Table 3.

Clinician Educator Distinction Experience—Themes, Subthemes, and Representative Quotes

Themes, Subthemes	Representative Quotes
Theme 1: Motivation to Go Beyond the Expectations of Residency
Intrinsic motivators	“I have always been interested in medical education. I had done a similar distinction program in medical school, even before this…So I would say [I applied] just to get more exposure to medical education in general. Both theory and also practically. The opportunity to teach and be observed.” (T12)
Extrinsic motivators	“We have these talents that we develop and it's difficult to convey that in something like a CV…to have a distinction in education I think it makes it obvious to anyone who's looking through your application regardless of what you're applying to, that you have some background in education.” (T3) “It seemed like doing a distinction pathway was an incredible opportunity even though I didn't know a ton about it. It just seemed like, ‘Don't pass this up'.” (T8)
Theme 2: Early Educator Development Outcomes From Distinction Participation
Clinician educator self-efficacy	“One of the biggest things that it impacted for me was I could see a difference in my teaching between doing things on the fly versus things that were prepared. And when I say prepared, I don't just mean in terms of being like a knowledge content expert, but also trying to remember the techniques that I'd been taught. I think by recalling those techniques and trying to incorporate them best, is one of the biggest things that has changed for me. What I try to do now, if I know that I'm going to be teaching on something, I just try to review those techniques that I've learned.” (T2) “The pathway—specifically some of those evening sessions—I took away actionable skills. So, some of the ways I act when attending [are] affected by that. The projects that I did that counted towards the pathway are things that I'm still developing further and have become a big part of my academic focus and niche.” (PC2)
Professional identity development	“What I ended up doing for my CED scholarship thing was related to the [writing] course that [another resident] and I put together. I wouldn't have necessarily thought of that as something that could be scholarly, if I hadn't had this distinction…I think I had little understanding of the system of how people get promoted, or how people even do scholarship, or how people parse their time out, before [the CED]. I think just having a deeper understanding of academia in general, but also just what being an educator can look like, it's not just strictly medical students or strictly residents.” (MP2) “The CED definitely made me more interested in having a career in medical education. The one thing that I found that I didn't necessarily love was the sort of research project aspect of medical education. So, I think it was actually helpful for me to get some exposure to that and realize that I enjoy teaching, the teaching environment and all those things, I didn't necessarily enjoy as much the formal academic research part of medical education.” (T9)
Enhanced job search	“It made me sound more informed on the interview trail for fellowship…I think being able to talk intelligently about understanding that medical education, as a career, is not just ‘I love to teach,' but how do you substantively buy some of your time and have a dedicated role as a clinician-educator.” (MP3)
Membership in educator community	“It was just the community that existed of clinician educators to know that people so valued it and to then inspire my self-driven search for how do you become a good clinical educator. More through experience just by signing up to do physical exam rounds or actually delivering part of the POCUS curriculum. I think that those experiences taught me a lot. It was the community that the CED built for me that I took away the most from the distinction.” (T5)
Theme 3: Factors Enabling Curricular Efficacy
Flexible requirements and experiential learning	“It actually keeps you a little more focused on accomplishing that goal by having requirements that you have to turn in. I don't know that I would have necessarily made so many of them because I think that the actual going to the meetings and the practice stuff and being observed—I think all of that was the most valuable. I thought the… [curriculum sessions] themselves were probably my favorite part of the whole thing…” (T10)
Increased opportunities for observed teaching with feedback	“I like the evaluation sheets. I think they standardize something that could otherwise be like, ‘But he observed me and gave me verbal feedback.' They show that somebody observed you and gave you feedback. And they give you a thing to reference in the future, which is nice.” (MP1)
Exposure to educator community and role models	“The exposure to faculty that were doing clinical education was helpful and just also reinforcing that being involved with teachers and learners is something that I liked. And so I think that it reinforced to me that I did want some sort of academic career. I wouldn't want to be completely removed from the clinical education component of a career.” (T9)
Theme 4: Opportunities for Program Improvement
Accessibility of curriculum events	“[The didactics] would start at 6:00 or 6:30pm, and a lot of our sign-outs and then some of our rotations you don't get out until 7. So when I was on those I didn't really attend [the didactics], or there was no protected time for people and the track to go to these.” (T7)
Mentors with education research skills	“The [faculty] I worked with was phenomenal but not as well versed in medical education research. So the methodology I think we used wasn't the best.” (T6)
Logistics and navigation of requirements	“I think keeping track of what I had completed and not putting them in [MedHub], and not counting things the right way was really frustrating. Especially as I was graduating, I got this email from [the CED administrator] being like, ‘Oh, you're not meeting the requirements for any of the sections.' And I was like, ‘Well, I was actually smart enough to keep track of them according to what it actually should be.' And I was actually meeting every single one of them. But it's just annoying and stressful when you know that you are meeting requirements, and this other person is telling you that you're not.” (T7)

Abbreviations: CED, Clinician-Educator Distinction; T, traditional internal medicine; PC, primary care; MP, internal medicine-pediatrics; POCUS, point-of-care ultrasonography.