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Where is the next generation of medical educators?
... [6][7][8][9][10][11][12][13] The lack of formalized training and standardized career pathways, as well as institutional prioritization of clinical and research productivity, pose challenges to CE career development, satisfaction, recruitment, retention, and promotion. [14][15][16][17] Academic programs require an established pipeline of educators to meet the needs of learners and systems. ...
... Advanced research training 3 (10) 3 (14) Mean months graduation to interview (range) NA 9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Abbreviations: CED, Clinician Educator Distinction; NA, not applicable. a See online supplemental data for a description of the elective. ...
Background
Despite increasing prevalence of longitudinal clinician educator tracks (CETs) within graduate medical education (GME) programs, the outcomes of these curricula and how participation in these tracks affects early career development remains incompletely understood.
Objective
To describe the experience and outcomes of participating in a CET and its effects on recent internal medicine residency graduates' perceived educator skills and early career development.
Methods
We conducted a qualitative study between July 2019 and January 2020 using in-depth semi-structured interviews of recently graduated physicians from 3 internal medicine residencies at one academic institution who had participated in a CET, the Clinician Educator Distinction (CED). Iterative interviews and data analysis was performed via an inductive, constructionist, thematic analysis approach by 3 researchers to develop a coding and thematic structure. Results were sent electronically to participants for member checking.
Results
From 21 (out of 29 eligible) participants, thematic sufficiency was reached at 17 interviews. Four themes related to the CED experience were identified: (1) motivation to go beyond the expectations of residency; (2) educator development outcomes from Distinction participation; (3) factors enabling curricular efficacy; and (4) opportunities for program improvement. A flexible curriculum with experiential learning, observed teaching with feedback, and mentored scholarship allowed participants to enhance teaching and education scholarship skills, join a medical education community, transform professional identities from teachers to educators, and support clinician educator careers.
Conclusions
This qualitative study of internal medicine graduates identified key themes surrounding participation in a CET during training, including positively perceived educator development outcomes and themes surrounding educator identity formation.
... [6][7][8] These primary professional identities almost inevitably take precedence over the educator role because they are better supported and carry more social capital, and because individuals are likely to have invested more emotionally in acquiring them. 5 Both Hu et al. 9 and Sabel et al. 5 suggest that the stress involved in negotiating the changes necessary to acquire what is perceived as an inferior and nebulous identity often deters junior educators from becoming more involved, regardless of programme or organisational support. ...
... The literature reports an almost universal experience among educators of periods of frustration, disappointment, stress, demoralisation and burnout, coupled with a lingering sense of loss at the erosion of their primary professional identity. [4][5][6][7][8][9]29 Furthermore, although there are few data to show how many of those who express a desire to teach actually go on to develop a significant medical education career, we do know that for most medical schools the retaining of teaching staff is a major challenge, with 42% of medical school faculty in one study expressing 'serious intent to leave'. 30,31 This 4S framework therefore offers an appropriate structure for helping colleagues who are inexperienced or at risk of struggling to explore some fundamental questions about the changes they will negotiate on their journey towards gaining a settled professional identity as an educator. ...
Context:
Medical educators often have prior and primary experience in other academic and clinical disciplines. Individuals seeking successful careers in the education of medical students and doctors must, at some point in their development, make a conscious transition into a new identity as a medical educator. This is a necessary move if individuals are to commit to acquiring and maintaining specialist expertise in medical education. Some achieve this transition successfully, whereas others struggle and may even lose interest and abandon the endeavour. We explored senior educators' experiences of achieving the transition into medical education and their views on what helps and what hinders the process.
Methods:
In 2015 we conducted three focus groups with 15 senior medical educators. All focus group discussions were audiorecorded and transcribed verbatim. We applied transition theory to guide our deductive analysis, using Schlossberg's Four S (4S) framework to code and report participants' self-reported perceptions of those factors relating to Self, Situation, Support and Strategy that had assisted them to make a successful transition to a fully acknowledged medical educator identity. Through inductive analysis, we then identified 17 explanatory sub-themes common to all three focus groups.
Results:
Background and circumstances, individual motivation, a sense of control, organisational support, and effective networking and information-seeking behaviour were factors identified as contributing to successful transition into, and maintenance of, a strong self-identity as a medical educator.
Conclusions:
The experiences of established medical educators and, in particular, an exploration of the factors that have facilitated their transition to an acknowledged self-identity as a medical educator could assist in supporting new educators to cope with the changes involved in developing as a medical educator.
... There is increasing concern about a medical education workforce shortage [1]. Currently, the education and training of medical students and junior doctors is delivered by a combination of university-employed academics (either medically or non-medically trained), clinicians with academic titles and both health service and university contracts, and health practitioners, mainly doctors, employed solely by health service providers. ...
... The increasing number of applicants each year for the MWAC-funded MER posts indicates a growing interest from junior doctors in this career pathway. Given the current concern about a shortage of medical and clinical educators [1], this study is timely and aims to explore the motivations and experiences of junior doctors wishing to pursue an education career pathway firstly through a non-academic post. We were interested in the outcomes of these posts in terms of plans to continue as an educator, and whether such plans would involve an academic career and why/why not. ...
Background
Despite an increasing concern about a future shortage of medical educators, little published research exists on career choices in medical education nor the impact of specific training posts in medical education (e.g. academic registrar/resident positions). Medical educators at all levels, from both medical and non-medical backgrounds, are crucial for the training of medical students, junior doctors and in continuing professional development. We explored the motivations and experiences of junior doctors considering an education career and undertaking a medical education registrar (MER) post.
Methods
Data were collected through semi-structured interviews with junior doctors and clinicians across Queensland Health. Framework analysis was used to identify themes in the data, based on our defined research questions and the medical education workforce issues prompting the study. We applied socio-cognitive career theory to guide our analysis and to explore the experience of junior doctors in medical education registrar posts as they enter, navigate and fulfil the role.
Results
We identified six key themes in the data: motivation for career choice and wanting to provide better education; personal goals, expectations and the need for self-direction; the influence of role models; defining one’s identity; support networks and the need for research as a potential barrier to pursuing a career in/with education. We also identified the similarities and differences between the MERs’ experiences to develop a composite of an MER’s journey through career choice, experience in role and outcomes.
Conclusions
There is growing interest from junior doctors in pursuing education pathways in a clinical environment. They want to enhance clinical teaching in the hospitals and become specialists with an interest in education, and have no particular interest in research or academia. This has implications for the recruitment and training of the next generation of clinical educators.
... The definition of clinician-educator varies considerably within the small body of published work that describes this role, [5][6][7][8] and the precise scope of abilities or competencies for 21st-century CEs has not been established. The roles described for CEs-both clinical (e.g., physician in practice versus full-time educator) and educational (e.g., clinical teaching versus education design)-are heterogeneous, inconsistent, and often undefined. ...
... Specialist medical educators have the expertise and commitment to lead and deliver evidence-based educational improvements, and to engage and motivate the many teaching clinicians. 5 Perhaps the primary distinguishing characteristic of a clinician-educator is that they produce scholarship related to their educational activities. 16 [D]octors employed by health service providers, [who] are primarily engaged in clinical practice, regularly teach, and have some or little involvement in research. ...
To determine a consensus definition of a clinician-educator and the related domains of competence.
During September 2010 to January 2011, the authors conducted a two-phase mixed-methods national study in Canada using (1) focus groups of deans of medicine and directors of medical education centers to define the attributes, domains of competence, and core competencies of clinician-educators using a grounded theory analysis, and (2) a survey of 1,130 deans, academic chairs, and residency program directors to validate the focus group results.
The 22 focus group participants described being active in clinical practice, applying theory to practice, and engaging in education scholarship-but not holding a particular administrative position-as essential attributes of clinician-educators. Program directors accounted for 68% of the 350 survey respondents, academic chairs for 19%, and deans for 13% (response rate: 31%). Among respondents, 85% endorsed the need for physicians with advanced training in medical education to serve as educational consultants. Domains of clinician-educator competence endorsed by >85% of respondents as important or very important were assessment, communication, curriculum development, education theory, leadership, scholarship, and teaching. With regard to training requirements, 55% endorsed a master's degree in education as effective preparation, whereas 39% considered faculty development programs effective.
On the basis of this study's findings, the authors defined a clinician-educator as a clinician active in health professional practice who applies theory to education practice, engages in education scholarship, and serves as a consultant to other health professionals on education issues.
... In response, LMIC medical schools have rapidly grown in number, size, and global outlook. 2 Some have adopted international accreditation standards, 3 which require teacher expertise through staff recruitment, professional development, and performance appraisal. 4 The demand for medical education expertise has been met by migration of medical educators, 5 transnational medical program partnerships, 6,7 and international aid, such as faculty development projects initiated by universities, governments, and non-government agencies from high income countries. 8-10 Signs of increasing professionalization of medical educators in the Indo-Pacific include specialist qualifications such as masters degrees, regional communities of practice, medical education units and professional associations. ...
Medical educators are particularly needed in Low- and Middle-Income Countries (LMIC), where medical schools have grown rapidly in size, number, and global outlook in response to persistent health workforce shortages and increased expectations of quality care. Educator development is thus the focus of many LMIC programs initiated by universities and governments of high income countries. While signs of medical educator professionalization such as postgraduate qualifications, specialized units, and professional associations have emerged in LMIC, whether these relate to programs originating from outside LMIC contexts is unknown. This study investigated the contextual influences on the long-term impact of an international faculty development program a decade after its delivery in a LMIC context - Vietnam.
Ten years after an international aid program to develop clinical skills teaching expertise in Vietnam, we conducted in-depth qualitative interviews with eight medical educators from all eight participating medical schools. Selected for their leadership potential, each participant had completed the Maastricht Masters in Health Professions Education during the program. Interview transcripts underwent thematic analysis, using the Theory of Practice Architectures as a conceptual lens to highlight the contextual influences on professional practice.
Four themes were identified: Careers and Practices before, during, and after the program, Unrecognized and Unseen practice, Structural Restraints on individual advancement and collective activity, and the Cultivation of Connections through social traditions. Participants reported being in well-established teaching delivery roles. However, the absence of professionalizing discourses and material resources meant that practice was restricted and determined by institutional leadership and individuals' adaptations.
Informed by the theory of practice architectures, we found that change in medical education practice will falter in contexts that lack supporting discursive, material-economic, and socio-political arrangements. While there were emerging signs of individual agency, the momentum of change was not sustained and perhaps unapparent to Western framings of educational leadership. Practice architectures offers a framework for identifying the contextual features which influence practice, from which to design and deliver sustainable and impactful interventions, and to advance context-relevant evaluation and research. Our findings suggest that faculty development delivered across diverse contexts, such as in distributed or transnational medical programs, may have more effect if informed by a practice architectures analysis of each context.
... Findings from qualitative research on the teaching motivations of clinicians and scientists who become medical educators [24][25][26][27][28][29] is relevant to the barriers faced by item writers, such as the challenge of balancing clinician or basic scientist roles with that of an educator [25,26]. Browne et al. [25] recognised the acceptance of a change in role or status as a motivating factor to take up education; increased responsibility for assessment may prompt clinicians and academics to write assessment items but this task was not been specifically examined. ...
Background:
The challenge of generating sufficient quality items for medical student examinations is a common experience for medical program coordinators. Faculty development strategies are commonly used, but there is little research on the factors influencing medical educators to engage in item writing. To assist with designing evidence-based strategies to improve engagement, we conducted an interview study informed by self-determination theory (SDT) to understand educators' motivations to write items.
Methods:
We conducted 11 semi-structured interviews with educators in an established medical program. Interviews were transcribed verbatim and underwent open coding and thematic analysis.
Results:
Major themes included; responsibility for item writing and item writer motivations, barriers and enablers; perceptions of the level of content expertise required to write items; and differences in the writing process between clinicians and non-clinicians.
Conclusions:
Our findings suggest that flexible item writing training, strengthening of peer review processes and institutional improvements such as improved communication of expectations, allocation of time for item writing and pairing new writers with experienced writers for mentorship could enhance writer engagement.
... [7][8][9][10][11][12][13][14] Furthermore, the career paths for health professions education leaders and scholars are not well developed or understood by learners or even junior faculty members, who often receive little guidance or formal preparation for their actual responsibilities. [15][16][17] This is in contrast to faculty paths to traditional research careers, which are well defined and contain relatively well-delineated training experiences including master's and doctoral degrees and preparation through the research grant making process. O'Sullivan and colleagues have shown that visibility of career pathways, interaction with role models and mentors, and early exposure to research are among the key elements related to student interest in academic careers. ...
Problem: Training the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner. Intervention: The University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation. Context: Through course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice. Outcome: From 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment). Lessons Learned: Learners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator communities of practice. Also important for learner success was alignment of their projects with the goals of the local educator community of practice. Our community of practice approach to educator career development has shown promising early outcomes by nurturing learners' passion for teaching; expanding their interest in educational leadership, innovation, and scholarship; and focusing on their identity formation as future educators.
... Daneben gibt es an vielen Standorten die Möglichkeit weitere Stufen zur Vertiefung zu absolvieren [10,11]. Diese tragen zweifelsohne zur Verbesserung der Qualität in der Lehre bei [12,13] [15][16][17][18]. ...
... This concept fits well with commitment to excellence in teaching and student learning in medicine (Morahan & Fleetwood, 2008), and engagement in scholarship is seen as part of the skill set of the clinician educator (Varpio et al., 2017). The challenge of providing appropriate training for medical educators to meet these clinically-relevant academic demands is widely recognised (Hu, McColl, Thistlethwaite, Schuwirth & Wilkinson, 2013;Medical Research European Science Foundation, 2012). This challenge presents a major barrier to the delivery of excellence in teaching, research and scholarship in medical schools. ...
Background: Providing evidence-based, high-quality medical education requires asolid research base with ongoing development. Academic teachers in medical schools are expected to establish and maintain research involvement as part of their university appointment. This paper used a mix of methods to explore teaching interest as a vehicle for increasing research capacity among clinician teachers.Methods: Ten clinician teachers participated in semi-structured one-on-one interviews exploring their experiences and attitudes to medical education and biomedical research. Data were analysed thematically. From this, a quantitative survey focusing on clinical teachers’ research interest and involvement was developed and administered across the medical school.Results: Two common themes from the interviews were an expressed interest in participating in medical education research and a perceived value and relevance to clinician teachers’ academic appointments. The two major inhibiting factors that were identified were a lack of time and unclear pathways to research participation. Of those surveyed, 51% were currently involved in research and 24% were interested in becoming involved in research. Perceived barriers to research participation were time (73%), lack of skills (22%) and funding (36%).Conclusions: Increasing teacher participation in medical education research represents a significant untapped source of research output for the school, an area of important professional development for the teachers and an avenue for attaining excellence in education for the students and the institution. These are in addition to the opportunity to contribute to scholarship in teaching and learning.
... The rising number of educational leadership programs designed to develop leaders in medical education (Armstrong et al. 2003;Gruppen et al. 2003;Thibault et al. 2003;Steinert 2012), as well as medical education PhD and master programs (Cohen et al. 2005;Huwendiek & Scheffer 2006;Junger et al. 2008;Tekian & Harris 2012;Tekian 2014) also delineate the development towards a professional guild. This is in line with Hu et al. (2013) who argue that medical education has a professional standing in the form of dedicated societies, journals, and conferences but, although strongly advised, is yet to be recognized as a specialty. ...
Background:
Little is known about medical educators' self-definition.
Aims:
The aim of this study is to survey an international community of medical educators focusing on the medical educators' self-definition.
Methods:
Within a comprehensive, web-based survey, an open question on the participants' views of how they would define a "medical educator" was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis.
Results:
Of the, 200 medical educators invited to participate, 685 (31.1%) provided a definition of a "medical educator". The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as "Professional Expert", "Facilitator", "Information Provider", "Enthusiast", "Faculty Developer", "Mentor", "Undergraduate and Postgraduate Trainer", "Curriculum Developer", "Assessor and Assessment Creator", and "Researcher".
Conclusions:
Our survey revealed that medical educators predominantly define themselves as "Professional Experts" and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.
Objective
There is a paucity of any long‐term follow up of trainees’ career pathways or organisational outcomes from medical education registrar posts in emergency medicine training. We report on the experience of a selected group of medical education trainees during and subsequent to their post and reflect on the value added to emergency medical education at three institutions.
Methods
We conducted an online survey study, examining quantitative outcomes and qualitative reflections, of emergency physicians who had previously undertaken a medical education registrar post. Descriptive statistics were used to summarise responses to Likert items. The authors independently analysed and interpreted the reflective responses to identify key themes and sub‐themes.
Results
Nineteen of 21 surveys were completed. Most respondents were in formal educational roles, in addition to clinical practice. The thematic analysis revealed that the medical education registrar experience, and the subsequent contribution of these trainees to medical education, is significantly shaped by external factors. These include the extent of faculty support, and the value placed on medical education by hospitals/departments/leaders. Acquisition of knowledge and skills in medical education was only part of a broader developmental journey and transitioning of identity for the trainees.
Conclusions
Our findings suggest that medical education trainees in emergency medicine progress to educational roles, and most respondents attribute their career progression to the medical education training experience. We recommend that medical education registrar programmes need to be valued within the clinical service, supported by faculty and a ‘community of practice’, to support trainees’ transition to clinician educator leadership roles.
Problem:
Training the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner.
Intervention:
The University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation.
Context:
Through course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice.
Outcome:
From 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment).
Lessons learned:
Learners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator communities of practice. Also important for learner success was alignment of their projects with the goals of the local educator community of practice. Our community of practice approach to educator career development has shown promising early outcomes by nurturing learners' passion for teaching; expanding their interest in educational leadership, innovation, and scholarship; and focusing on their identity formation as future educators.
Context: Despite a demand for educational expertise in medical universities, little is known of the roles of medical educators and the sustainability of academic careers in medical education. We examined the experiences and career paths of medical educators from diverse professional backgrounds seeking to establish, maintain and strengthen their careers in medical schools. Methods: Semi-structured interviews were conducted with 44 lead and early-career medical educators from all 21 Australian and New Zealand medical schools. Questions explored career beginnings, rewards and challenges. Transcripts underwent systematic coding and independent thematic analysis. Final themes were confirmed by iterative review and member checking. Analysis was informed by Bourdieu's concepts of field (a social space for hierarchical interactions), habitus (individual dispositions which influence social interactions) and capital (economic, symbolic, social and cultural forms of power). Results: Participants provided diverse accounts of what constitutes the practice of medical education. Serendipitous career entry and little commonality of professional backgrounds and responsibilities suggest an ambiguous habitus with ill-defined career pathways. Within the field of medicine as enacted in medical schools, educators have invisible yet essential roles, experiencing tension between service expectations, a lesser form of capital, and demands for more highly valued forms of scholarship. Participants reported increasing expectations to produce research and obtain postgraduate qualifications to enter and maintain their careers. Unable to draw upon cultural capital accrued from clinical work, non-clinician educators faced additional challenges. To strengthen their position, educators consciously built social capital through essential service relationships, capitalising on times when education takes precedence, such as curriculum renewal and accreditation. Conclusions: Bourdieu's theory provides insight into medical educator career paths and the positioning of medical education within medical schools. Medical educators have an indistinct practice, and limited cultural capital in the form of research outputs. In order to maintain and strengthen their careers, educators must create alternative sources of capital, through fostering collaborative alliances.
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