Educational Coaches: Facilitating Academic Vitality and a Pathway to Promotion for Clinician-Educators

Abstract

Department chairs want their faculty to experience vitality, thrive, and be promoted. Vitality has been described as “professional fulfillment, motivation, and commitment to ongoing intellectual and personal growth, full professional engagement, enthusiasm, positive feelings of aliveness and energy, and excitement about work.”1Ryan R.M. Frederick C. On energy, personality, and health: subjective vitality as a dynamic reflection of well-being.J Pers. 1997; 65: 529-565Crossref PubMed Scopus (1292) Google Scholar Faculty, in turn, thrive when they are appreciated and supported by leadership, of which promotion is an important result. Each of these factors poses challenges for department leaders. With regard to vitality, faculty rank at an institution has an impact: both junior and mid-career faculty are at higher risk of experiencing burnout and attrition than are their senior colleagues.2Dankoski M.E. Palmer M.M. Nelson Laird T.F. Ribera A.K. Bogdewic S.P. An expanded model of faculty vitality in academic medicine.Adv Health Sci Educ Theory Pract. 2012; 17: 633-649Crossref PubMed Scopus (19) Google Scholar,3Pololi L.H. Evans A.T. Civian J.T. Gills B. Coplit L. Billum L. et al.Faculty vitality-surviving the challenges facing academic health centers: a national survey of medical faculty.Acad Med. 2015; 90: 930-936Crossref PubMed Scopus (32) Google Scholar Workload also can affect vitality. Buckley et al demonstrated that internal medicine faculty who spent >50% of their time in clinical work lagged behind their similarly age peers in academic rank and were less satisfied with their jobs.4Buckley L.M. Sanders K. Shih M. Hampton C.L. Attitudes of clinical faculty about career progress, career success and recognition, and commitment to academic medicine. Results of a survey.Arch Intern Med. 2000; 160: 2625-2629Crossref PubMed Scopus (97) Google Scholar A study of junior faculty whose work is primarily clinical in a large radiology department found that 45% and 42% identified high clinical workload and lack of time to achieve academic goals, respectively, as disincentives for staying in an academic career.5Kelly A.M. Cronin P. Dunnick N.R. Junior faculty satisfaction in a large academic radiology department.Acad Radiol. 2007; 14: 445-454Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Faculty members who feel they do not have enough time to engage in the most meaningful aspect of their work may become emotionally exhausted and burned out.6Shanafelt T.D. West C.P. Sloan J.A. Novotny P.J. Poland G.A. Menaker R. et al.Career fit and burnout among academic faculty.Arch Intern Med. 2009; 169: 990-995Crossref PubMed Scopus (282) Google Scholar Recognition leading to promotion can be elusive. For instance, faculty whose primary efforts are clinical or research have a historically well-defined pathway to promotion, whereas faculty whose primary efforts are educational often are less likely to be promoted because their work is less likely to be adequately recognized.7Beasley B.W. Simon S.D. Wright S.M. A time to be promoted. The Prospective Study of Promotion in Academia (Prospective Study of Promotion in Academia).J Gen Intern Med. 2006; 2: 123-129Google Scholar Hence, academic leaders should celebrate individual and collective clinical, research, and educational achievements equally in public forums and leverage these successes.2Dankoski M.E. Palmer M.M. Nelson Laird T.F. Ribera A.K. Bogdewic S.P. An expanded model of faculty vitality in academic medicine.Adv Health Sci Educ Theory Pract. 2012; 17: 633-649Crossref PubMed Scopus (19) Google Scholar Department chairs also have the task of balancing both academic achievements and clinical work of their faculty, as well as addressing institutional initiatives needed to increase faculty vitality.2Dankoski M.E. Palmer M.M. Nelson Laird T.F. Ribera A.K. Bogdewic S.P. An expanded model of faculty vitality in academic medicine.Adv Health Sci Educ Theory Pract. 2012; 17: 633-649Crossref PubMed Scopus (19) Google Scholar Personal achievement and recognition are more important than compensation in motivating faculty and increasing job satisfaction.8Herzberg F. One More Time: How do you motivate Employees? Harvard Business Review.https://hbr.org/2003/01/one-more-time-how-do-you-motivate-employeesDate: 2003Date accessed: May 26, 2020Google Scholar The practice of peer coaching is well established in higher education.9Astin A.W. Korn W.S. Dey E.L. The American college teacher: National norms for the 1989-90 higher education research institute faculty survey. Higher Education Research Institute. University of California Graduate School of Education, Los Angeles1991Google Scholar,10Centra J. Reflective faculty evaluation: enhancng teaching and determining faculty effectiveness. Jossey-Bass, San Francisco1993Google Scholar It has been recognized in medical education as a powerful tool to improve teaching effectiveness.11Sekerka L.E. Chao J. Peer coaching as a technique to foster professional development in clinical ambulatory settings.J Contin Educ Health Prof. 2003; 23: 30-37Crossref PubMed Scopus (37) Google Scholar Schwellnus and Carnahan describe key components of successful peer coaching, including, “focus on individual strengths, goal directed, cooperative, feedback and self-reflection.”12Schwellnus H. Carnahan H. Peer-coaching with health care professionals: what is the current status of the literature and what are the key components necessary in peer-coaching? A scoping review.Med Teach. 2014; 36: 38-46Crossref PubMed Scopus (50) Google Scholar We describe an approach that leverages educational coaching and consultation as a means to prepare faculty for institutional success. We posit that coaching will facilitate academic vitality by building relationships and delineating a pathway to promotion for clinician-educators. In 2014, a large academic department introduced education coaches to help faculty on an education track receive recognition for work they do daily. An education coach is a midcareer to senior faculty member who has expertise in educational principles and practices, founded in the Glassick13Glassick C. Huber M. Maeroff G. Scholarship assessed. Jossey-Bass, San Francisco1997Google Scholar definition of scholarship, and aspires to transform educational efforts into scholarly products. The coach may also possess skills in peer mentoring and coaching. What follows is a brief overview of our program. The Association of American Medical Colleges developed a model known as the Q2Engage14Association of American Medical CollegesEducational Scholarship: How Do We Define and Acknowledge It?.https://www.aamc.org/professional-development/affinity-groups/gfa/faculty-vitae/defining-educational-scholarshipDate accessed: May 26, 2020Google Scholar that allows faculty to describe both the quality and quantity of their educational work and how it contributes to knowledge of the field. Educators' portfolios and curriculum vitaes are increasingly being used by academic institutions to document scholarly educational efforts, but the former are still relatively new for some medical schools.15Seldin P. Miller J.E. The academic portfolio: a practical guide to documenting teaching, research, and service. Jossey-Bass, San Francisco2010Google Scholar A portfolio provides a rich, vibrant portrait of the educator's work, coupled with reflection of the faculty, and can be helpful to those writing letters of support for promotion. At Baylor College of Medicine, the Norton, Rose, Fulbright Faculty Excellence Award (NRF) utilizes portfolios to determine if the self-nominating educator meets or exceeds Baylor College of Medicine's consensus standards of excellence in the categories of teaching and evaluation, educational leadership, enduring educational materials, and educational research. The awards serve as internal recognition of educational excellence and provide credible evidence of scholarly educational activities or products. Other institutions have successfully replicated this program.16Searle N.S. Teal C.R. Richards B.F. Friedland J.A. Weigel N.L. Hernandez R.A. et al.A standards-based, peer-reviewed teaching award to enhance a medical school's teaching environment and inform the promotions process.Acad Med. 2012; 87: 870-876Crossref PubMed Scopus (7) Google Scholar We created a logic model to better describe the inputs, outputs (activities and participants), and expected outcomes for the consult program (Figure 1; available at www.jpeds.com). A logic model can serve as a “roadmap” that helps to conceptualize the relationship between a program and its intended effects. As a work in progress, many of the outcomes and impacts described in a logic model need time to develop and mature. The coaches are charged with (1) encouraging faculty to develop an educator portfolio and to apply for the NRF awards; (2) teaching the application process; (3) promoting guided reflection of teaching endeavors; (4) reviewing draft portfolios for completeness/competiveness; and (5) providing feedback for improvement. All coaches have received at least 1 NRF award and serve on the award review panel. Essential qualities of the coach include good communication skills, strong interpersonal skills, and a high tolerance for faculty ambiguity. To encourage consistency, all coaches receive training that includes attending and participating in a portfolio workshop, demonstrating proficiency navigating the award webpage, and providing feedback on initial reviews. Because of the increasing number of faculty on the clinician-educator track (Table; available at www.jpeds.com), departmental funds were used to secure 0.1 full time employee to ensure that anyone who wanted and requested help could receive assistance. Over time, the pool of volunteer coaches has continued to grow. To raise awareness and encourage award applications, coaches give 20- to 30-minute presentations at department subspecialty section meetings. Sections not well represented in terms of awards received or applications submitted are identified and asked to present during an upcoming faculty meeting. In addition to these smaller meetings, 2-hour workshops are scheduled quarterly for the entire department to explain how to create a portfolio. The first hour is an interactive dialogue explaining Glassicks criteria of scholarship and the “how to” of assembling a portfolio. The second hour is a hands-on experience wherein participants review examples of successful portfolios and begin writing an outline of their application. Faculty coaches circulate among the participants to provide guidance and answer individual questions. With the advent of coronavirus disease 2019, coaches have now adapted their coaching modalities into virtual platforms. Coaches spend the bulk of their time providing one-to-one portfolio consultations, targeted specifically to each faculty member's specific request. Some faculty require extensive coaching and several sessions to meet their goals. Coaches attempt to maximize their time by answering questions beforehand and directing the faculty to a website with instructive videos so they can focus the consult on more productive work. Faculty submit their applications to the coach at least 2 weeks prior to the deadline so they can be reviewed for errors, omissions, and necessary revisions. Coaches offer feedback for improvement, but ultimately the faculty decides which changes to incorporate. Recently, our coaches have participated in peer observations of both clinical and classroom teaching. The process of peer observations helps improve teaching and can be used to document improvements in educational processes in a teaching portfolio. In all cases, the coaches seek to create psychological safety to help the applicant feel secure and comfortable sharing their educational successes and failures. According to Edmonson,17Edmondson A. Psychological safety and learning behavior in work teams.Admin Sci Q. 1999; 44: 350-383Crossref Scopus (4272) Google Scholar psychological safety, is a consensus that the team is safe for interpersonal risk-taking, and has been shown to play a critical role in enabling performance. To build trust, coaches may share stories of their own challenges or mistakes in either teaching or creating a portfolio and how they grew from those experiences. Using guided reflection, coaches ask probing questions to better understand the faculty's previous experiences, preparation, and reasons for teaching. To do this well, the coach needs to receive the faculty's curriculum vitae and portfolio prior to the consult to sharpen the discussion and feedback. The coaches also provide consultation to each other, which allows for inter-coaching reliability and continued growth as novel educational issues arise. In addition to assisting the faculty with their portfolio applications, the coach who oversees the program attends quarterly educational meetings with senior leadership to provide updates and reports on issues or concerns related to the role. Having this direct line of communication with senior leaders legitimizes the coach's role and provides an opportunity to problem solve with those who can make changes and provide access to resources. Lastly, the number of consultations and the number of awards received are monitored to assess effectiveness and ongoing needs. From 2014 to 2019, faculty in the Department of Pediatrics received a total of 159 NRF awards, and 95 faculty were promoted. Of those 95 promotions, 64 (67%) were on the clinician educator track, 76 (80%) were promoted from Assistant to Associate Professor, and 59 (62%) were female (Table). This compares with the previous 5 years (2009-2014) of 77 promotions, with 31 (40%) clinician educators, and 60 (78%) going from Assistant to Associate and 36 (47 %) female. Faculty promotions, during 2 time periods (July 2014 to June 2019 vs July 2014 to June 2019), was summarized by the characteristics: sex, rank, track, and NRF awards by department (pediatrics vs all others). χ2 tests were used to test whether the differences in proportions were statistically significant. Statistical analysis was performed using SAS statistical software v 9.4. (SAS Institute).18SAS Institute IncSAS/ACCESS 9.4 Interface to ADABAS.2013Google Scholar Two-sided α of 0.05 was used. In 2014-2019, we had 64 clinician educators promoted, which was a statistically significant increase from the previous 5 years (Table). Of those 64 faculty promotions, 86% had received a NRF award prior to promotion and 53% of those awardees had received a consult. In addition to these awards and promotions, Figure 2 (available at www.jpeds.com) shows the results from the “Resident Evaluation of Faculty” end-of-rotation survey that assessed faculty teaching effectiveness on 12 different items. Eleven questions were assessed on a Likert scale of 1-5 (1 – strongly disagree to 5 – strongly agree) and 1 question used a 5-point Likert-type scale to assess teaching effectiveness with 1 being poor and 5 being excellent. Three questions directly related to teaching skills, feedback, time spent, and overall teaching effectiveness, revealed an increase within 2 years of implementing education coaches. Although the increase in teaching effectiveness is not totally explained by the addition of coaches, it does reflect a corresponding increase in educational faculty development activities created and taught by many of the coaches. We have created an “education consult” service for faculty seeking assistance in their development of an education portfolio and have described our process. With the implementation of our educational consult program, we realized at least 2 of our logic model outcomes, specifically improved teaching skills as evidenced by the increased number of criterion based teaching awards, and improved perception of teaching by trainees as demonstrated on the in-house evaluation of resident perceptions of teaching effectiveness. In addition, we realized a statistically significant increase in the number of faculty who are successfully promoted on a clinician educator track (Table). We acknowledge a limiting factor in this report is that we do not have the absolute number of faculty on the clinician-educator track during the years described as faculty do not declare their mission pathway until they submit their paperwork for promotion. Attainment of other outcomes are yet to be determined. But to that end, our department provides abundant resources for educational faculty development. There regularly scheduled retreats and workshops, and the department supports the Center for Research, Innovation, and Scholarship in Medical Education providing pediatric faculty with assistance in educational research design, statistical analysis, and professional writing. Although we do not have a scholastic oversite committee per se, senior leaders give annual presentations on scholarship and strategies for promotion. Individually, the section directors meet with each faculty to discuss clinical, research and educational targets and goals for promotion. Future research plans will include identifying additional indicators for evaluating the outcomes and impacts of our logic model. Meanwhile, we believe that providing resources such as education coaches can help “set-up” faculty for success in both productivity and promotion. We thank Dr B. Lee Ligon of the Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital for editorial assistance, and Shelley Kumar, MS for her statistical support. BCM, Baylor College of Medicine. The result significant at P < .05 is bolded.