Unlocking Potential: Elevating Faculty Development in Liberia through a Localized Training-of-Trainers Model

Unlocking Potential: Elevating Faculty Development in Liberia through a Localized Training-of-Trainers Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unlocking Potential: Elevating Faculty Development in Liberia through a Localized Training-of-Trainers Model Marie Martin, Odell Kumeh, Megan Croly, Sydell Goll, Comfort Enders, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4870423/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Over the past few decades, the University of Liberia College of Health Sciences (ULCHS) has faced increased challenges in providing high quality health education due to societal turmoil, disease outbreaks, and a critical lack of human resources. In 2018, ULCHS leadership identified the building of a faculty development program focused on pedagogy and teaching skills as a top priority to strengthen educational output. Methods This paper describes the creation and implementation of a pedagogical training program within the Center for Teaching, Learning, and Innovation (CTLI) at the University of Liberia College of Health Sciences (ULCHS). Using an innovative South-South Training-of-Trainers (ToT) model which leveraged local trained educators within the same city and country, the program aimed to bridge teaching and learning gaps among ULCHS faculty members. Results Surveys administered across three iterations of the program indicated a substantial improvement in participants' perceived knowledge in 11 competency domains related to teaching, learning, and assessment. Results demonstrated (1) the effectiveness of the pedagogy training program in building perceived skills, and (2) usage of a South-South ToT model to foster a supportive learning environment and promote systemic change. Conclusions This study highlights the potential of a three-phase ToT model for transforming pedagogical practices in low-resource settings and emphasizes the importance of peer instruction in creating effective, student-centered learning environments. Trial registration: Not applicable Train the Trainer model faculty development Liberia program evaluation pedagogy Figures Figure 1 Figure 2 Background Once a model training program in West Africa, the A.M. Dogliotti School of Medicine (AMD) in Liberia, which is now part of the University of Liberia College of Health Sciences (ULCHS), has faced economic challenges, destructive civil wars, and disease outbreaks, weakening its ability to provide high quality healthcare and health education. Most recently, the 2014 Ebola outbreak strained Liberian health systems, resulting in a yearlong closure of AMD and the loss of 8% of the country's doctors, nurses, and midwives [ 1 ]. AMD has also been challenged by a critical lack of human resources in terms of teaching faculty and administrators, particularly since it has relied on working clinicians to teach many of the medical school courses. In 2018, AMD had just three full-time Liberian faculty, which included the dean, assistant dean/clinical coordinator, and pre-clinical coordinator. A 2017 mixed-method study conducted among university faculty and students revealed a demoralizing learning environment characterized by non-interactive lectures that discouraged student inquiries [ 2 ]. It is against this backdrop that ULCHS developed a five-year strategic plan in 2018 that outlined priority objectives and interventions to enhance educational outcomes. Informed by two mixed-method studies, ULCHS leadership identified the creation of a faculty development program focused on pedagogy and teaching skills as a top priority [ 2 ]. The program would help faculty create a positive, student-centered learning environment by enhancing their use of a variety of pedagogical methods. This recommendation is in line with health domain trends, as several studies have underscored the expanding use of faculty development programs for pedagogical training [ 3 , 4 ]. Furthermore, research has shown that faculty development programs positively impact teaching performance and student outcomes [ 5 , 6 ]. In 2018, ULCHS, Vanderbilt University, Yale University and University of Massachusetts were awarded funding from the U.S. Agency for International Development through the Partnership for Enhanced Engagement in Research Program (PEER) to strengthen medical education in the country. It was under the PEER-Liberia program that a faculty development program, developed previously by Mother Patern College of Health Sciences (MPCHS), a local institution, and Jhpiego for nurse educators, was expanded and contextualized for an interprofessional faculty at ULCHS. The two health education institutions located in the same city and country, MPCHS and ULCHS, engaged in a South-South Training-of-Trainers (ToT) approach to build pedagogy expertise at ULCHS. It was established to foster best practices in teaching and learning techniques, ultimately aiming to cultivate a student-centered learning atmosphere. The program was piloted in 2019 and 2020 in close collaboration with MPCHS and Vanderbilt University and then run independently by ULCHS in 2021. In 2021, the University of Liberia College of Health Sciences partnered with Yale University, Vanderbilt University, and other public sector and innovation partners to launch BRDIGE-U: Liberia, a 5-year, $ 15 million USAID-funded project. Central to this initiative is the creation of a Center for Teaching, Learning, and Innovation (CTLI) at ULCHS. Within the CTLI framework, a faculty development program was proposed to offer a variety of training opportunities including institutionalizing the pedagogy program established under the PEER-Liberia funding. Methods Pedagogical approach: Training-of-Trainers (ToT) Model The ULCHS pedagogy program was developed using a Training-of-Trainers (ToT) model. A ToT model pairs experienced instructors with new instructors who are less familiar with a particular topic area or course. The experienced instructors introduce course content, materials, teaching techniques, and activities to the new instructors and coach them on how to implement the program. Through this process, the new instructors build the knowledge and skills necessary to implement the program independently [ 7 ]. In this case study, nursing faculty at Mother Patern College of Health Sciences (MPCHS), one of five colleges of the Stella Maris Polytechnic University and a fellow Liberian academic institution also located in Monrovia, served as the experienced instructors to the new instructors at ULCHS, who were all medical faculty. Since the pedagogy course itself was adapted from a similar program at MPCHS, their faculty were experts in the creation and delivery of these pedagogy materials. In 2019, faculty from MPCHS led the first iteration of the ULCHS pedagogy program. The new instructors at ULCHS, who intended to lead the program in the future, participated in this installment as learners. The second iteration of the program implemented in 2020 was co-taught by MPCHS and ULCHS faculty. This collaboration allowed the new instructors to gain experience delivering content and running the course, while having support from the expert instructors. ULCHS faculty delivered the third iteration in 2021 independently. This occurrence of the course marked a successful transfer of knowledge and skills. This represents a truly local South-South collaboration in the faculty development field where faculty trainers and participants came from different higher education institutions within the same city and country. It also serves as an example of effective interprofessional education, with nursing educators teaching physician educators. Learning Environment As mentioned previously, there is a severe shortage of healthcare workers and health sciences instructors in Liberia. Many of Liberia’s skilled healthcare professionals fled the country during the long periods of civil crisis, and 8% of the health workforce lost their lives during the Ebola outbreak [ 1 ]. To circumvent this shortage, ULCHS has relied on visiting faculty from foreign universities to teach key courses while it could develop faculty expertise through a faculty apprentice program which has now trained 14 individuals outside the country in masters programs in various scientific disciplines [ 2 ]. Many of the Liberian full and part-time faculty are constrained by time and resources. Budgeting limitations at the University mean that faculty are paid significantly less than they would be in the private sector. Faculty often have a second job to make ends meet and view their teaching positions as a sacrifice for the school and country. These competing demands have led to a teaching culture marked by minimal preparation, underprepared lessons, a lack of visual aids, and non-interactive lectures which discourage student inquiry or engagement. ULCHS is home to four schools: the AMD School of Medicine, School of Pharmacy, School of Public Health, and School of Midwifery. The pedagogy course is offered to faculty teaching at any of the four schools of ULCHS, and thus each cohort of the program is multidisciplinary and includes both clinical and non-clinical faculty. Most ULCHS faculty had no formal pedagogical training prior to the faculty development program. Many clinical faculty never had the intention to teach in the medical school; they were called from the bedside into the classroom out of necessity. Because of these factors, most faculty only “lecture,” and do not have adequate teaching skills to employ a dynamic instructional model. ULCHS has not historically required that instructors attend trainings for teaching skills to receive promotion or appointment (though a plan for this is now in development). Program Structure Each iteration of the ULCHS pedagogy course was taught over three months in three weeklong phases. The three phases of the workshop covered a range of topics related to teaching, learning, assessment, leadership, and equity. In phase one, the focus is on foundational elements of leadership, teaching, and assessment, including identifying key elements of leadership, demonstrating excellence in teaching, facilitating clinical practice, assessing learning, evaluating teaching, and gender sensitivity. Phase two builds on these foundational elements by expanding the focus to include change management, research utilization, and more advanced teaching skills. This phase of the workshop emphasizes the importance of leadership in driving change and incorporating research into teaching practice. Finally, phase three focuses on practical skills such as coaching and small group work, as well as creating and analyzing effective student assessments. This phase emphasizes the importance of equity in assessment and teaching, ensuring that all learners have access to effective instruction and assessment that meets their needs. Content for the ULCHS pedagogy program was based on the existing pedagogy course at MPCHS. However, it was adapted and expanded upon to meet the needs of ULCHS faculty as identified in two internal reports in 2018 and 2019 respectively. These reports found a need to provide instruction in research skills, mentorship, and exam best practices. ULCHS also adapted the course for institutional contextual relevancy. Data Collection Surveys were administered on paper or online through REDCap [ 8 ] at the end of each three-month iteration of the training and were kept consistent across iterations. Participants were asked to rate their perceived knowledge or skill in 22 (11 knowledge, 11 skill) key areas of competency using a five-point Likert scale. The surveyed competencies aligned with those that the program intended to teach. Over the course of the three iterations, 53 participants who were current or future faculty at ULCHS completed the program. Sixty percent (60.4%) identified as male, while 37.7% identified as female. Respondents had varying levels of teaching experience. About a quarter were relatively novice, with less than a year under their belts (24.5%), while another quarter were veterans with at least a decade of experience (22.6%). The plurality of educators fell between those extremes, with 30.2% having 1–3 years of experience, and 15.1% with 4–9 years of teaching under their belts. The majority (81.3%) were between 31–60 years of age. Acknowledgment of limitations This case has a few limitations that restrict the generalizability of the findings. First, data comes from just 53 participants. Because of the small sample size, there is a limit to the statistical power that can be ascertained from these responses. Secondly, since the data collection relied on self-reported surveys, participants may have over- or under-reported their knowledge or skills in the surveyed competencies. Finally, there has not yet been a follow-up assessment to evaluate the retention of knowledge or skills gained during the program or the actual impact of the program on participants' teaching practices and student outcomes. Results Survey results indicate that this pedagogy training was highly successful in a number of ways. First, participants perceived substantial improvement in knowledge across the 11 surveyed competencies. Using a five-point Likert scale, the average score rose from 2.57 to 4.2 across all three iterations, representing a 63.4% average increase in self-perceived knowledge. The training helped participants improve their knowledge in a range of areas, including teaching, assessment, and gender inclusivity. Improving faculty members’ knowledge in these areas was a significant step towards equipping instructors at ULCHS with the tools they need to create effective, student-centered learning environments. Survey results also suggest that this implementation of a localized South-South ToT model for faculty development was effective and is a viable model for future trainings. The ULCHS team was also able to leverage existing tools and resources, including the curriculum. Each of the three iterations implemented between 2019 and 2021 involved a differing level of ULCHS facilitation. In the first iteration in 2019, MPCHS faculty solely taught the program. ULCHS faculty began co-teaching the program in 2020 and independently led it in 2021. Despite this change in leadership, the average increase in knowledge perception remained positive: 74% in 2019, 65% in 2020, and 57% in 2021 (see Fig. 2). While these are encouraging outcomes, it should be noted that there was a slight decrease in the average score improvement over time. This could be explained by an increase in the before-training knowledge score and a stable after-training knowledge score. Specifically, the before-training knowledge score was 2.42 in 2019, 2.54 in 2020, and 2.71 in 2021. The after-training knowledge score was 4.20 in 2019, 4.18 in 2020, and 4.25 in 2021 (see Fig. 1). These results suggest that the ToT model was an effective framework in this context for transferring content and facilitation expertise. Conclusions and Implications The survey results from this pedagogy training program demonstrate its effectiveness in improving participants' knowledge across various competencies and the successful implementation of a South-South ToT model for faculty development. The ToT model not only facilitated the transfer of content and facilitation expertise but also fostered a supportive and non-judgmental learning environment, which is essential for achieving systemic change. Furthermore, the training program's adaptability to local cultural contexts and the increasing involvement of ULCHS faculty in facilitation demonstrate the potential for scalability and sustainability of this model. This case contributes to the growing body of evidence that supports the use of the ToT model in transforming pedagogical practices and highlights the importance of peer instruction in creating effective, student-centered learning environments. Our findings suggest that the effectiveness of this training was substantially improved by adopting the ToT model, which successfully garnered strong participant support and was a more sustainable model than training faculty outside of the country in costly training programs or supporting short-term foreign faculty to facilitate trainings locally. This pedagogy program aimed to change the teaching habits of its participants substantially, some of whom had been teaching for well over a decade. The South-South ToT model allowed participants to be taught by experts in their own country who shared similar teaching backgrounds. In the first two phases of the program, nursing faculty were teaching medical faculty. Importantly, in the final two phases, ULCHS faculty participants were taught by members of ULCHS who had just recently completed the course themselves. This local cultural context and relatability suggests that the localized ToT can create a positive learning environment where participants are able to learn new ways of teaching without judgment. Buy-in from participants is crucial in achieving long term systemic effects. The ToT model relies on the acceptance and endorsement of both the content and the model to affect real, system-wide change [ 9 ]. The model presented in this article could be a viable option for future programs looking to make systemic change to pedagogical practices because of its emphasis on peer instruction. Moreover, the South-South approach, particularly a localized one, promises to be a contextually relevant, sustainable approach particularly for low resource contexts. Declarations Ethics approval and consent to participate We received ethics approval for this study from the Vanderbilt University Medical Center Institutional Review Board and the University of Liberia PIRE Ethical Review Committee. Consent for publication All authors have approved this manuscript for submission. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests We have no conflicts of interest to disclose nor any issues relating to journal policies. Funding Funding for this project was provided by the United States Agency for International Development (USAID)/National Academy of Sciences Partnership for Enhanced Engagement in Research (PEER)/Liberia (subaward number 2000009598) and the USAID Bringing Research to Impact for Development, Global Engagement, and Utilization (BRIDGE-U) Applying Research for a Healthy Liberia (award number 7200AA21CA00010). Authors' contributions MHM, MC, CS, CP, KTS analyzed and interpreted the evaluation data. OK, SG, CE, BB, HMP, GHB, EB, BD were major contributors in facilitating the program and writing the manuscript. All authors read and approved the final manuscript. Acknowledgements We acknowledge the helpful contributions of Chidimma Ndubiosi Oluavuand Qianwen Zen. References Evans DK, Goldstein M, Popova A. Health-care worker mortality and the legacy of the Ebola epidemic. Lancet Global Health. 2015;3(8):e439–40. Talbert-Slagle K, Ajami I, Currey B, Galvao R, Hadush J, Li SS, Flowers JT, Ziah M, Amuh D, Rabb M, Ilesanmi OS. Transforming medical education in Liberia through an international community of inquiry. PLOS Global Public Health. 2023;3(3):e0001610. Leslie K, Baker L, Egan-Lee E, Esdaile M, Reeves S. Advancing faculty development in medical education: a systematic review. Acad Med. 2013;88(7):1038–45. Steinert Y, Mann K, Anderson B, Barnett BM, Centeno A, Naismith L, Prideaux D, Spencer J, Tullo E, Viggiano T, Ward H. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide 40. Med Teach. 2016;38(8):769–86. Kamel AM. Role of faculty development programs in improving teaching and learning. Saudi J Oral Sci. 2016;3(2):61–8. Hoque KE, Alam GM, Abdullah AG. Impact of teachers’ professional development on school improvement—an analysis at Bangladesh standpoint. Asia Pac Educ Rev. 2011;12:337–48. 2019;16:2019.Centers for Disease Control and Prevention. Understanding the training of trainers model. Retrieved, Evans DK, Goldstein M, Popova A. July. Health-care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health. 2015;3(8):e439-40. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. Attard Tonna M, Bugeja G. Evaluating a Train the Trainer programme and the way this empowers educators to bring about systemic change. Eur J Teacher Educ. 2018;41(4):496–516. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Aug, 2024 Editor assigned by journal 16 Aug, 2024 Submission checks completed at journal 16 Aug, 2024 First submitted to journal 06 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4870423","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":342010661,"identity":"5bec5af5-4fcd-40d1-8112-8b0d5ea74948","order_by":0,"name":"Marie 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Dogliotti School of Medicine (AMD) in Liberia, which is now part of the University of Liberia College of Health Sciences (ULCHS), has faced economic challenges, destructive civil wars, and disease outbreaks, weakening its ability to provide high quality healthcare and health education. Most recently, the 2014 Ebola outbreak strained Liberian health systems, resulting in a yearlong closure of AMD and the loss of 8% of the country's doctors, nurses, and midwives [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. AMD has also been challenged by a critical lack of human resources in terms of teaching faculty and administrators, particularly since it has relied on working clinicians to teach many of the medical school courses. In 2018, AMD had just three full-time Liberian faculty, which included the dean, assistant dean/clinical coordinator, and pre-clinical coordinator. A 2017 mixed-method study conducted among university faculty and students revealed a demoralizing learning environment characterized by non-interactive lectures that discouraged student inquiries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is against this backdrop that ULCHS developed a five-year strategic plan in 2018 that outlined priority objectives and interventions to enhance educational outcomes. Informed by two mixed-method studies, ULCHS leadership identified the creation of a faculty development program focused on pedagogy and teaching skills as a top priority [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The program would help faculty create a positive, student-centered learning environment by enhancing their use of a variety of pedagogical methods. This recommendation is in line with health domain trends, as several studies have underscored the expanding use of faculty development programs for pedagogical training [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Furthermore, research has shown that faculty development programs positively impact teaching performance and student outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2018, ULCHS, Vanderbilt University, Yale University and University of Massachusetts were awarded funding from the U.S. Agency for International Development through the Partnership for Enhanced Engagement in Research Program (PEER) to strengthen medical education in the country. It was under the PEER-Liberia program that a faculty development program, developed previously by Mother Patern College of Health Sciences (MPCHS), a local institution, and Jhpiego for nurse educators, was expanded and contextualized for an interprofessional faculty at ULCHS. The two health education institutions located in the same city and country, MPCHS and ULCHS, engaged in a South-South Training-of-Trainers (ToT) approach to build pedagogy expertise at ULCHS. It was established to foster best practices in teaching and learning techniques, ultimately aiming to cultivate a student-centered learning atmosphere. The program was piloted in 2019 and 2020 in close collaboration with MPCHS and Vanderbilt University and then run independently by ULCHS in 2021.\u003c/p\u003e \u003cp\u003eIn 2021, the University of Liberia College of Health Sciences partnered with Yale University, Vanderbilt University, and other public sector and innovation partners to launch BRDIGE-U: Liberia, a 5-year, \u003cspan\u003e$\u003c/span\u003e15\u0026nbsp;million USAID-funded project. Central to this initiative is the creation of a Center for Teaching, Learning, and Innovation (CTLI) at ULCHS. Within the CTLI framework, a faculty development program was proposed to offer a variety of training opportunities including institutionalizing the pedagogy program established under the PEER-Liberia funding.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003ePedagogical approach: Training-of-Trainers (ToT) Model\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe ULCHS pedagogy program was developed using a Training-of-Trainers (ToT) model. A ToT model pairs experienced instructors with new instructors who are less familiar with a particular topic area or course. The experienced instructors introduce course content, materials, teaching techniques, and activities to the new instructors and coach them on how to implement the program. Through this process, the new instructors build the knowledge and skills necessary to implement the program independently [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this case study, nursing faculty at Mother Patern College of Health Sciences (MPCHS), one of five colleges of the Stella Maris Polytechnic University and a fellow Liberian academic institution also located in Monrovia, served as the experienced instructors to the new instructors at ULCHS, who were all medical faculty. Since the pedagogy course itself was adapted from a similar program at MPCHS, their faculty were experts in the creation and delivery of these pedagogy materials. In 2019, faculty from MPCHS led the first iteration of the ULCHS pedagogy program. The new instructors at ULCHS, who intended to lead the program in the future, participated in this installment as learners. The second iteration of the program implemented in 2020 was co-taught by MPCHS and ULCHS faculty. This collaboration allowed the new instructors to gain experience delivering content and running the course, while having support from the expert instructors. ULCHS faculty delivered the third iteration in 2021 independently. This occurrence of the course marked a successful transfer of knowledge and skills. This represents a truly local South-South collaboration in the faculty development field where faculty trainers and participants came from different higher education institutions within the same city and country. It also serves as an example of effective interprofessional education, with nursing educators teaching physician educators.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eLearning Environment\u003c/h2\u003e \u003cp\u003eAs mentioned previously, there is a severe shortage of healthcare workers and health sciences instructors in Liberia. Many of Liberia\u0026rsquo;s skilled healthcare professionals fled the country during the long periods of civil crisis, and 8% of the health workforce lost their lives during the Ebola outbreak [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. To circumvent this shortage, ULCHS has relied on visiting faculty from foreign universities to teach key courses while it could develop faculty expertise through a faculty apprentice program which has now trained 14 individuals outside the country in masters programs in various scientific disciplines [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Many of the Liberian full and part-time faculty are constrained by time and resources. Budgeting limitations at the University mean that faculty are paid significantly less than they would be in the private sector. Faculty often have a second job to make ends meet and view their teaching positions as a sacrifice for the school and country. These competing demands have led to a teaching culture marked by minimal preparation, underprepared lessons, a lack of visual aids, and non-interactive lectures which discourage student inquiry or engagement.\u003c/p\u003e \u003cp\u003eULCHS is home to four schools: the AMD School of Medicine, School of Pharmacy, School of Public Health, and School of Midwifery. The pedagogy course is offered to faculty teaching at any of the four schools of ULCHS, and thus each cohort of the program is multidisciplinary and includes both clinical and non-clinical faculty. Most ULCHS faculty had no formal pedagogical training prior to the faculty development program. Many clinical faculty never had the intention to teach in the medical school; they were called from the bedside into the classroom out of necessity. Because of these factors, most faculty only \u0026ldquo;lecture,\u0026rdquo; and do not have adequate teaching skills to employ a dynamic instructional model. ULCHS has not historically required that instructors attend trainings for teaching skills to receive promotion or appointment (though a plan for this is now in development).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eProgram Structure\u003c/h2\u003e \u003cp\u003eEach iteration of the ULCHS pedagogy course was taught over three months in three weeklong phases. The three phases of the workshop covered a range of topics related to teaching, learning, assessment, leadership, and equity. In phase one, the focus is on foundational elements of leadership, teaching, and assessment, including identifying key elements of leadership, demonstrating excellence in teaching, facilitating clinical practice, assessing learning, evaluating teaching, and gender sensitivity.\u003c/p\u003e \u003cp\u003ePhase two builds on these foundational elements by expanding the focus to include change management, research utilization, and more advanced teaching skills. This phase of the workshop emphasizes the importance of leadership in driving change and incorporating research into teaching practice.\u003c/p\u003e \u003cp\u003eFinally, phase three focuses on practical skills such as coaching and small group work, as well as creating and analyzing effective student assessments. This phase emphasizes the importance of equity in assessment and teaching, ensuring that all learners have access to effective instruction and assessment that meets their needs.\u003c/p\u003e \u003cp\u003eContent for the ULCHS pedagogy program was based on the existing pedagogy course at MPCHS. However, it was adapted and expanded upon to meet the needs of ULCHS faculty as identified in two internal reports in 2018 and 2019 respectively. These reports found a need to provide instruction in research skills, mentorship, and exam best practices. ULCHS also adapted the course for institutional contextual relevancy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eSurveys were administered on paper or online through REDCap [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] at the end of each three-month iteration of the training and were kept consistent across iterations. Participants were asked to rate their perceived knowledge or skill in 22 (11 knowledge, 11 skill) key areas of competency using a five-point Likert scale. The surveyed competencies aligned with those that the program intended to teach.\u003c/p\u003e \u003cp\u003eOver the course of the three iterations, 53 participants who were current or future faculty at ULCHS completed the program. Sixty percent (60.4%) identified as male, while 37.7% identified as female. Respondents had varying levels of teaching experience. About a quarter were relatively novice, with less than a year under their belts (24.5%), while another quarter were veterans with at least a decade of experience (22.6%). The plurality of educators fell between those extremes, with 30.2% having 1\u0026ndash;3 years of experience, and 15.1% with 4\u0026ndash;9 years of teaching under their belts. The majority (81.3%) were between 31\u0026ndash;60 years of age.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAcknowledgment of limitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis case has a few limitations that restrict the generalizability of the findings. First, data comes from just 53 participants. Because of the small sample size, there is a limit to the statistical power that can be ascertained from these responses. Secondly, since the data collection relied on self-reported surveys, participants may have over- or under-reported their knowledge or skills in the surveyed competencies. Finally, there has not yet been a follow-up assessment to evaluate the retention of knowledge or skills gained during the program or the actual impact of the program on participants' teaching practices and student outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eSurvey results indicate that this pedagogy training was highly successful in a number of ways. First, participants perceived substantial improvement in knowledge across the 11 surveyed competencies. Using a five-point Likert scale, the average score rose from 2.57 to 4.2 across all three iterations, representing a 63.4% average increase in self-perceived knowledge. The training helped participants improve their knowledge in a range of areas, including teaching, assessment, and gender inclusivity. Improving faculty members\u0026rsquo; knowledge in these areas was a significant step towards equipping instructors at ULCHS with the tools they need to create effective, student-centered learning environments.\u003c/p\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003cp\u003eSurvey results also suggest that this implementation of a localized South-South ToT model for faculty development was effective and is a viable model for future trainings. The ULCHS team was also able to leverage existing tools and resources, including the curriculum. Each of the three iterations implemented between 2019 and 2021 involved a differing level of ULCHS facilitation. In the first iteration in 2019, MPCHS faculty solely taught the program. ULCHS faculty began co-teaching the program in 2020 and independently led it in 2021. Despite this change in leadership, the average increase in knowledge perception remained positive: 74% in 2019, 65% in 2020, and 57% in 2021 (see Fig. 2). While these are encouraging outcomes, it should be noted that there was a slight decrease in the average score improvement over time. This could be explained by an increase in the before-training knowledge score and a stable after-training knowledge score. Specifically, the before-training knowledge score was 2.42 in 2019, 2.54 in 2020, and 2.71 in 2021. The after-training knowledge score was 4.20 in 2019, 4.18 in 2020, and 4.25 in 2021 (see Fig. 1). These results suggest that the ToT model was an effective framework in this context for transferring content and facilitation expertise.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Conclusions and Implications","content":"\u003cp\u003eThe survey results from this pedagogy training program demonstrate its effectiveness in improving participants' knowledge across various competencies and the successful implementation of a South-South ToT model for faculty development. The ToT model not only facilitated the transfer of content and facilitation expertise but also fostered a supportive and non-judgmental learning environment, which is essential for achieving systemic change. Furthermore, the training program's adaptability to local cultural contexts and the increasing involvement of ULCHS faculty in facilitation demonstrate the potential for scalability and sustainability of this model. This case contributes to the growing body of evidence that supports the use of the ToT model in transforming pedagogical practices and highlights the importance of peer instruction in creating effective, student-centered learning environments.\u003c/p\u003e\u003cp\u003eOur findings suggest that the effectiveness of this training was substantially improved by adopting the ToT model, which successfully garnered strong participant support and was a more sustainable model than training faculty outside of the country in costly training programs or supporting short-term foreign faculty to facilitate trainings locally. This pedagogy program aimed to change the teaching habits of its participants substantially, some of whom had been teaching for well over a decade. The South-South ToT model allowed participants to be taught by experts in their own country who shared similar teaching backgrounds. In the first two phases of the program, nursing faculty were teaching medical faculty. Importantly, in the final two phases, ULCHS faculty participants were taught by members of ULCHS who had just recently completed the course themselves. This local cultural context and relatability suggests that the localized ToT can create a positive learning environment where participants are able to learn new ways of teaching without judgment.\u003c/p\u003e\u003cp\u003eBuy-in from participants is crucial in achieving long term systemic effects. The ToT model relies on the acceptance and endorsement of both the content and the model to affect real, system-wide change [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The model presented in this article could be a viable option for future programs looking to make systemic change to pedagogical practices because of its emphasis on peer instruction. Moreover, the South-South approach, particularly a localized one, promises to be a contextually relevant, sustainable approach particularly for low resource contexts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe received ethics approval for this study from the Vanderbilt University Medical Center Institutional Review Board and the University of Liberia PIRE Ethical Review Committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have approved this manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have no conflicts of interest to disclose nor any issues relating to journal policies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this project was provided by the United States Agency for International Development (USAID)/National Academy of Sciences Partnership for Enhanced Engagement in Research (PEER)/Liberia (subaward number 2000009598) and the USAID Bringing Research to Impact for Development, Global Engagement, and Utilization (BRIDGE-U) Applying Research for a Healthy Liberia (award number 7200AA21CA00010).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMHM, MC, CS, CP, KTS analyzed and interpreted the evaluation data. OK, SG, CE, BB, HMP, GHB, EB, BD were major contributors in facilitating the program and writing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the helpful contributions of Chidimma Ndubiosi Oluavuand Qianwen Zen.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEvans DK, Goldstein M, Popova A. Health-care worker mortality and the legacy of the Ebola epidemic. Lancet Global Health. 2015;3(8):e439\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalbert-Slagle K, Ajami I, Currey B, Galvao R, Hadush J, Li SS, Flowers JT, Ziah M, Amuh D, Rabb M, Ilesanmi OS. Transforming medical education in Liberia through an international community of inquiry. PLOS Global Public Health. 2023;3(3):e0001610.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeslie K, Baker L, Egan-Lee E, Esdaile M, Reeves S. Advancing faculty development in medical education: a systematic review. Acad Med. 2013;88(7):1038\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinert Y, Mann K, Anderson B, Barnett BM, Centeno A, Naismith L, Prideaux D, Spencer J, Tullo E, Viggiano T, Ward H. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide 40. Med Teach. 2016;38(8):769\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamel AM. Role of faculty development programs in improving teaching and learning. Saudi J Oral Sci. 2016;3(2):61\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoque KE, Alam GM, Abdullah AG. Impact of teachers\u0026rsquo; professional development on school improvement\u0026mdash;an analysis at Bangladesh standpoint. Asia Pac Educ Rev. 2011;12:337\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2019;16:2019.Centers for Disease Control and Prevention. Understanding the training of trainers model. Retrieved, Evans DK, Goldstein M, Popova A. July. Health-care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health. 2015;3(8):e439-40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAttard Tonna M, Bugeja G. Evaluating a Train the Trainer programme and the way this empowers educators to bring about systemic change. Eur J Teacher Educ. 2018;41(4):496\u0026ndash;516.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Train the Trainer model, faculty development, Liberia, program evaluation, pedagogy","lastPublishedDoi":"10.21203/rs.3.rs-4870423/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4870423/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOver the past few decades, the University of Liberia College of Health Sciences (ULCHS) has faced increased challenges in providing high quality health education due to societal turmoil, disease outbreaks, and a critical lack of human resources. In 2018, ULCHS leadership identified the building of a faculty development program focused on pedagogy and teaching skills as a top priority to strengthen educational output.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis paper describes the creation and implementation of a pedagogical training program within the Center for Teaching, Learning, and Innovation (CTLI) at the University of Liberia College of Health Sciences (ULCHS). Using an innovative South-South Training-of-Trainers (ToT) model which leveraged local trained educators within the same city and country, the program aimed to bridge teaching and learning gaps among ULCHS faculty members.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSurveys administered across three iterations of the program indicated a substantial improvement in participants' perceived knowledge in 11 competency domains related to teaching, learning, and assessment. Results demonstrated (1) the effectiveness of the pedagogy training program in building perceived skills, and (2) usage of a South-South ToT model to foster a supportive learning environment and promote systemic change.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study highlights the potential of a three-phase ToT model for transforming pedagogical practices in low-resource settings and emphasizes the importance of peer instruction in creating effective, student-centered learning environments.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Unlocking Potential: Elevating Faculty Development in Liberia through a Localized Training-of-Trainers Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-14 07:57:17","doi":"10.21203/rs.3.rs-4870423/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-19T08:46:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-16T13:27:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-16T13:20:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-08-06T19:23:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e9f6fee4-638a-4d3a-af3c-7fe84cd6c79f","owner":[],"postedDate":"October 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-21T10:54:49+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-14 07:57:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4870423","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4870423","identity":"rs-4870423","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}