Figure 1. Overall design, implementation and evaluation process of the educational faculty development program for clinical faculty

In the evaluation phase, the response rate to the questionnaire was 81.2%. The majority of respondents (80%) were women. Almost all (98.4%) were assistant professors, and just one respondent was an associate professor. Most of the respondents were affiliated with the internal medicine department (61.5%), and 15.3% were from general surgery department. The Pediatrics respondents (9.2%) were almost equal in number to the respondents from obstetrics and gynecology department (7.6%). The respondents from orthopedics department were 4.6% and one respondent was from dermatology department (1.5%).
The mean (SD) of participants' satisfaction was 71.76 (4.29), indicating high overall satisfaction with the faculty development program. These results indicate that the informal and group-based approach is suitable for clinical faculty members who have a heavy work-load and limited time.
The mean (SD) of all items’ scores in terms of context evaluation, input evaluation, process evaluation, and product evaluation were 3.47 (0.35), 4.0 (17.34), 4.32 (0.47), and 4.41 (0.40), respectively (Table 3).

Table 3. Comparison of mean and standard deviation in the context, input, process, and product evaluation scores

The lowest score was attributed to the context domain and the highest was about the product evaluation of the program. Independent t-test showed no significant difference between the mean scores of context, input, process, and product domain (P > 0.05).

Discussion
This study aimed to design, implement and evaluate a long-term educational faculty development program for clinical faculty members. Harden’s 10 Questions of educational program development framework approach was adopted to design this program. In the implementation phase, a longitudinal, informal program in a group setting was considered based on Socio-cultural theory. The program was evaluated using the CIPP evaluation model.
Using Harden’s 10 Questions of educational program development framework approach as a systematic approach provided high-quality evidence of program designing. This well-structured and conceptualized approach goes beyond the conventional emphasis on just goals and educational methods in designing an educational program. It may be that the organizational impact of faculty program design will be of more long-term efficacy rather than simple improvement of program material (14). Sezer and the colleague (2021) developed a faculty development program consisting of six modules, 34 hours, and various teaching strategies in nursing education based on Harden’s model. They reported this program's advantages, including increasing students' academic success,  developing their clinical practices and generating a constant learning environment (15).
The relevance of content to the participants’ work and responsibility to address the professional needs of faculty was frequently highlighted in the review of Steinert et al. (2016) (4). Tenzin and colleagues (2019) designed a faculty development program based on educational need assessment. They reported significant improvements in teacher self-efficacy in the domain of teaching, developing creative ways to cope with system constraints and improvement of their communication skills (16). In our study, the incorporation of clinical faculty’s educational needs, including "clinical education", "clinical assessment" and "clinical professionalism" with the content of the program was a key feature. Some of these findings have been noted in previous studies that had focus on the need assessment of faculty development programs. Manzoor et al. (2018) identified areas for faculty development programs, including educational psychology, teaching skills, assessment techniques, educational research, and management skills for 194 clinical and basic science faculty (17).
The present study's results align with the findings of Abdelkreem et al. (2020), which assessed the perceived development needs of medical faculty and the factors affecting these needs. They determined that designing a faculty development program adjusted to faculty members' needs would promote professional growth (18).
Application of a longitudinal, informal, and group-based approach grounded on Sociocultural theory in the implementation phase argued that the developmental theories of Vygotsky resting on the concepts of the social basis of mental functions, agreement of performance and awareness, mediation, and mental structures can help more richly understand the faculty development in their workplaces. Shabani (2016) outlined that the sociocultural theory of professional development embraces both the theoretical and practical features. It creates relations between theory and practice by illustrating the multifaceted mechanisms of learning procedures in real sociocultural settings (19). Hora et al. (2021) emphasize the need to use sociocultural theory in faculty development programs to inform broader contexts of teachers' interaction in faculty development programs and to determining how individual capacities are generated (20).
Lippe et al. (2018) used the CIPP model to evaluate a nursing education program. The results showed that this model serves as a practical guide for in-depth and comprehensive evaluation of educational programs (21). Molope and colleagues (2020) evaluated a community development practitioners program using the CIPP model and reported that the benefits of this model lead to the evaluation of all influential factors from designing to implementation and evaluation of the faculty development program and provided valuable guidelines for improving future programs (22).
A wide range of long-term or short-term activities, formal or informal, individual or group-based approaches including workshops, seminars, mentorship programs, work-based learning, communities of practice, electronic and online learning, reflecting on experience, learning by observing peer coaching, and longitudinal programs such as fellowships can be considered for faculty development of clinical faculty members (4). Studies evaluating the faculty development programs have reported various levels of individual and organizational effects (23). The faculty development programs are implemented in the form of short-term and formal courses such as workshops and seminars. The results of these programs are the individual development of the faculty members (24). In some other cases, formal and individual approaches such as learning by observing peer coaching and mentorship are used. The results of such short-term or long-term programs are reflected in the personal and professional development of the faculty members (25). A limited number of policymakers of faculty development programs consider informal approaches such as work-based learning and communities of practice which impact at the organizational level (26). An informal and group-based approach provides an opportunity for reflecting on experiences and group discussion. These approaches greatly impact individual and organizational capacities to adapt and perform activities in a complex clinical setting with various underlying factors. However, these approaches have been used in a few cases (27).
Group discussion and interaction in education is rooted in sociocultural theory. According to this theory, learning is a socially mediated process in which individuals acquire knowledge through collaborative dialogues with more knowledgeable members of society (28). Therefore, reflection on experience and group discussion lead to the faculty members' active role in learning educational skills. Our positive results because of using the concepts of sociocultural theory are consistent with previous studies. Qureshi (2021) applied the sociocultural theory in medical education and revealed that this theory could be efficiently used on various levels of medical sciences education, including undergraduate education, postgraduate education, and continuous professional development (12).
In the present study, the combination of informal, longitudinal and group-based approaches greatly increased its effectiveness, leading to results such as enhancement in the process of clinical education and training clinical educators for future faculty development programs. These results are confirmed in the results of Salajegheh (2021), that studied the contribution of a long-term faculty development program to organizational development through capacity development (23).
In response to the open-ended questions of the questionnaire, the faculty reported awareness of strengths and weaknesses in education, increasing self-confidence and higher motivation for teaching, acquiring teaching skills in clinical settings, and providing effective feedback as the program's achievements. These outcomes are likely to be developed by the longitudinal approach of the program. As Steinert (2020) described, faculty development programs that extend over time yield results that go beyond teaching effectiveness and be more permanent (24).
One of the most notable findings was the agreement of faculty on the importance of collective participation for better learning. These outcomes are consistent with the impact of faculty development programs studied by prior research. Carvalho-Filho and colleagues (2020) described that communities of practice for faculty development suggest an effective and sustainable approach for implementing best practices (29).
Moreover, the results indicated that the participants believed the program's content addressed their professional needs specifically. Wong et al. (2020) similarly enhanced teaching proficiency at the end of their educational intervention for clinical faculty with a program that included relevant specific content (30).
Limitation and recommendation
One of the limitations of the present study was the implementation of the program in only one university, which may restrict the generalizability of the results. However, embedding the program in a theoretical framework and utilizing an evaluation model in the interpretation of the results may greatly reduce this limitation. As another limitation, however, the CIPP model is more comprehensive compared to other evaluation models, but it greatly emphasizes the process instead of focusing on the results. On the other hand, this characteristic helps policymakers of faculty development programs to systematically review all phases of these programs from various aspects (31). Also, this evaluation model should be planned for every educational program specifically due to the different and unique characteristics of each program, so the questionnaire designed and psychometrically analyzed in current research may need to be adjusted or modified for implementation in other settings.
Therefore, due to the constant challenge in medical universities regarding the insufficient participation and lack of interest of clinical faculty members in faculty development programs, we recommend considering the results of the present study to review and re-implement these programs.

Conclusion
Clinical faculty members are a most significant resource. Investing in their development is vital in improving capacities at all levels of the educational continuum. The Key features of effective faculty development for clinical faculty include evidence-informed educational design, relevant content to the participants' needs, longitudinal program design, multiple teaching methods such as flipped classrooms, incorporation of reflection, and group discussions.

Ethical considerations
This work was funded by the National Agency for Strategic Research in Medical Education. Tehran. Iran. Grant No.4000568.
Conflict of Interests
There are no conflicts of interest.
Acknowledgment
We would like to thank the faculty members who participated in this study for their support and involvement.