Clinician-educator Faculty Research Articles

Controlled Burn: Managing the "Forest Fire" of Leaving a Professional Identity in Medical Education.

Professional identity formation is central to physicians' identity over their full careers. There is little guidance within military service on how to leave careers as clinician educator faculty in graduate medical education programs. The objective of our study was to explore how leaving this community of practice (COP) affects a clinician educator's professional identity. We used reflexive thematic analysis with Communities of Practice as a sensitizing construct. Fifteen semi-structured interviews were conducted among active-duty clinician educators at the point of their retirement from the military. Interview questions focused participants' lived experiences as clinician educators and professional identity changes leading to and resulting from the decision to retire. We found the clinician educators' journey through a time of professional transition led to three connected themes: Loss Precedes Growth, Fallow Season-Liminal Space, and New Growth. The experiences of military clinician educators retiring from active duty demonstrate how leaving one COP emanates across a range of professional identities. In addition, the decision to leave a professional COP can lead to a sense of disloyalty to that community. Normalizing this transition in a way that honors the community's values offers the opportunity to enable the decision to retire. Understanding retirement as a process that first involves identity loss, followed by the discomfort of a liminal space before achieving new growth creates the opportunity to engage in rituals that celebrate the service of departing community members, releasing them to grow into new identities.

New ACGME Clinician Educator Milestones as a Roadmap for Faculty Development: a Position Paper from the Society of General Internal Medicine Education Committee.

Traditionally, clinician educators are tasked with the responsibility of training future physician workforce. However, there is limited identification of skills required to fulfill this responsibility and a lack of consensus on effective faculty development for career growth as a clinician educator. The newly released Accreditation Council of Graduate Medical Education (ACGME) Clinician Educator (CE) Milestones framework outlines important skills for clinician educators and provides the opportunity to create robust faculty development. In this paper, members of the Society of General Internal Medicine Education Committee discuss the importance of these CE Milestones, outline the novel themes highlighted in the project, and provide recommendations for proper application on both the individual and institutional levels to optimize faculty development. The paper discusses strategies for how to apply the CE Milestones as a tool to create a culture of professional growth and self-directed learning. Using a reflective approach, CE faculty and mentors can identify areas of proficiency and opportunities for growth, thereby creating individualized professional development plans for career success. Institutions should use aggregate CE Milestones data as a needs assessment of their faculty "population" to create targeted faculty development. Most importantly, institutions should not use CE Milestones for high-stakes assessments but rather encourage reflection by CE faculty and create subsequent robust faculty development programs. The ACGME CE Milestones present an exciting opportunity and lay an important foundation for future CE faculty development.

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

The Power of Social Media in the Promotion and Tenure of Clinician Educators.

IntroductionSocial networking sites (or social media [SM]) are powerful web-based technologies used to bolster communication. SM have changed not only how information is communicated but also the dissemination and reception of a variety of topics. This workshop highlighted the benefits of SM for clinician educators. The use of SM was explored as a way to maximize opportunities for clinician educators to network, establish themselves as experts, and build a national reputation leading to promotion. The target audience for this submission is faculty developers who would like to implement a similar workshop, and clinician-educator faculty motivated by promotion and advancement.MethodsThe training workshop involved an interactive session, with approximately 20 minutes of content, 20 minutes of individual and small-group activities, and 15 minutes of large-group discussion. The effectiveness of the workshop was evaluated by asking participants to complete a postsession survey of SM knowledge, attitude, and action.ResultsSurvey responses (n = 14) demonstrated an increase in participants’ knowledge of SM platforms, ability to identify benefits of SM, skills to disseminate their work, and eagerness to build their personal brand.DiscussionThis workshop provided a foundation for clinician educators to think strategically about SM use in ways that highlight access to a broader network of colleagues and potential collaborators and that influence the impact of publications and work.

Radiology Resident Journal Club: Enhancements Add Educational Value

Resident journal clubs are essential to develop skills to critically appraise existing literature. However, most reports of journal clubs focus on logistics of the activity and less on established roles of those involved. Our objective is to report on an innovative journal club from the perspective of key participants. Journal club schedule, assignments, evaluations, and analysis are proffered from our institution. The journal club goals were formulated as: (1) improving resident understanding of research (biostatistical and epidemiologic) methods and statistical concepts, (2) teaching critical appraisal skills, and (3) promoting the use of evidence-based medicine. Each session's format is interactive, consisting of a 10 minute lecture with radiology examples of a research or statistical concept, followed by a journal club style discussion. Crucial to the success of this curriculum has been input and engagement of multiple parties: radiology residents, epidemiologist directors, and subspecialist clinician educator faculty members. A well-thought out and well-run resident journal club offers numerous solutions to radiology residencies. To residency program leadership and to each individual resident annually, resident journal club offers cutting edge medical knowledge, interactive conferences in the formal didactic curriculum, resident training in critical thinking skills and research design, resident training in interpersonal and communication skills, opportunity for residents to be teachers, and expanded resident interprofessional education. It meets Accreditation Council for Graduate Medical Education common program, Residency Review Committee diagnostic radiology program, and American Board of Radiology Milestones requirements.

Video Observation With Guided Reflection: A Method for Continuing Teaching Education.

Best practices for faculty development programs include longitudinal, practice-based formats incorporating experiential learning with opportunities for reflection and community building. Peer coaching for faculty development provides personalized, learner-centered, work-based learning. Implementation of traditional 1-on-1 peer coaching programs is challenging due to time, logistics, and methodological barriers. We sought to improve observation and reflection skills and to expand personal teaching practices of clinician educators. In 2016, we developed and evaluated an innovative "1-to-many" peer-coaching model utilizing large group review of video-recorded teaching encounters. Forty-three clinician-educator faculty in general internal medicine at the University of Pittsburgh attended at least 1 of 6 sessions between February and August 2016. Sessions were moderated by a master facilitator who guided direct observation of, and reflection on, observed teaching and highlighted efficacious teaching methods. The study evaluated the acceptability and efficacy of this novel faculty development program qualitatively, with semistructured, postcurriculum telephone interviews with 20 participating faculty. All respondents stated that they would continue to attend faculty development sessions and would recommend them to others. The most frequently cited advantages included exposure to new teaching strategies, direct feedback, safe environment, community of practice, and growth mind-set, yet barriers emerged, such as discomfort reviewing video, difficulty giving feedback across hierarchy, and initial skepticism. None described the curriculum as critical or unsafe. Most reported increased self-reflection and adoption of new teaching behaviors. This peer-coaching, video-based faculty development program was well received, feasible, and effective in changing self-reported teaching attitudes and practices.

Developing a Clinician Educator Faculty Development Program: Lessons Learned.

Developing a Clinician Educator Faculty Development Program: Lessons Learned.

Training the teachers. The clinician-educator track of the University of Washington Pulmonary and Critical Care Medicine Fellowship Program.

The University of Washington was the first pulmonary and critical care medicine fellowship training program accredited by the Accreditation Council for Graduate Medical Education to create a dedicated clinician-educator fellowship track that has its own National Residency Matching Program number. This track was created in response to increasing demand for focused training in medical education in pulmonary and critical care. Through the Veterans Health Administration we obtained a stipend for a clinician-educator fellow to dedicate 12 months to training in medical education. This takes place predominantly in the second year of fellowship and is composed of several core activities: fellows complete the University of Washington's Teaching Scholars Program, a professional development program designed to train leaders in medical education; they teach in a variety of settings and receive feedback on their work from clinician-educator faculty and the learners; and they engage in scholarly activity, which may take the form of scholarship of teaching, integration, or investigation. Fellows are guided throughout this process by a primary mentor and a mentoring committee. Since funding became available in 2009, two of the three graduates to date have successfully secured clinician-educator faculty positions. Graduates uniformly believe that the clinician-educator track met their training goals better than the research-based track would have.

A Peer Mentoring Group for Junior Clinician Educators

To study the effect of a peer mentoring group (PMG). Six junior clinician educator faculty and one senior faculty at the University of Washington Medical Center's Department of Psychiatry formed a PMG in 2006. The PMG had 30 meetings during 2006-2010. Group format, goals, and meeting agendas were determined solely by participants. Feedback about positive and negative outcomes of participation in the PMG was determined by open-ended response to three sets of questions; qualitative analysis was performed by an outside research consultant. Program evaluation revealed benefits and undesirable or unintended outcomes. Reported benefits were increased workplace satisfaction; improved social connection; increased professional productivity and personal growth/development through accountability, collaboration, mutual learning, support, and information sharing; synergy, collaboration, and diversity of thought; increased involvement in professional activities; opportunity for peer discussions in a safe environment; and increased accountability and motivation. Undesirable or unintentional outcomes were exclusivity, lack of hierarchy, scheduling of meetings, absence of an intentional curriculum, diverse and competing interests, personal-professional enmeshment, and occasional loss of focus due to overemphasis on personal matters. Every member of the PMG was retained, and scholarly productivity increased, as did collaboration with other group members. Participants in this PMG experienced qualitative benefits and perceived advantages in career advancement and scholarly productivity. Negative consequences did not deter participation in the PMG or outweigh benefits. The self-sufficient and low-cost structure makes it particularly portable.

Promotion as a Clinician Educator in Academic Radiology Departments: Guidelines at Three Major Institutions

Faculty promotion within an academic department of radiology may place emphasis on scientific research, administrative contributions, educational contributions, or a combination of all endeavors that enrich the department and further its academic mission. For those departments considering the establishment of a promotion pathway that emphasizes teaching talents and education-oriented research, the authors provide examples of three different clinician-educator faculty appointment and promotion schemes. Faculty development and defining scholarly work as a clinician-educator, as well as documentation of academic productivity within this pathway, are discussed.

From the Editors’ Desk: Realizing the Dream: Mentorship in Academic Medicine

From the Editors’ Desk: Realizing the Dream: Mentorship in Academic Medicine

A Systems Approach to Morbidity and Mortality Conference

A Systems Approach to Morbidity and Mortality Conference Jason H. Szostek, MD, Mark L. Wieland, MD, MPH, Laura L. Loertscher, MD, MPH, Darlene R. Nelson, MD, Christopher M. Wittich, MD, PharmD, Furman S. McDonald, MD, MPH, Joseph C. Kolars, MD, Darcy A. Reed, MD, MPH From the Department of Medicine, Mayo Clinic, Rochester, Minn; Department of Medicine, Providence St Vincent Medical Center, Portland, Ore; Internal Medicine Residency Program, Mayo Clinic, Rochester, Minn; Department of Medicine, University of Michigan, Ann Arbor, Mich.

Preparing the Next Generation of Leaders in Clinician-Education and Academic Administration

Interest has been increasing in supporting the career advancement of faculty clinician-educators in psychiatry. This is best evidenced by the development of the Clinician-Educator Section of the Association for Academic Psychiatry in 2003. Over the past few decades, the role of the clinician-educator has grown, as have the responsibilities. Not only are clinician-educators teachers in the classical sense, but they are often called to serve as leaders in multiple realms: clinical program chiefs, residency training directors and innovators, hospital administrators, advisers to managed care organizations, consultants for legislative policy change, physician educators, and disseminators of information to the community at large (1, 2). Despite expectations for academic career advancement being relatively clear cut for faculty dedicated to research, promotion criteria for clinician-educators are widely ill defined (3). As a result, clinician-educators often have difficulty advancing in academic rank, even though their impact on a system may be remarkable. Levinson and Rubenstein (4) highlight the problems with “the present system of recognition for clinician-educators—i.e., the requirement for regional and national reputation, the lack of reliable measures of clinical and teaching excellence, and the lack of training opportunities for young clinician-educators.” To address such issues, some major academic centers have developed clinician-educator faculty tracks that more clearly define career paths (3, 5). Historically, psychiatric residents have not been explicitly targeted for nonresearch career paths during residency. As a result, many graduating psychiatrists are behind in developing the formal skills necessary to take on leadership roles within the academic and clinical infrastructure. This contrasts with efforts to create research training opportunities from medical school onward (6). In recent years, several U.S. psychiatric residency training programs have attempted to address this shortcoming by creating specialized residency training tracks for clinician-educators. The first of these appears to be the University of Michigan’s Clinical Scholars Track, established in 1998 (7). Likewise, Baylor’s Menninger Department of Psychiatry developed a Clinician-Educator Track, and the University of California Davis created a specialized Teaching Track. This trend is encouraging, but in general, specialized residency training tracks geared toward clinicianeducators are still in the early stages of development, and it is unclear how successful these tracks have been in promoting their aims into long-term faculty careers. Furthermore, none of the existing tracks explicitly focus on developing the administrative skills crucial to the promotion of young physicians into subsequent leadership roles in academic or other care delivery settings.

Does mentoring matter: results from a survey of faculty mentees at a large health sciences university

Background: To determine the characteristics associated with having a mentor, the association of mentoring with self-efficacy, and the content of mentor–mentee interactions at the University of California, San Francisco (UCSF), we conducted a baseline assessment prior to implementing a comprehensive faculty mentoring program.Method: We surveyed all prospective junior faculty mentees at UCSF. Mentees completed a web-based, 38-item survey including an assessment of self-efficacy and a needs assessment. We used descriptive and inferential statistics to determine the association between having a mentor and gender, ethnicity, faculty series, and self-efficacy.Results: Our respondents (n=464, 56%) were 53% female, 62% white, and 7% from underrepresented minority groups. More than half of respondents (n=319) reported having a mentor. There were no differences in having a mentor based on gender or ethnicity (p≥0.05). Clinician educator faculty with more teaching and patient care responsibilities were statistically significantly less likely to have a mentor compared with faculty in research intensive series (p<0.001). Having a mentor was associated with greater satisfaction with time allocation at work (p<0.05) and with higher academic self-efficacy scores, 6.07 (sd = 1.36) compared with those without a mentor, 5.33 (sd = 1.35, p<0.001). Mentees reported that they most often discussed funding with the mentors, but rated highest requiring mentoring assistance with issues of promotion and tenure.Conclusion: Findings from the UCSF faculty mentoring program may assist other health science institutions plan similar programs. Mentoring needs for junior faculty with greater teaching and patient care responsibilities must be addressed.

A Model Intensive Course in Geriatric Teaching for Non-geriatrician Educators

Because of the aging demographics nearly all medical specialties require faculty who are competent to teach geriatric care principles to learners, yet many non-geriatrician physician faculty members report they are not prepared for this role. To determine the impact of a new educational intervention designed to improve the self-efficacy and ability of non-geriatrician clinician-educators to teach geriatric medicine principles to medical students and residents. Forty-two non-geriatrician clinician-educator faculty from 17 academic centers self-selected to participate in a 3-day on-site interactive intensive course designed to increase knowledge of specific geriatric medicine principles and to enhance teaching efficacy followed by up to a year of mentorship by geriatrics faculty after participants return to their home institutions. On average, 24% of their faculty time was spent teaching and 57% of their clinical practices involved patients aged over 65 years. Half of all participants were in General Internal Medicine, and the remaining were from diverse areas of medicine. Tests of geriatrics medical knowledge and attitudes were high at baseline and did not significantly change after the intervention. Self-rated knowledge about specific geriatric syndromes, self-efficacy to teach geriatrics, and reported value for learning about geriatrics all improved significantly after the intervention. A quarter of the participants reported they had achieved at least one of their self-selected 6-month teaching goals. An intensive 3-day on-site course was effective in improving self-reported knowledge, value, and confidence for teaching geriatrics principles but not in changing standardized tests of geriatrics knowledge and attitudes in a diverse group of clinician-educator faculty. This intervention was somewhat associated with new teaching behaviors 6 months after the intervention. Longer-term investigations are underway to determine the sustainability of the effect and to determine which factors predict the faculty who most benefit from this innovative model.

Comparison of Scholarly Productivity of General and Subspecialty Clinician-Educators in Internal Medicine

Background: Peer-reviewed publications and extramural reputation are criteria used to evaluate clinician–educators for promotion. There is concern that these criteria may be disadvantageous to clinician–educators in generalist fields relative to their specialist counterparts. Purpose: To determine whether medicine subspecialists had more peer-reviewed publications and academic activities outside their home institution than general internal medicine (GIM) faculty, and to explore possible explanations for observed differences. Method: Cross-sectional survey of all clinician–educators in a department of medicine at a leading public U.S. medical school. The survey assessed clinical duties, publications, and professional activities. Results: Seventy-one percent (42/59) of clinician–educator faculty responded. GIM clinician–educators spent fewer months on inpatient services (p = 0.01), but more time in clinic (p = 0.05). Specialist clinician–educators had more peer-reviewed publications (p = 0.003), but total publications since entering a clinician–educator track was similar (p > 0.2). After multiple linear regression, only academic rank (p = 0.001) and subspecialty membership (p = 0.005) remained significant predictors of peer-reviewed publication. GIM faculty reported spending more scholarly time on "activities unlikely to result in publication" (p < 0.01). A greater proportion of specialists served on extramural committees (72% vs. 41%, p = 0.05) and lectured outside their home institution in the preceding year (92% vs. 59%, p = 0.02). Conclusions: In this single-institution survey, specialist clinician–educators reported more peer-reviewed publications and greater participation in other reputation-enhancing activities than did GIM clinician–educators.

Results of an academic promotion and career path survey of faculty at the Johns Hopkins University School of Medicine.

Clinician-educator faculty are increasing in numbers in academic medical centers, but their academic advancement is slower than that of research faculty. The authors sought to quantify the magnitude of this difference in career advancement and to explore the characteristics of faculty that might explain the difference. In 1999, a questionnaire was administered to all MD faculty at the rank of instructor and above (259) in the Department of Medicine at the Johns Hopkins University School of Medicine. A total of 180 (69%) faculty returned questionnaires. Of these, 178 identified with one of four career paths: basic researcher (46), clinical researcher (69), academic clinician (38), or teacher-clinician (25). Career path did not differ by age, gender, rank, years on faculty, hours worked per week, family responsibility, or global work satisfaction. After adjusting for age, gender, time at rank, and work satisfaction, the odds of being at a higher rank were 85% less for academic clinicians (odds ratio,.15; 95% confidence interval, 0.06-0.40) and 69% less for teacher-clinicians (odds ratio,.31; 95% confidence interval, 0.11-0.88) than for basic researchers. Clinical researchers did not differ from basic researchers in the likelihood of being at higher rank. Similarly, compared with basic research faculty, the adjusted odds of being more satisfied with progress towards academic promotion were 92% lower for academic clinicians and 87% lower for teacher-clinicians. Clinician-educator faculty were less likely to be at higher rank at this institution than were faculty in research paths. Differences in rank may be explained by lower rank at hire for faculty in these career paths, time available for scholarly activities, or other resources available to support scholarship. Retaining clinician-educators will require further exploration of barriers to promotion inherent to these career paths and methods of modifying these barriers.

Scholarship in the Medical Faculty from the University Perspective

Academic medicine and research universities have enjoyed a close relationship that has strengthened both, spawning an era of discovery and scholarship in medicine that has earned the U.S. academic medical enterprise a high level of public trust and a deserved leadership position in the world. However, changes in the financing of medical care and in the organization of health care delivery have dramatically affected the medical school-university partnership. The growing emphasis on delivery of clinical services and the concomitant decrease in time for tenured and clinician-educator faculty to teach and do scholarly work jeopardizes both the potential for continued discovery and the education of the next generation of medical scholars. The background of the medical school-university relationship and the factors leading to the development of clinician-educator faculty tracks are reviewed, and recent trends that impact faculty scholarship are discussed. Both tenure-track and clinician-educator medical faculty, as members of the broader university community, should expect from their university colleagues a continued demand for scholarship and educational activity that reflects the underlying philosophy of the parent university. As a corollary, the university, through its medical school, must provide these faculty the time and the financial support necessary to fulfill their academic mission. The size of the clinician-educator faculty should be determined by the academic needs of the medical school rather than by the service demands of its associated health care delivery system. To accomplish this, academic medical centers will have to develop cadres of associated or clinical faculty whose primary focus is on the practice of medicine.

Innovations in education and clinical practice

Innovations in education and clinical practice

Enhancing the training of internal medicine residents at Stanford by establishing a model group practice and raising its clinical educators' status.

The education of residents is shifting to the ambulatory care setting. In addition, there is a growing trend toward managed care and increasing competition for patients to be served by "real-world" practices. The authors describe the formation and operation of a program that was established in 1981 at the Stanford University School of Medicine to respond to these changes: the Stanford Medical Group (SMG), a model group practice in internal medicine that operates within the academic medical center. Because raising the status of the clinician-educator faculty was a critical issue for the SMG, the authors also describe the Medical Center Professoriate, a separate faculty track created in 1989 to recognize and reward Stanford's clinician-educators. The authors conclude that the SMG has succeeded in its training and patient care goals and has weathered the great changes in the health care environment that have taken place since 1981. They also report that the separate faculty track is serving its purpose well. They hope that educators and program directors at other academic medical centers may find the descriptions of the SMG and the professoriate useful in solving similar problems.