Volume 58, Issue 3 p. 299-307
RESEARCH ARTICLE
Open Access

Curriculum renewal towards critically conscious graduates: Implications for faculty development

Susan van Schalkwyk

Susan van Schalkwyk

Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

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Julia Blitz

Corresponding Author

Julia Blitz

Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Correspondence

Julia Blitz, Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, South Africa.

Email: [email protected]

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First published: 12 September 2023
Citations: 1

Abstract

Introduction

Globally, faculty development initiatives in support of health professions (HP) educators continue to extend their remit. This work becomes more critical as HP curriculum renewal activities are influenced by needing to move beyond a biomedical focus attending to issues such as social accountability, social justice and health equity. This raises questions about how best to support our HP educators who may need to change their teaching practice as they embrace these more complex, social constructs.

Methods

The research question for this qualitative study was: What implications are there for faculty development that can support HP educators as they are expected to incorporate the principles of critical consciousness and social accountability into their teaching as part of a curriculum renewal process? Data from 11 focus group discussions and 11 subsequent individual interviews with HP educators from two undergraduate programmes were thematically analysed after which further analysis focussed on the implications of these findings for faculty development. Transformative learning theory and models about change provided a sensitising framework.

Results

Our findings pointed to an expanded role for HP educators and consequently also for those responsible for faculty development. Three main ideas were highlighted: Curriculum renewal catalyses a renewed need for faculty development, the nature of faculty development that can enable change and new foci for faculty development.

Conclusions

Faculty development can make a significant contribution to enabling change, including in the context of curriculum renewal that often extends the roles and responsibilities of HP educators. When renewal seeks to shift fundamental curriculum principles, providing support to embrace this expanded remit results in an equally expanded remit for faculty developers—one that calls for initiatives that enable critical, dialogic encounters that might foster critical consciousness, leading to change in HP education. This challenges us, as faculty developers, to turn the mirror on ourselves to consider the nature of such expanded support.

PODCAST

1 BACKGROUND

There is general consensus in the literature that those responsible for the education of the next generation of healthcare professionals often assume a teaching role having had little, if any, formal, or even informal, training for this role.1-5 Increasingly, institutions across the world are implementing a range of initiatives to support teachers to strengthen their practice. In health professions education (HPE), such initiatives are often referred to as ‘faculty development’, and in recent years, there has been significant growth in this area.6 Steinert et al have argued that faculty development ‘refers to all activities health professionals pursue to improve their knowledge, skills and behaviours as teachers and educators, leaders and managers, and researchers and scholars, in both individual and group settings’.6(p769) Early understandings of faculty development as being about ‘tips and tricks’ and intermittent workshops focussing on skills and practice have been supplanted by this more encompassing definition that includes notions of scholarship, educational leadership and supporting the development of a professional (educator) identity.7-9 Accordingly, faculty development work has extended its remit and its potential to influence not only educational practice but also the educational space.

The educational space is, however, not static. Global calls for health professions (HP) curricula to enable new ways of knowing10 and for graduates to become more responsive to the communities they serve11 have catalysed important debates about curricula needing to move beyond a biomedical focus and foreground issues such as social accountability, social justice and health equity. The intention of such renewal is the development of students who are not only clinically competent but also critically conscious12-17 The notion of ‘critical consciousness’ emanates from the work of Paulo Freire who argued that such consciousness leads to us being ‘in the world as transformers of that world’.18 The term has been used in HPE to refer to ‘health professionals (including those in training) who question the causes of health inequity and intervene in health care contexts and systems with a view to transforming them into more socially just spaces’.19 Responding to these calls for curriculum renewal, however, requires revisiting both what is taught and how it is taught20 and signals an expanded role for educators who must interpret these philosophical or ideological perspectives and then also help their students make sense of them. It further suggests the ‘reorientation of the traditional teacher-student paradigms …’17(p786) and comes with additional responsibilities and expectations. Bleakley reminds us that just as medical interventions can have unintended consequences (‘iatrogenesis’), misjudged or mismanaged educational interventions can also cause harm (‘educational iatrogenesis’).21 It is therefore incumbent upon educators to recognise the emotional currents in the classroom as important ingredients of learning—thus further adding to their responsibilities.

This all raises questions about the preparedness of our HP educators, including clinical educators, who may or may not feel that they have the knowledge and skills to embrace these philosophical shifts in the curricula they must work with, or the ability to make the adaptations to their teaching that may be required. Consequently, scholars have drawn attention to the need for faculty development to support the HP educator tasked with this work.15, 22, 23

We explored HP educators' experiences of a curriculum renewal process that intentionally sought to foster graduates who are both clinically competent and critically conscious, which highlighted the need to revisit pedagogic practices.19 We argued that while the focus of renewed curricula may be on producing graduates who are both clinically competent and critically conscious, success is embedded in the steps taken by the HP educators themselves to expand their own way of knowing, doing and being and to question their own worldviews and assumptions.20, 24 In this context, supporting HP educators, specifically through faculty development, should conceivably take on a whole new guise. We therefore looked to answer the following research question: What implications are there for faculty development that can support HP educators who are expected to incorporate the principles of critical consciousness and social accountability into their teaching as part of a curriculum renewal process?

1.1 Conceptual framework

It is axiomatic to argue that teaching beyond the biomedical with a view to embracing more complex, social constructs will require a different approach—it will require change.25, 26 Similarly, Frye and Hemmer posit that educational programmes, and they include a broad definition of educational programmes that could encompass faculty development programmes, are fundamentally also about change.27 Bligh argues that faculty development seeks to assist HP educators through enabling them to think about their practice and to bring about change.28 Change is often conceptualised as a process. For example, in their seminal work around organisational change, Hersey et al emphasise the need for a change in behaviour or practice to be preceded by either a change in understanding or an awareness of new information that has become available.29 There are other critical success factors for change including recognition by those involved of the value of the change; understanding the nature of the change and the implications of it; the feasibility of the change; and continuous engagement about the process as it evolves.30

A theory that paves the way for change envisaged during a curriculum renewal process—particularly one that seeks societal change—is transformative learning. Emanating from the work of sociologist, Jack Mezirow, transformative learning theory has been described as ‘learning that transforms problematic frames of reference—sets of fixed assumptions and expectations (habits of mind, meaning, perspectives, mindsets)—to make them more inclusive, discriminating, open, reflective, and emotionally able to change’.31(p7) It sets as its purpose the promotion of social justice, leading to social change. This transformation is catalysed by exposure to a disorienting dilemma that challenges what was previously known, and ultimately leads to a new awareness, and an altered way of being and doing. Thus, the theory offers much for those seeking to design curricula that can foster critically conscious graduates. In a scoping review on the uptake of transformative learning theory in HPE, Van Schalkwyk et al drew attention to the role of the educator, including the clinical educator, in terms of creating enabling environments where transformative learning might manifest.32 Importantly, they argued that in order to do this, the HP educator would themselves need to be willing to critically engage with their own positions and thinking on these broader societal issues.24, 32 Transformative learning theory has also recently been applied in the context of faculty development when researchers from Singapore foregrounded Mezirow's work to frame and evaluate a faculty development workshop arguing that it will ‘change the way we train’.33(p88) In this study, the theory serves as a sensitising concept for our work.34

2 METHODOLOGY

We were part of a project team that conducted an exploratory qualitative study situated in an interpretive paradigm seeking to uncover the meaning individuals ‘ascribe to a social or human problem’.35(p8) Ethical approval was obtained from the Health Research Ethics Committee at our institution. All of the programme co-ordinators, course leaders and HP educators in two undergraduate programmes (MBChB and BSc in Physiotherapy) undergoing curriculum renewal were invited to participate in the study and everyone who accepted the invitation voluntarily, was included. The data collection process was conducted in sequence first gathering data at the programme level and then gathering data at the module level and included 11 focus group (FG) sessions followed by 11 individual interviews (IN). In most instances, an interview was conducted to explore in greater depth, issues raised by participants in the FG. In some cases, they were with interested parties who had been unable to participate in an FG. These represented a total of 34 respondents (including clinicians responsible for student learning in the clinical space).

Data collection occurred over a period of approximately 9 months. After written consent had been obtained from each participant, interviews were conducted by an experienced senior researcher, recorded and subsequently transcribed. At each interview, participants were reminded of the principles underpinning their curriculum renewal processes, especially those of relevance to the issue of developing a critical consciousness of the context within which their graduate healthcare professionals will work. Participants were asked to reflect on their understanding of curricula that equip the graduates to be both clinically competent and critically conscious as well as how their understanding influenced their teaching practices.

Open coding of the transcripts informed the iterative development of a coding framework, which was then applied across all of the data.19 We identified four themes: what these understandings mean for curriculum development; how participants understand the broad principles underpinning their curriculum; what these mean for their teaching practices; and what this means for them as HP educators.19 However, as two members of the project team, and HPE scholars with an interest in faculty development, we focussed on the last theme of what the renewal process meant for the HP educators themselves with a view to positing how we might best support our HP educator colleagues. Specifically, we asked: What are the implications for faculty development that flow from the HP educators' responses? In this paper, therefore, we explore how participants experienced the process of implementing the renewed curriculum and their perceived needs to make such shifts. Our intention with this work was to uncover the implications for faculty development initiatives that can enable HP educators as they incorporate new principles such as critical consciousness and social accountability into their teaching.

3 FINDINGS

Our findings clustered around three main ideas: firstly, that faculty development was needed to support them through the change that was mandated through the curriculum renewal process; secondly, how they believed faculty development could facilitate or enable them in this change process; and thirdly, that the focus of faculty development engagements and initiatives would need to respond to the uncertainty and complexity that was a consequence of the curriculum renewal process.

3.1 A renewed need for faculty development

The participants acknowledged a need for faculty development to aid them in navigating the renewed curriculum. They also realised that implementing a curriculum that aimed at changing cultures, touching on people's norms and values, was not easy and could place them in difficult positions. This caused them to question their abilities and preparedness for this role.

But if you talk about toolbox, … I don't think there are enough tools for the teachers … How are they going to make that mind shift? It's not just by telling them this is how you are going to have to do it. It's going to take a huge mind shift from people and people might have to be trained to teach differently. (FG1.171)

Then the other thinking was that this is difficult. I am myself struggling with it, to manage all of these demands and making me this person with all of these abilities. How am I going to teach a student this? (FG7.53)

There also was a sense that it was not only needed once-off, but that support would have to be ongoing.

The issue, it's not a once-off thing. It's an ongoing process. … it's clear, the one thing people want more is support and faculty development. (FG11.62)

In addition, there was a need for the scaling up of faculty development to respond to the distributed training platform envisaged in the renewed curriculum.

We've got a few sites that are well trained in our apprenticeship idea, but now there is almost 20 additional sites that we will have to do some Faculty development, so that they understand what we are hoping to achieve. (FG11.33)

Obviously we would identify the hotspots where we have the most resistance, and where people are the least exposed to students, and then visit the sites … and then obviously we'd have to scale up, because getting people scattered all over to one place wouldn't be a feasible option. … We will have regional supervisors that are familiar with the outcomes and trained in what we want, and they would be visiting sites continuously and building on that Faculty development. (FG11.28)

3.2 Faculty development that enables change

In describing their understanding of the principles on which the renewed curricula had been built and the teaching practices that they believed would be relevant for the renewed curriculum, the participants provided insight into what they felt would assist them in successfully navigating this complex change process. Some of these insights were practice-focussed seeking support for and guidance on how to teach in this new and uncertain milieu. In addition, however, they expressed a desire for community engagement, for networking, for enabling dialogue.

A key concern raised by the participants related to confidence in terms of expanding their teaching to include aspects of critical consciousness. The need for guidelines were highlighted as being central to addressing this concern but also recognising that it was going to require a change in thinking and an awareness of self and others:

So, I think that would be nice to have some practical guidance, how to actually teach them, not to learn as we assess them and then just forget what they have learnt, and that's the basics. … So, how to actually incorporate this accountability to self and to others, …. (FG5.175)

A golden thread across the data, however, was the need expressed for enabling opportunities to discuss and debate and share experiences and success stories—this with a view to clarifying uncertainties and building confidence. The importance of reflection as part of these dialogic engagements was also emphasised.

But as I say, I'm a bit uncertain on how far we can go with this. I think it's an important question, because it might just pop up that a student wants to take further action and report a clinician, or even take it further than that, go to the media. … I think that would also be a good idea to discuss that at some stage. (FG11.33)

I think one of the things, or two things that come to mind, is the engagement in terms of the curriculum planning process with representatives of communities, … But I mean, whether there is an opportunity there of having some kind of engagement at some point … engaging with other professionals, which I think is an important part of dealing with some of this. Certainly there were a lot of people from the other professional programmes involved in the early stages of current development, and most of them have fallen by the wayside because I think they can't quite see how to engage. But what we were talking about this morning is that, I mean, we need to give some attention to that again … (FG8.143)

A characteristic of these dialogues was that they be explicit and be used as an opportunity to learn from one another.

I think our problem is we are not probably explicit enough about these things. But it is certainly our accountability and social accountability influence every single decision we make around our patients every day. I think maybe even discussing it openly and what we do. I just don't call it social accountability, what we call all these factors and all these things. I think this is part of being a doctor anyway, even if you work in a tertiary setting. (FG10.63)

If I look at our current sort of curriculum bits that we teach in, let's call it the clinical space, it's important for us to take time to think how we can bring context, community, change agent, into that what we do. For that we need time and we need to talk to other environments and see how did you do this, how did you do that. It's effort, and then a busy day. So, it needs to be made explicit also to the teachers. (FG1.218)

3.3 New foci for faculty development

Evident from the data was that faculty developers would need to expand their own curricula and to embrace new foci in their work—that the focus of faculty development engagements and initiatives would need to evolve in response to the uncertainty and complexity that was a consequence of the curriculum renewal process.

On a practical level, there was a concern about feasibility and workload, with responses highlighting the emotional and human investment that was required to effect the change. It appeared, therefore, that aspects of professional development and time management should also be foregrounded as part of faculty development work.

It was actually to learn balance, and that should probably be part of it. … So, in the end it's your family, friends that need to be your priority. I think that is for me, but in the clinical work as well, you work very hard, and unfortunately, you don't always have a choice because if someone is dying, you have to help them. But at some point, you must start to say no for stuff, because otherwise, 24 hours will not be enough for everything that they could potentially ask you to do … it's massive, and it's a lot of work, which is all extra, and not part of our normal … and to make it all happen under the load that we are currently under is quite daunting. … You know, the people want to change, but they're just too exhausted to do anything about it. (FG9.109)

Participants described the ongoing jostling for space in the curriculum and that navigating competing expectations with colleagues was another challenge requiring critical engagement and discussion that would need support and guidance.

I mean, we can meet with them and discuss it, but actually, it can't be every little sub-specialty vying for their place. So, it's that kind of challenge, and that speaks to the broader Faculty development that needs to take place. But how you reach those people is the challenge, I think. (FG8.76)

It can be argued that the teaching and training of future health professionals is complex. Across the course of their studies, students are exposed to biomedical scientists in the classroom or the laboratory, to clinical facilitators in simulation learning, to clinicians at the academic teaching hospital as well as to ‘outside’ teachers (clinical trainers) at smaller hospitals and clinics. Faculty development initiatives that provide opportunity to manage the change process and to offer guidance through the process of ‘ticking’ the many (additional) boxes that the renewed curriculum required of them would appear to be important.

No, of course, and that's what we are going to try and do. But what I am trying to say is I don't think we should be too hard on ourselves in the sense that there are so many boxes that one has to tick in preparing a healthcare professional. With this new curriculum, there are a hell of a lot more boxes that we have to start ticking now, which is good. (FG7.67)

The participants expressed concerns about the extent to which the different role-players were equipped to take the new curriculum on board, and understood their roles and responsibilities, particularly given the additional focus within the curriculum, to take student learning outside of the classroom into communities. Their responses not only highlighted the need for faculty development but also provided insights into the sort of guidance being sought. In the second quote below, it appears that the need to work with something tangible, akin to the sort of algorithm that characterises much of medicine, was being asked for.

They didn't train to be a teacher, they didn't train to be working with students. They didn't train to be talking about concepts of social accountability, etc. (IN15.26)

There's no template, there's no format, and you say when you are going in, and they just can't cope with that. I think maybe that's where the confidence gets lost outside of. It's like with my skills, I know what to do. I've got a recipe, I've got a template. I have examined, this is what I can do, but actually outside of that, just in terms of thinking and using, using my head and trying to work it out, I am out of my depth, and I'm insecure. (FG1.227)

Having the sort of engagement that is needed to implement the curriculum, particularly when they were working across different health disciplines (another one of the foci of the renewed curriculum), was specifically described as being ‘very difficult’. Infusing critical consciousness into an already packed curriculum further amplified this complexity, making it very ‘tricky’.

Well, I think that is going to be a tricky subject, … So I think because students are, look, our world, our communities are evolving all the time, you know, changing all the time. We are mixing, and to get the students to explore different experiences is going to be tricky, because if we take different students, it is sort of – ja, we must be very careful not to label students. (FG6.149)

These conversations could, however, have implications for the educators themselves. The quote below, for example, suggests the need to encourage the sort of meta conversations that move beyond how to teach the core content to recognising one's own role as an advocate for social accountability and how to help students work through the complexity that comes with taking on an advocacy role. Another topic, therefore, for faculty development centred around facilitating difficult conversations with students.

No, I think we should, … We should not kid ourselves how difficult it is. … For instance students will come to me and say we now taught them that you should look at the patient in a much broader context, you should look at the health system, and all those things. Now they are stuck because this woman doesn't have money. What must they now do? So, you create an awareness, but with that awareness, you should surely then also give them the tools to address whatever they get confronted with. … We always talk about how we teach our students about social accountability, but what is our accountability towards the students, to actually help them to be able to do this. (FG10.31)

Participants also highlighted the challenge of convincing colleagues to take the new ideas that the renewed curriculum offered on board rather than passing the responsibility for ‘this funny stuff’ on to their colleagues.

I wish there was a way that all clinicians could just have an awareness of the renewed curriculum in their heads (FG9.105)

But I mean, it's interesting, I think the people in this module have gained a sort of respect for this stuff. I mean, they don't fully understand what all this funny stuff is, but they kind of are not saying it's not important. It's now much more, we have kind of gradually sort of meshed things a bit more together maybe. But it's interesting, you see, they said to you, I don't think we can talk about this stuff. You must go and talk to X. He′ll tell you about ‘the other’. (IN20.25)

As hinted at above, beyond the challenge of curriculum renewal was the nature of that renewal—a curriculum that would be situated within a socially just paradigm. There was an awareness among participants that this would challenge their own thinking as much as it would challenge that of the students. This, too, spoke to the need for introspective and self-reflective engagements.

Ja, I think a large part of our module will probably fall into that category of it's an experience that they will hopefully remember. It's going to be difficult for us to pin it down. It's obviously useful if we could pin it down, almost more for our sake than for theirs, because I'm thinking logistically, it might become challenging here and there, and if you're not sure of what you are doing, is really being successful in terms of what you want, it's very easy to get demotivated. (FG6.118)

4 DISCUSSION

Curriculum renewal implies change, and faculty development initiatives as well as faculty developers themselves can make a significant contribution to enabling HP educators to navigate that change.36, 37 Change to the curriculum will always hold implications for the educators responsible for its implementation, irrespective of whether or not they have been involved in its conceptualisation, often extending their roles and responsibilities. An additional expectation is laid at the HP educator's door when the intention behind the renewal is that it should engender change that is transformative, leading to new ways of knowing (being critically conscious) and the valuing of different knowledges (in the case of this work knowledge relating to issues of social justice and health equity). This expectation is potentially disruptive. Mezirow has argued that in order for learning to be transformative, the learner should be confronted by a disorienting dilemma that challenges preconceived ideas.31 In the case of our participants, it was clear that despite recognising the importance of the new curriculum, they acknowledged that change was not easy, and navigating this posed a challenging dilemma for them as HP educators.15, 38 However, transformative learning theory posits that being challenged is merely the first step towards the process of fully embracing new ways of knowing, being and doing.32 Embodying critical consciousness requires a willingness to delve into ‘complex and messy areas’,23 challenging one's own position of power and privilege such that it leads to a different way of being in the world.24 Paradis et al talk about ‘disruptive change’, which ‘is made possible by identifying, unpacking, and replacing potentially oppressive discourses’.39(p843) This will be true for not only the student but also for the HP educator who may experience a sense of discomfort,38 even disempowerment when asked to examine aspects of bias, identity and their own position in society.15

What does this all mean for faculty development? Our purpose in this work was to offer insights into ways in which faculty developers and faculty development initiatives might enable the sort of transformative learning journey needed by HP educators tasked with implementing renewed curricula that seek to encourage critically conscious and socially responsive graduates. Our data suggest that the expanded role for HP educators implies an expanded role for faculty developers. Our findings point to four key features of faculty development initiatives that can foster the change being sought, which faculty developers can consider. These key features are that the initiatives are ongoing or longitudinal; that they build community; that they enable dialogue and critical reflexivity; and that conversations be explicit and offer clear guidelines.

These features are aligned with current debates in several different ways. In their systematic review of faculty development initiatives, Steinert et al drew attention to the benefits that accrue from more longitudinal approaches.6 These included enhanced self-awareness, which is pivotal to the sort of reflexivity being called for in this paper, and it could be argued that applying a more ongoing approach is not that difficult to address. Similarly, there is a growing awareness of the value of building communities and networks that create opportunities for engagement among those responsible for the educational project. These communities have the potential to ‘engender the change we need in the academic culture towards teaching and learning’.40 (p148), 41

However, while the first two key features can be regarded as relatively easy to address—and are already common practice in many contexts, the latter two, that of enabling dialogue and critical reflexivity, and explicitly placing ‘the political’ on the agenda, may prove to be more complex. Faculty developers will need to facilitate and model the sort of ‘courageous conversations’42 that HP educators will be expected to have with their students and with one another. Although writing from a school education context, Singleton's guidelines for courageous conversations resonate with what has already been mooted: stay engaged over time; know that there will be discomfort; and speak your truth (be explicit).42 Writing from an HPE perspective, Molloy and Bearman argue that in the context of transformative learning, ‘expressing vulnerability may help individuals to access different ways of knowing’. They acknowledge, however, that demonstrating such vulnerability can involve risk—is ‘tricky’—and can create tension for the educator who seeks to balance vulnerability with their credibility. Instead, the authors propose ‘intellectual candour’, which they define as ‘the verbalisation of thinking with respect to a genuinely complex problem or situation. … It is not polished, and the discourse is emergent, hesitant, and fraught with the possibility of failure’.43(p36) It is also purposeful (explicit) and dialogic, thus in alignment with what we have argued thus far.

In their work on developing ‘humanistic professional identities’, Kumagai and Naidu call for ‘deliberate moments of reflection and dialogue’, emphasising the role of space (conceptualised broadly as time, duration, place and freedom) for such reflection, and dialogue that ‘calls forth deeply held beliefs, memories, and values’.14(p287) The role of time, space and the freedom to be and do can be seen as central in fostering the professional learning of academics (faculty development), which should provide for ‘spaces to flourish’.44

Embarking on the enabling, courageous, open and explicit dialogue, facilitating reflection and creating the necessary environment for such dialogue to occur is a tall order for faculty developers who themselves will need to consider their own views, beliefs and actions. Critical consciousness has been described as a ‘dangerous, uncomfortable educational practice’,38 and it makes sense that it could be equally so in the context of faculty development. We should be wary of the threat of Bleakley's ‘educational iatrogenesis’,23 cautious of doing more harm than good and intentionally seek ways in which we can disrupt within a ‘care-full’ environment45 even as we challenge ourselves. Manca et al conclude their article by stating that ‘any enterprise working toward embedding critical pedagogy within curricula must acknowledge and challenge the current structure and culture of medical education itself’.22(p966) As faculty developers, we are often expected to support existing structures and cultures within our respective contexts. Our expanded remit may require that we move to challenge the status quo and become part of the process of dismantling these structures with a view to enabling equity and social justice in HPE.10

There are limitations to this work. We had a specific intent when we engaged with the data, namely, that of identifying the implications that the initial study's findings held for faculty development. We acknowledge that the data were not generated specifically for this reason. We argue, however, that in bringing the data to bear on the practice of faculty development through this additional analytical process, we make a contribution towards the sort of scholarship that is currently being sought in the field.9 In addition, we did not differentiate between the two different programmes that participated in the study. Future work in this regard would be of value.

5 CONCLUSION

In this paper, we offer a re-conceptualisation of faculty development in the context of curriculum renewal initiatives. Moving outwards from the curriculum, we have shown how implementing curricula that seek to move beyond the biomedical to also embrace issues of social accountability, social justice and health equity will not only have implications for how and what students learn but also for how our HP educators teach and how faculty development will need to re-envisage itself to offer guidance to our educators in these endeavours. We have further argued that while transformative learning theory offers a pedagogical approach that can enable student learning, the tenets of this theory might equally hold when HP educators consider their own new ways of being and doing. Supporting HP educators to embrace this expanded remit, suggests an equally expanded remit for faculty developers – one that calls for initiatives that enable sometimes difficult, dialogic encounters to foster critical consciousness, and enable change, while challenging us to turn this same mirror on ourselves as faculty developers.

AUTHOR CONTRIBUTIONS

Susan van Schalkwyk led the conceptualisation of the study. Julia Blitz and Susan van Schalkwyk both contributed equally to data analysis, as well as the development and finalisation of the manuscript.

ACKNOWLEDGMENTS

This paper has emerged from work conducted as part of the Responsive Curriculum Project which is a South African based multi-institutional project led by the Centre for Health Professions Education at the Faculty of Medicine and Health Sciences, Stellenbosch University in collaboration with the Cape Peninsula University of Technology, Sefako Makgatho University, the University of Cape Town, the University of the Western Cape and the University of the Witwatersrand. The authors wish to acknowledge all of the staff in these different institutions who participated in the study. The authors also thank all participants for taking part in the focus group discussions and interviews and for sharing their experiences. Noeline Fobian is acknowledged for technical assistance while finalising the manuscript. We would like to thank the reviewers for their comments that have strengthened this paper and Cecilia Jacobs for assisting us with our response.

    CONFLICT OF INTEREST STATEMENT

    The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

    ETHICS STATEMENT

    The project lead institution received ethical approval from the university institutional review board (reference number: TL-2018-8838).

    DATA AVAILABILITY STATEMENT

    The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.