The Clinician Educator Revisited

This is anything but a scholarly work, but my thoughts about the role of the clinician educator in academia need expression. The last time I wrote about this was about the time I started blogging, back in 2011. It was in the context, unfortunately, of a resident getting the impression that pursuing a clinician-educator role was something less than worthy in academic medicine. My post at the time included a couple of pertinent references.

Since this in part a historical essay, I think the role of the consultation-liaison psychiatrist as clinician educator ought to be in the context of the history of the discipline itself. Don Lipsitt does the job better than anyone (Lipsitt). Dr. Lipsitt’s remarks about the modern role of the C-L psychiatrist in the general hospital are still pertinent, and they’re in the latter two sections, “Current Status of General Hospital Psychiatry” and “Promises, Problems, and Perspectives for the 21st Century.” In general, the advent of managed care has been a hindrance to say the least, and the need is great for us to hone our skills in the business aspects of medicine.

Moving on, I thought I would just try to make a quick update to the status of clinician educators (CEs) since my remarks in 2011.

I’ll just mention an early paper published in 1987 which was about the emergence of the clinical track (Jones). It was tied to the expanding patient care mission at the time, which Don mentioned in his historical review. The author, Robert F. Jones, PhD, defined the clinical track as “a formal, full-time, nontenure-earning appointment track for M.D. faculty members who are primarily engaged in patient care and teaching.”

In general, this was my role in the mid-1990s as the track was defined at that time at Iowa. The scholarly activity required for promotion was still being worked out although the “publish or perish” expectation was less than for tenure-track faculty members.

The study by Jones presented results determining the frequency of CE tracks in U.S. medical schools and other features of interest. At the time, of 126 accredited medical schools, 61 had a clinical track in place with another 16 indicating that the track was actively being considered.

Since then, there has been a good deal of time and energy spent refining the definition and expectations of the CE track.

This is by no means an exhaustive review because, after all, it’s just a blog post by a geezer CE.

Core Competency Pizza

 

Defining scholarship for the CE faculty member is challenging. Ander and Love point out that standards have been evolving for a long time and mention the Accreditation Council for Graduate Medical Education (ACGME) core competencies structure which began in 2009, focusing on educational outcomes with respect to achieving the competencies (Ander).

According to these physicians, the definition of scholarship has evolved over several decades. After 1990, four types of scholarship were described:

  • Scholarship of discovery—original research
  • Scholarship of integration—making connections across disciplines
  • Scholarship of application—using research, experience, and expertise to provide community service
  • Scholarship of teaching—using a systematic method to improve learning

How to measure quality in scholarship in teaching? The authors go on to outline criteria:

The work must be made public, available for peer review, and susceptible to replication by other scholars. Five educational activities for review by promotion committees could be teaching, curriculum development, advising and mentoring, education leadership and administration, and learner assessment.

An approach to developing a scholarly project might include a clear description of what you want to do, collecting data to improve what you do, and then sharing your findings with others.

Given that background, though, you need to consider “busyness” or time constraints. A CE C-L psychiatrist in the general hospital has to cope with running around the hospital and the Emergency Department putting out all kinds of fires. The key challenges to overcome are addressing time management concerns, academic recognition for teaching service, and confidence in teaching ability.

The University of Iowa Office of Consultation and Research in Medical Education regularly have Skills for Educators Workshops that focus on small group teaching, interactive lecturing, and clinical teaching.

I have never had time to go. Part of the problem is the classes are often scheduled during the busiest time of the day, generally from 8 to around noon. Yet, somehow, I got by and trainees have been appreciative.

A few recommendations from the authors of one study is to involve CEs in curriculum development, compensate physicians for time or income loss as a result of teaching, highlight the intrinsic rewards of teaching the next generation of doctors, and reduce patient volumes. It may be possible to raise teacher recruitment and retention rates by using these ideas (McCullough).

It would also be helpful for department chairs to know what trainees and junior faculty would like to do in academic medicine. Several major obstacles have been identified in 3 areas including financial challenges, personal mentoring, and academic skills acquisition (Kubiak). Some specific recommendations include developing workshops to enhance teaching skills (such as the University of Iowa workshops mentioned above), assistance with educational debt management, and establishing formal mentoring programs.

There are other experts who have suggestions on how to address barriers to establishing the mentoring relationships, for example, to refrain from “assigning” them (Fertig).

By the way, my former department chair, Robert G. Robinson, MD, was honored in October with the 2017 Distinguished Mentor Award. Moreover, Keith Carter, MD, University of Iowa professor and head of ophthalmology and visual sciences, the Lillian C. O’Brien and Dr. C.S. O’Brien Chair in Ophthalomology, and president of the American Academy of Ophthalmology recommends strongly that trainees find and learn from a mentor. His prescriptions include:

  • Prioritize fit over prestige
  • Be proactive
  • Don’t reject hard feedback
  • Give constructive feedback
  • Value medical diversity
  • Embrace limits

“To achieve great things, two things are needed; a plan, and not quite enough time”—Leonard Bernstein

References:

LIPSITT, D. R. (2003). Psychiatry and the general hospital in an age of uncertainty. World Psychiatry2(2), 87–92.

Jones, R. F. (1987). “Clinician-educator faculty tracks in U.S. medical schools.” J Med Educ 62(5): 444-447.

Ander, D. S., & Love, J. N. (2017). The Evolving Definition of Education Scholarship: What the Clinician Educator Needs to Know. Western Journal of Emergency Medicine18(1), 1–3.

McCullough, B., Marton, G. E., & Ramnanan, C. J. (2015). How can clinician-educator training programs be optimized to match clinician motivations and concerns? Advances in Medical Education and Practice6, 45–54.

Kubiak, N. T., et al. (2012). “Recruitment and retention in academic medicine–what junior faculty and trainees want department chairs to know.” Am J Med Sci 344(1): 24-27.

Fertig, A. M., et al. (2017). “Developing a Clinician Educator Faculty Development Program: Lessons Learned.” Academic Psychiatry 41(3): 417-422.

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