Training Generations of Clinician Educators: Applying the Novel Clinician Educator Milestones to Faculty Development

Abstract

The act of teaching in medical education has been woven into the core fabric of medicine, embodied in the concept of “it takes a village” to train a doctor. Skilled educators are critical to the development and training of the future generations of doctors.1Santhosh L. Abdoler E. Babik J.M. Strategies to build a clinician-educator career.Clin Teach. 2020; 17: 126-130Crossref PubMed Scopus (3) Google Scholar Aligning with this, the last 3 decades have seen a massive growth in the breadth of the roles, responsibilities, and destinations of clinician educator careers.2Sherbino J. Frank J.R. Snell L. Defining the key roles and competencies of the clinician-educator of the 21st century: a national mixed-methods study.Acad Med J Assoc Am Med Coll. 2014; 89: 783-789Crossref Scopus (79) Google Scholar, 3van Lankveld T. Thampy H. Cantillon P. et al.Supporting a teacher identity in health professions education: AMEE Guide No. 132.Med Teach. 2021; 43: 124-136Crossref PubMed Scopus (22) Google Scholar, 4Chang A. Schwartz B.S. Harleman E. et al.Guiding academic clinician educators at research-intensive institutions: a framework for chairs, chiefs, and mentors.J Gen Intern Med. 2021; 36: 3113-3121Crossref PubMed Scopus (8) Google Scholar A career as a clinician educator can span complimentary yet distinct roles as administrators, clinical teachers, and scholars.5Shinkai K. Chen C.A. Schwartz B.S. Loeser H. Ashe C. Irby D.M. Rethinking the educator portfolio: an innovative criteria-based model.Acad Med J Assoc Am Med Coll. 2018; 93: 1024-1028Crossref Scopus (14) Google Scholar,6Turner T. Palazzi D. Ward M. Lorin M. Transforming teaching into scholarship.Clin Teach. 2012; 9: 363-367Crossref PubMed Scopus (5) Google Scholar In gastroenterology, for example, clinician educators play pivotal roles in teaching across the educational spectrum and throughout various settings, span distinct backgrounds (including nonphysician educators), and also encompass a growing contingent of educational leaders and scholars. Although this diversity of career pathways for clinician educators meets the training needs of the future workforce, the development of educators across these distinct domains remains challenging, unstructured, and informal. Often, seasoned educators describe their pathway as a serendipitous process of “figuring it out” along the way, without clear signposts for mentees pursuing a similar pathway. Additionally, informal methods to develop as a clinician educator often allow for limited feedback opportunities on the diverse aspects of their role.7Gormally C. Evans M. Brickman P. Feedback about teaching in higher ed: neglected opportunities to promote change.CBE Life Sci Educ. 2014; 13: 187-199Crossref PubMed Scopus (60) Google Scholar Furthermore, pathways for professional development targeting the clinician educators can be unclear to novices seeking added training. To overcome these issues, there is a need for clear guidance for ongoing professional development across diverse clinician educator roles. This article showcases a new resource, the Clinician Educator Milestones8Accreditation Council for Graduate Medical Education. Clinician Educator Milestones.www.acgme.org/what-we-do/accreditation/milestones/resources/clinician-educator-milestones/Date accessed: September 28, 2022Google Scholar (CEMs), which provides a blueprint to support, develop, and grow clinician educators in their vital role of shaping future physicians. Creating a professional development framework for clinician educators requires a structured approach to professional development, while still providing the flexibility for faculty to choose relevant skillsets across the full spectrum of career pathways defining clinician educator roles. With this in mind, the CEMs were created to provide a potential framework for educators, trainees, programs, and institutions. The innovative CEMs were developed using a similar philosophy as the residency and fellowship Accreditation Council for Graduate Medical Education (ACGME) Milestones in Graduate Medical Education (GME) settings,9Philibert I. Brigham T. Edgar L. Swing S. Organization of the educational milestones for use in the assessment of educational outcomes. The Accreditation Council for Graduate Medical Education Suite.J Grad Med Educ. 2014; 6: 177-182Crossref PubMed Google Scholar,10Holmboe E.S. Yamazaki K. Edgar L. et al.Reflections on the first 2 years of milestone implementation.J Grad Med Educ. 2015; 7: 506-511Crossref PubMed Scopus (62) Google Scholar aiming to provide a novel trajectory-based approach to ongoing faculty development. In GME, for example, the ACGME milestones are used to ensure that trainees are developing along a specified trajectory across all the subcompetencies deemed necessary for independent physician practice. The CEMs embrace this global tenet of the milestones framework, recognizing that skill development occurs through a progressive nature, consistently working toward higher levels of expertise with time, practice, and experience11Ericsson K.A. Krampe R.T. Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance.Psychol Rev. 1993; 100: 363-406Crossref Google Scholar (as outlined through the Dreyfus model12Dreyfus S.E. The five-stage model of adult skill acquisition.Bulletin of Science, Technology & Society. 2004; 24: 177-181Crossref Scopus (576) Google Scholar,13Lyon L.J. Development of teaching expertise viewed through the Dreyfus model of skill acquisition.J Scholarsh Teach Learn. 2015; 1: 88-105Google Scholar) (Figure 1). Embedded within this model, the CEMs aim to promote life-long learning of faculty educators, providing recommendations and potential assessment strategies for programs and educators.14Heath J.K. Dine C.J. Burke A.E. et al.Teaching the teachers with milestones: using the ACGME Milestones Model for professional development.J Grad Med Educ. 2021; 13: 124-126Crossref PubMed Scopus (4) Google Scholar Ultimately, this framework recognizes that ongoing faculty development is critical to progressive skill development as a clinician educator, and an individual requires ongoing practice and feedback to continue to grow in the various domains of the clinician educator role. The CEMs were thus created to provide this trajectory-based approach to various skills of a clinician educator. Starting in early 2020, the initial iteration of the CEMs were created through collaboration between the ACGME, the Accreditation Council for Continuing Medical Education, the Association of American Medical Colleges, and the American Association of Colleges of Osteopathic Medicine. The development process included a group of clinician educators and stakeholders across the continuum of medical education, in various specialties, and with varying levels of experience. (See Supplementary Table 1 for the complete CEM development team).Supplementary Table 1Clinician Educator Milestone Development TeamThomas Boyle, DO, MBACalvin Chou, MD, PhDNicole Croom, MD, MPH (resident)Tyler Cymet, DORebecca Daniel, MDNancy Davis, PhDDaniel Dent, MDLaura Edgar, EdDJanae Heath, MDLisa Howley, PhDJoseph M. Kaczmarczyk, DO, MPH, MBAJohn D. Mahan, MDKatie Marney (medical student)Amy Miller Juve, EdD, MEdBrijen Shah, MDJanine Shapiro, MDChristine Stabler, MD, MBA Open table in a new tab Using a modified Delphi approach, the group worked to identify knowledge, skills, and attitudes that would be significant for clinician educators (across the medical education continuum), ultimately creating developmental trajectories (themes) within individual milestones. Additionally, the group created a concomitant supplemental guide aimed to provide relevant resources, strategies for assessment, and examples of what progression across each Milestone would look like. After pilot testing with iterative adjustments, the finalized CEMs and supplemental guide were available for public use in September 2022. In the current iteration, the CEMs span 5 overarching competencies felt to represent potential areas of skill development for the clinician educator in the 21st century: (1) universal pillars of the clinician educator, felt to represent critical skills to all clinician educators regardless of role, (2) administration, (3) education theory and practice, (4) diversity, equity, and inclusion in the learning environment, and (5) well-being (Table 1).Table 1Overview of Clinician Educator MilestonesClinician educator milestoneSubcompetencies within the milestoneUniversal pillarsaThe universal pillars represent skills essential to all clinician educators, regardless of career path.Reflective practice and commitment to personal growthWell-beingRecognition and mitigation of biasCommitment to professional responsibilitiesEducational theory and practiceTeaching and facilitation of learningProfessionalism in the learning environmentLearner assessmentFeedbackPerformance improvement and remediationProgrammatic evaluationLearner professional developmentScience of learningMedical education scholarshipLearning environmentCurriculumWell-beingWell-being of learners and colleaguesDiversity, equity, and inclusion in the learning environmentbThe diversity, equity, and inclusion in the learning environment milestone does not have discrete subcompetencies.AdministrationAdministration skillsLeadership skillsChange managementa The universal pillars represent skills essential to all clinician educators, regardless of career path.b The diversity, equity, and inclusion in the learning environment milestone does not have discrete subcompetencies. Open table in a new tab Within these overarching competencies, there are 20 unique subcompetencies, providing various domains for skill development for today’s clinician educator. For example, within the education theory and practice competency, subcompetencies include discrete skillsets such as the feedback subcompetency (which aims to encourage educators to become masters at delivering feedback), the learning environment subcompetency (which aims to promote a skillset that fosters a diverse and inclusive environment to optimize learning), and the teaching and facilitating learning subcompetency (providing effective teaching across the medical education continuum). Each of these subcompetencies provides important guidance for an individual pursuing excellence in bedside teaching. Within the administration milestone, the subcompetency of change management may be a critical skill for a program director (particularly over the course of significant national changes in medical education, such as the coronavirus disease 2019 pandemic) and can provide a scaffold for refining skills in this domain. Because the CEMs are intended to promote development for the diverse career pathways of clinician educators, there is a flexibility inherent to their use. These CEMs are not unique to one facet of the medical education continuum, and instead provide a framework to promote skill development for educators across undergraduate and GME, through continuing professional development. Furthermore, recognizing the unique career pathways of clinician educators, an individual can opt to focus on a subset of the CEMs depending on their career and interests. Different CEMs may further promote the skills of an educator, whereas others may be more applicable to educational scholars (eg, an individual who focuses on the discovery of new assessment practices may focus on different milestones than an educator at the bedside). In contrast, those in educational leadership roles (including administrators, program directors, etc) may find other milestones more suitable to their career development. Determining which milestones align with ones’ ongoing development ultimately depends on the individual, including their interest, their career stage, and future career goals. Overall, there are a host of potential ways to use the CEMs within your own educational setting, which may differ for individuals, mentors, and programs. We outline several potential ways that CEMs may be useful, including for the established educator, for the educator-in-training, and for programmatic innovation for institutions. The CEMs are organized to allow faculty to know which milestones are vital for various types of clinician educator activities. For most faculty, CEMs will provide the blueprint of the knowledge, skills, and attitudes needed for being a clinician educator. These can be used for self-assessment at various time points and provide references for further learning. For example, some faculty will need to develop an educator portfolio as part of their promotion. In addition to the overarching CEMs (Table 1), the supplemental guide highlights various methods for demonstrating performance across various milestones. As faculty roles change (eg, shifting from direct teaching roles instead to more mentorship roles), faculty can turn to the CEMs to know where to start their development and the blueprint for skill development. The CEMs provide suggestions for resources for further skill development, as well as assessment mechanisms in the various domains. Finally, faculty could use this tool to help communicate the development needs with divisional leaders (who may not understand the full breadth of work of clinician educators), such as division chiefs. In addition to practicing clinician educators, the CEMs are also applicable to the physician learners at earlier stages of training. As physician learners move from medical school to the clinical learning environment, they are expected to teach patients, medical students, and coresidents/fellows, yet many trainees are never formally taught how to be effective teachers. Similarly, there is growing interest in pursuing careers as clinician educators, even from earlier stages in training.15Hill A.G. Yu T.C. Barrow M. Hattie J. A systematic review of resident-as-teacher programmes.Med Educ. 2009; 43: 1129-1140Crossref PubMed Scopus (125) Google Scholar,16Yang Y. Gielissen K. Brown B. et al.Structure and impact of longitudinal Graduate Medical Education curricula designed to prepare future clinician-educators: a systematic scoping review: BEME Guide No. 74.Med Teach. 2022; 44: 947-961Crossref PubMed Scopus (2) Google Scholar Overall, the CEMs and accompanying supplemental guide helps to fill these gaps. The CEMs can help a trainee to identify ways in which faculty members can better support their journey to performance improvement, while also providing concrete examples of how the trainee can develop and improve their own unique teaching style. For example, a resident or fellow interested in medical education leadership roles could use the administration milestones to identify pathways to grow the necessary skillset for these roles. Beyond the discrete skill development, these milestones also provide examples of how the trainee can prioritize personal and professional well-being and acknowledge the importance of diversity, equity, and inclusion in all learning environments. The CEMs can be used by the trainee in conjunction with the specialty-specific milestones for their well-rounded career development as they prepare to move toward unsupervised practice. Finally, and most important, because the CEMs provide a roadmap for career development and potential career trajectories for future clinician educators, these can be used as a framework for a curriculum within structured medical education tracks across the UME and GME settings. In addition to benefits to individual educators, the CEMs can provide guidance for programs as they consider which topics to engage in for faculty development. Fellowship programs could use the CEMs to guide core faculty through self-assessments in the teaching and feedback milestones, two core competencies. Similarly, faculty mentors could assess their abilities in the coaching and mentoring milestones. Program directors should look to the CEMs associated with becoming an educational leader to assess opportunities for independent growth and development. These can also be used as new faculty assume roles as associate program directors or program directors. Ultimately, for an institution, faculty development can be developed using the CEMs and feature relevant readings, workshops, and lectures based on guidance from the CEMs. For the gastroenterology and hepatology community nationally, the CEMs can guide planning for live or virtual meetings, identifying areas of focus for faculty development. The novel CEMs span a host of potential areas for educator development, including diversity, equity, and inclusion; professional identity development; program evaluation; and importantly, link to regulatory efforts in undergraduate, graduate, and continuing medical education. Overall, the CEMs are intended to be used across the medical education continuum and for educators in various stages of their career. Importantly, despite the parallel nature of the CEMs to the ACGME GME Milestones, there are important differences worth mentioning. Specifically, the CEMs are not intended to be reported to any accreditation body, but rather intended for self-discovery, self-assessment, and individual growth. Also distinct from the GME ACGME Milestones, it is not the expectation that an individual completes all milestones within the series. In fact, the CEMs were created to allow for an educator to pick and choose the relevant skillset depending on their stage of career, interests, and career trajectory and goals. Finally, there is not a set expectation for a level of milestone rating (different than the graduation target), because the expectation is that educators may be starting at all different levels on different domains. In summary, the new CEMs provide a novel, trajectory-based framework to promote the development of clinician educators across a variety of important skills. The CEMs include suggestions for assessment, resources, and avenues for professional development. There are multiple avenues for using these for professional development, varying based on ones’ career paths, including for the educator, the educational leader, and the educational scholar. There are also a multitude of strategies to implement this depending on the user, with varying uses by the established educator, the educator in training, and for an institution or program in charge of faculty development. Overall, we hope these CEMs provide necessary guidance across a span of clinician educator careers, an imperative focus to ensure we continue to provide the best training for future physicians.