs. The focus group interview participants of the internal review included 20 instructors from the health science college, Jimma University (JU). Also, the consultative workshop participants included 75 health professionals from Ethiopian 12 public universities, the Ministry of Science and Higher Education (MoSHE) and Jhpiego. The final curriculum revision consisted of collaborative revision and validation by experts (n = 71); of these, 25 experts participated in curriculum revision and another 46 participants from HEIs (health science subject matter experts, higher diploma coordinators, leaders, and tutors) and experts from MoSHE and Jhpiego participated. The outcomes of the focus group interview and consultative workshop recommendations served as input for the final curriculum revision and validation. Then, the final revision and validation produced recommendations for use.

Conceptual Model of the Study

This study was guided by a five-step process conceptual model, comprising of needs assessment survey, program customization, initial and secondary reviews, and revision of a PD program for health professionals in HE context. Figure 1 presents the conceptual model of the study, consisting of the mechanisms and processes of curriculum development and validation.

Fig. 1.

A conceptual model of the study

The conceptual model presented in Fig. 1 represents the overall program development, review, and revision processes, which is intended to help researchers understand how individual educationalists and developers work together in the development and review of the HDP for health professionals as a continual process evolving thorough the five stages. The conceptual model presented here represents an effort to design a critical research process using needs assessment survey and focus group interviews. Each stage has a chunk of specific activities and expected outcomes to be achieved in accordance to the research questions stated in the introduction.

Study Instruments

In this study, both needs assessment survey and focus group interviews were conducted at the different stages of the research processes.

PD Needs Assessment Questionnaire

In this study, we used SurveyMonkey as the platform for our needs assessment survey. The SurveyMonkey includes contents about staff perceptions of PD. Specifically, it addressed what health professional educators perceive as the strengths and areas for improvement in their current PD practices in the Health Science College. Also, it asks study participants about their PD participation and the resultant satisfaction in terms of convenience and accessibility of training, quality of training they received, and ongoing support and reinforcement of materials. The authors adopted the contents of this SurveyMonkey from the past experiences in developing and revising curricula in university programs.

Focus Group Interview

Focus group interviews, first proposed by Fiske and Kendall [45] were employed to generate data. Here group dynamics became an integral part with participants engaged in discussion with each other before directing comments to the moderator. The moderator kept the direction of discussions under control by utilizing a list of questions set by a facilitator.

After much consideration and debate, it was decided to conduct these focus group interviews in workshops at a pre-planned conference specifically designed for validation purposes. Furthermore, since the knowledge being sought was to have an emancipatory nature, it was thought that having participants from different disciplinary backgrounds, as well as having a varied institutional and academic character, was important.

Consultative Workshops

There was a national consultative workshop at Debre-Markose University on the existing HDP design, content relevance to specific disciplines, and its implementation challenges. The workshop specifically focused on exploring the challenges, opportunities, and prospects of HDPs that have been running in all public HEIs with similar module contents.

During the workshop, the following three scientific papers relevant to the workshop themes were presented as a background to the workshops’ discussion: The impact of HDP on public HEIs academics’ teaching, learning, and research competencies in Ethiopia—cases of three institutions; exploration of the experiences of HDP trained instructors on improving teaching performance—a comparative study in Mekelle university college of health sciences; and HDP implementation assessment—a comparative study between HDP trained and untrained teachers at the University of Gondar. Hence, workshop discussions were stimulated by the brief highlights of paper presenters.

Program Revision and Validation Workshops

Two rounds of expert reviews (health science content experts and pedagogy experts) were held to improve the content, context, duration, and training delivery mode of the program. The validation workshop was organized after the experts’ revision of the initial customized HDP module for health sciences. The MoSHE, in collaboration with the Jhpiego Growth through Nutrition (GtN) project, has organized a 2-day HDP validation workshop. The discussion in the validation workshop focused on the relevance of the revised module contents to different discipline (one-fits-for-all contents), its proposed duration, training delivery modality, and the anticipated challenges of implementing the proposed HDP program for health sciences.

Study Procedures

First of all, the process started with a needs assessment survey to capture the felt needs of the program participants. Then, the existing HDP program was customized. Following customization, an initial validation was conducted via focus group interviews conducted with 2 cohorts of health professionals.

Since the main stakeholders are health professional educators, researchers, administrators, and technologists, it was decided to conduct a workshop that would attract participants from these groups. The strategy for data collection and exploration of participants’ views were devised in three stages. First, the required pre-understanding was established through a short presentation and discussion of the framework by the program initiators. Secondly, participants were asked to divide into small workgroups of four to six people and invited to discuss and negotiate their own views among themselves. Once they had completed this group discussion around the issues relating to each of the areas outlined in the module, they were then asked to draw up, in a tabular form, critical components related to each aspect of HDP for health professional educators’ implementation from their own perspective and to submit these to the workshop organizer for analysis and dissemination. Finally, a plenary discussion, moderated by the research team, invited and encouraged further discussion and the gathering of any additional comments.

Quantitative and Qualitative Data Analysis

The quantitative data were analyzed using descriptive statistics such as frequency and percentage distributions to summarize the data. The authors used descriptive statistics as this was found enough for the purpose intended or address the research questions. Also, the authors took a modest stance to making pragmatic generalizations drawn from the data considering the limited no. of quantitative study participants in the needs analysis.

Our qualitative analysis was led by an inductive approach [46] so that the themes and categories of analysis emerge from the data at each stage of the research [47]. The themes and categories are driven by how the authors interpret what is in the data based on subjective perspectives and intuitive field understanding. This justifies the reflexive nature of the process [1], which is the key to sparking insight and developing meaning from the existing qualitative data [48].

Based on the needs assessment results, the authors initially customized the HDP modules for health science and this was then reviewed by 20 instructors in health science college at JU, Ethiopia. From the focus group interview data, the authors anticipated generating evidence about the views and insights of the study participants regarding the appropriateness of the customized HDP to the health science’s PD context, the relevance of its contents, and its practicality within the health science’s PD setting. Also, the authors generated evidence about the implementation challenges and recommended changes for effective outcomes. With this, the authors produced initial evidence about the suitability of the customized HDP in the health science’s PD context.

Following the focus group interviews and a further refinement of the initial customized contents, the authors explored the issues more broadly in two different ways, including consultative workshops as well as revision and validation. Figure 2 presents a graphic framework of the emerged themes from the qualitative data that guides the entire analysis and the process of continuous meaning-making across the different stages of the research.

Fig. 2.

A graphic framework of the emerged themes from the qualitative data

As shown in Fig. 1, at each stage of the study process, 2–3 themes emerged from the qualitative data. The results of the qualitative data were systematically organized based on this framework and produced refined syntheses as presented in the “Results” section of this study.

Ethical Considerations

The protocol was approved by review Ministry of Science and Higher Education and Ethical Review Committee of Institute of Health Science, JU, for customization of HDP for health professionals for HEIs in Ethiopia. All needs assessment survey participants and consultative workshop participants were informed beforehand with a brief explanation of the study purposes and after obtaining informed consents verbally through a face-to-face interaction with the data collectors and workshop facilitators.

Results

Overview

The findings of this study are presented in three sections. Section 1 provides the descriptive summary of the study participants’ responses to the needs assessment survey. Sections 2 and 3 present the internal and external reviews summary and the final revision and validation summary, respectively.

Program Development Based on Needs Assessment

The overall response rate for the needs assessment survey was 88.9%. Table 1 presents the descriptive summary of the study participants’ responses to the needs assessment survey.

Table 1.

Summary results of the needs assessment survey

Items (N = 40)		Frequency	%
1. Do you believe Higher Diploma Program (HDP) in health professional education training is needed for you?
	Yes	37	92.5%
	No	3	7.5%
2. Which modality do you prefer?
	Face to face	2	5%
	Online	10	25%
	Blended	28	70%
3. Do you think the contents are relevant to your PD?
	Yes, all of the contents are relevant	4	10%
	Yes, some of the contents are relevant	36	90%
	No, all of the contents are irrelevant	0	0.00%
4. What additional content do you recommend to be included in the training?
	Clinical skill teaching	28	70%
	Problem based learning	26	65%
	Simulation based teaching	28	70%
	Objective structure clinical examination	22	55%
	No need to add other topic	12	30%
5. How long should be the duration of the training?
	3 months	27	67.5%
	6 months	13	32.5%
	9 months	0	0.00%
	One year	0	0.00%
6. What award do you recommend upon the completion of the training?
	Level 1 certificate of completion	1	2.5%
	Level 2 certificate of completion	1	2.5%
	Higher Diploma	22	55%
	Postgraduate certificate	16	40%
7. What method of performance assessment do you recommend?
	Activity Report	40	100%
	Assignments	34	85%
	Portfolio	22	55%
	Practical Exercises	32	80%
	Written exam	6	15%

As shown in Table 1, majority (39/92%) of the participants reported the importance of the program for their PD. Participants also reported their preference to blended learning modality (70%), the relevance of some program contents (90%), decreasing training duration to 3 months (67%), and higher diploma certificate award after successful completion of the program. In terms of the teacher participants’ responses to contents to be counted in the program, many participants in this study reported the importance of including clinical skill teaching (70%), problem-based learning (65%), simulation-based learning (70%), and objective structural clinical examination (35%). Almost all participants preferred activity report (100%), assignment (85%), practical exercise (80%), and portfolio (55%) as performance assessment methods.

Summary Results of Internal and External Reviews

In this section, the focus group interview and consultative workshop participants’ views and perspectives will be provided based on three primary categories identified as the participants’ perspectives of the HDP: (a) the PD context (internal and external), (b) the nature and use of HDP, and (c) content relevance for the instructors in health science. Additionally, another two secondary themes were developed to further describe the existing implementation challenges and recommended changes for better program suitability to instructors in health sciences. When necessary, subcategories may be developed within each of these categories to further delineate the views and perspectives participants had with the PD program studied.

The PD Context

Most of the study participants viewed that the PD context in teacher education and health science are largely different. For example, the study participants highlighted that instructors in the clinical health disciplines need clinical expertise together with teaching expertise. Also, the learning environment in health sciences is distinctively unique as it possesses health service delivery and functions in a hospital setup. As one of the experts from the Ministry of Science and Higher Education (consultative workshop participant) noted, different disciplines require different teaching, learning, and assessment methods related to the objectives of the PD program. Adult learning is effective when module contents are developed in the context of a specific discipline. This indicates the importance of understanding a disciplinary context in designing a PD program for HE instructors.

The Nature and Use of HDP

Teachers’ continuous learning via PD is universally accepted among professionals and other stakeholders in the HE sectors. Participants identified a variety of uses for the HDP. Most of the study participants reflected that HDP training increases the pedagogical skills of health professional educators. As one of the experts commented, HE teaching is a multifaceted activity that requires continuous professional development on how to teach and what to teach.

Participants identified a variety of contributions of the HDP. For example, participants highlighted that participation in HDP was a relevant mechanism for introducing new instructors in health sciences to important topics in teaching, managing, and assessing health science students and using HDP as a professional development opportunity for senior academics to fine-tune their pedagogic skills in a specific area of interest. These perceived contributions by participants suggested that HDP is a relevant mechanism to establish a PD program for instructors in health science.

Critical to providing current and relevant PD activities is an awareness of the unmet needs of instructors in HE, including the common (broader academic) as well as discipline-specific needs. While HDP was planned with a focus on active learning and continuous assessment, its practice, in the views of some participants, was directed toward delivering contents rather than supporting authentic professional learning. Also, another participant noted that “Instructors attended HDP primarily because it is mandatory but not necessary to fulfill their unmet needs.” This means the HDP is required because an authority mandated it instead of it being needed for a practical reason.

Content Relevance

The majority of the participants recognize HDP’s contribution to PD, but they have numerous complaints about the relevance of some module contents, the length of the training duration, and the technological aspect of the online training delivery modality. Another focus group interview participant of this study has reinforced this.

The HDP module contents demand reconsideration, because the module is developed in a teacher education context. For example, the health professional education curriculum needs problem-based learning, clinical skill teaching, bedside teaching, simulation-based learning, and objective-structured clinical examinations, which are totally missing in HDP modules. Therefore, it is better to consider teaching learning and assessment methods in the health professional curriculum context.

The module contents, in the views of the study participants, simply lacked important teaching, learning, and assessment methods relevant to health professional educators. Hence, the module contents need revision.

Anticipated Challenges

The study participants had several concerns in relation to the implementation of the HDP in health sciences. For example, one of the participants of this study commented the following: “HDP training is planned as ten-month training with an 80% attendance policy, and this makes the training boring and increases trainee dropouts.” The other issue with the program is the teaching learning modality, which is fully face-to-face. In the modern technology era, there is a possibility of flipping some HDP contents over to the online learning management system. This may be one of the solutions to problems raised related to the duration of training and attendance policies.

Also, another participant spoke of the challenges of having a universal design for HDP modules. She spoke of the adversity of universality as it overrides the domain-specific needs of the instructors in different disciplines. Moreover, the study participants viewed that the HDP lacked flexibility to fit with varying interests of the instructors. Another challenge identified by the study participants was the minimal involvement and support of the university management.

Recommended Changes

The study participants proposed conceptual and methodological changes based on philosophical assumptions congruent with evidence about teachers’ professional learning in health science. The majority of the study participants discussed and agreed that the module contents of the HDP needs modification in the context of health science. Also, other participants recommended the possibility of covering some module contents through an online learning management system. One of the experts recommended “the need for contextualizing the HDP training contents, revising the duration of the training, and training delivery modality without compromising the big picture of the program.” Also, he called on all stakeholders to take action on the customization of HDP for HPE. Overall, it was clear that the participants of this study had concerns regarding several aspects of the HDP program. Cognizant of this, paying attention to a context-appropriate intervention was found necessary.

Summary Results of Program Revision and Validation

Analysis of the qualitative data from the program revision and validation workshops generated three important themes: customized HDP modules, implementation plan for short-term goals, and recommendations for use for the better future.

Customized HDP Modules for Health Sciences

A customized module is a module consisting of change of functionalities to fit with the needs of instructors in health sciences major fields. Through the customization process, the study participants identified key areas of the HDP modules for instructors in health science. The customized modules consist of both module-specific and cross-cutting concerns. The module-specific concerns include those issues to be addressed only in a specific module, whereas cross-cutting concerns include those issues that apply across the different modules.

Cross-Cutting Concerns

All case studies in the module were written in the context of health science education, module syllabuses have been developed, all module activities were developed on a separate trainee workbook, face-to-face and online content were identified and evaluated, and online content was uploaded onto an online learning management system.

Module-Specific Concerns

Module one

Understanding human resources for health, the role of health science education in HEIs, the role of reflection among health science educators, ethics and professionalism in health science education, and the role of the health science teacher as a role model are some of the generic contents that have been revised into discipline-specific ones.

Module two

Additional health science education content is incorporated, such as problem-based learning, clinical skill teaching, bedside teaching, simulation-based learning, and objective-structured clinical examination.

Module three

The generic organizational and school placement has been revised to organizational placement. Its assessment checklist and the number of placements also improved.

Module four

The revision more emphasized the action research to be undertaken in the area of health science education.

As illustrated above, there are many issues that require consideration when customizing the PD modules for instructors in health sciences. This case illuminates the importance of customization in the PD programs for HE instructors both in the cross-cutting and in the module-specific domains.

Recommendation for Use

The study participants critically reviewed the customized HDP documents and delivered ample arguments for modifications in implementation strategies. For example, they recommended that the training modality can be either blended or face-to-face, depending on the preference and capacity of individual HEIs. Also, they agreed that the duration of the program be 4 and half months for the blended and around 6 months for the face-to-face session, all accounting 132 total h. The ministry appointed JU to pilot the blended customized HDP for health science education.

Implementation Plan

The way forward with pilot testing and the future implementation plan of the program in health science education were discussed among the study participants. Ultimately, the validation workshop participants agreed to start the HDP for health sciences with a pilot testing in one institution in a blended modality. This was implemented as planned. The proposed implementation plan was meant for guiding the short-term (pilot) implementation. Hence, there is a lot to work on the long-term use of PD for instructors in health sciences across the public universities in Ethiopia.

After all these phases of customization, the program was tested in a blended modality at Health Science Institute, JU, Ethiopia, and its effectiveness were evaluated internally and externally. The pilot test results are promising, and the program is currently being recommended for use in all health science education institutions across the country. The findings of the blended program pilot test evaluation are being submitted in a separate peer-reviewed journal.

Discussion

Teachers play key roles in promoting and integrating quality in HE [19]. Effective PD is based on a notion of professional learning as continuing, active, social, and related to practice [49]. The objective of this study was to present a case example of a three-stage process for the development and review of a specific PD program for health professional educators in universities in Ethiopia and the perspective and the challenges the staff developers and researchers face in performing this complex role.

According to the findings of the needs assessment survey, the existing PD for teacher educators had limitations on its relevance and alignment to the demands of instructors in health science fields. The study participants suggested various changes in the program to make it suitable for the needs of the health science teachers. This is consistent with the results of previous studies on HDP. For example, researchers recommended the need for the HDP material to be revised for the purpose of eliminating lots of repetition in each module and to enhance the relevance of the contents [21]. Also, it was suggested to consider the difference in teacher candidate’s discipline and demand of subject area methodology [20].

The study participants also acknowledged the importance of the program for their PD context. They also suggested the program to be delivered in blended modality. In line with this study results, other studies acknowledged its importance in increasing the teachers’ ability to develop necessary professional knowledge, skills, and attitudes in instructional design, collaborative work, reflection, and action research [34]. In addition, studies also recommended the use of technology in the HDP program [22]. It is believed that when teachers are educated to employ technology effectively and trained through technology, they can develop lessons that strengthen student understanding, cooperative learning, and problem-solving skills [50].

Most of the focus group interview participants had much reservation on the suitability of the HDP for instructors in health sciences due to contextual incongruity, content relevance issues, and implementation challenges. Participants reported the inappropriateness of the module contents designed for HDP in teacher education to health science. Also, they felt that 10-month duration is too long and bored to attain the program. In line with this finding, a study conducted in Arabic university stated that, after the introduction of HDP in Ethiopia in 2004, the module was revised only once in 2011 and it needs major revision to make the contents relevant to teachers’ day-to-day activity, in the context of the discipline specific demands and up to date [51]. Mizell (2010) also suggested that PD is most effective when it occurs in the context of educators’ daily work [23].

HE teachers are adult learners and their PD programs such as HDP should be approached from an adult education perspective. Institutions need to recognize the different sources of training as equally effective and offer a variety of options to their teachers [37]. With more choices, teachers will have different avenues to pursue and will not feel limited [52]. They will also feel more in control of their PD [24].

In the consultative workshop, stakeholders came together from different areas and discussed on the nature and use of HDP, and identified the current HDP’s various weakness or gaps. They also recommended a consideration of program revision as a relevant aspect of the customization and validation process [53]. A study also recommends the need for incorporating essential contents to teacher education and dropping too much redundant and irrelevant details [27]. Moreover, the online learning management system was suggested as an alternative training delivery modality, together with the need to revise the length of training duration, and establish a mechanism for motivating trained teachers to apply key lessons learnt from the program and contribute to the quality of education [54].

In this study context, customizing the PD program was conducted to improve the contents, context, design, program duration, and training delivery modality. There are values in contextualizing PD for instructors in health sciences because this helps to better serve instructors, students, and patients.

Limitations

This study was not without limitation. One of the limitations was the small sample size of the study participants of the needs assessment survey. Also, the SurveyMonkey was not pilot tested and this can be taken as another limitation of this study.

Conclusions and Practical Implications

Conclusions

To comprehensively understand the overall impact of providing an innovative PD for teaching academics in HE, this study analyzed the process of program development and validation of a specific PD program for health professional educators in Ethiopia across different dimensions such as program quality, HPE engagement and progression, and institutional effectiveness and efficiency. There are various potential indicators of each domain which further suggests that to capture the complexity of the program development and validation of PD, researchers can use a range of quantitative and qualitative methods, including questionnaires, interviews, reflections, and focus groups.

These study findings highlight the need to have a broader consideration of the PD program development and review from three perspectives including program development based on a survey of needs assessment, followed by an iterative review of internal and external stakeholders, and a collaborative revision and validation of the PD program for further improvement and better quality. Moreover, it was clear from the findings of this study that the HDP program is an important component of the PD for teachers in HE. While the HDP may be a good starting point to offer the basics of HE teachers’ professionalism, this is not enough to consume the full potentials of PD in HE. Hence, efforts should be underway to further extend HDP with other variants of PD programs that focus on improving weaknesses and planning for future.

Practical Implications

This study findings provide insight into the teachers’ own assessment of the PD development and validation experiences, the barriers they perceived, and the outcomes sought within the specific context of their respective academic institutions. The teachers’ perceptions and needs expressed in this research offer a foundation for further discussion of the existing situation and the potential for improvement. Using lessons learnt from this customization and review experiences, together with knowledge of the unique local context, the researchers drew practical implications of the findings of the study for future PD in Ethiopia and beyond.

Research reported that prolonged and extended PD interventions featuring multiple iterative activities are extremely important for significant organizational change. Seen in this way, the use of HDP for health may not be sufficient by itself and further extensions of this HDP for health professional’s initiative should be strengthened by other similar need-based PD opportunities. If HEIs believe that PD is a tool to improve outcomes and productivity of HE system, then efforts should focus on three areas, including the basics of professionalism, improving current weaknesses, and planning for the future.

Overall, the evidence base for developing and validating a PD program for teachers in HE is negligible, primarily due to the complexity of the development and validation processes and further difficulty in analyzing data and keeping records. Hence, the existence of internal and external influences is difficult not only to evaluate but also to map out changes in the program. In failing to grasp the complexity, most reviews were carried out simplistically, with a focus on the immediate reactions of participants. Thus, missing out on various ways, staff, academic developers, and the institution can potentially be affected. This study proposes a three-step approach, consisting of a curriculum development, an iterative research-based review, and collaborative revision to promote a commitment to systematic planning and research-based review and revision in a PD program of health professionals in Ethiopian HE and beyond.

Funding

This research was funded by JHPIEGO Feed the Future to a research project of the corresponding author.

Declarations

Ethical Approval

The protocol was approved by the Review Committee of Institute of Health Science, JU (IHRPGD/868/20 and 9/10/2020).

Informed Consent

Informed consent was obtained from all subjects involved in the study prior to data collection.

Conflict of Interest

The authors declare no competing interests.