Professional Identity Formation of Medical Science Educators: An Imperative for Academic Medicine

Abstract

Medical schools increasingly seek the expertise of talented medical science faculty to engage in the educational mission of the school; yet, the professional identity of these individuals is in flux. As courses and departments have become more integrated and less discipline-based, faculty with doctorates in biomedical science disciplines who primarily teach may suffer a loss of connection to their discipline, either in the courses they are teaching or in their home departments. Recent reports suggest that most medical science educators transitioned from the laboratory to the classroom by happenstance—not the most ideal way to build this key segment of the faculty. This article addresses the importance of foundational sciences in medical training, highlights the unique contributions of science educators in medical schools, and makes a case for why the professional identity of medical science educators should be studied. An imperative for academic medicine is to understand the factors that underpin the professional identity formation of medical science educators and to invest in training and nurturing this group of faculty members that are vital to educating the next generation of health professionals.

Much has been written in recent years about professional identity formation of medical students and physicians [1, 2]. The insights from such studies have provided important guidance on how best to design the curriculum, optimize the training of physicians, and plan better for the careers of physician educators. However, there is a paucity of information on the professional development of medical science educators1 who teach in the pre-clerkship curriculum in medical schools, both in terms of their identity as teachers and the pathway(s) they took from obtaining a doctorate in a foundational biomedical science to transitioning from a research-intensive training to a career as an educator. The authors of this commentary are three past-presidents of the International Association of Medical Science Educators (IAMSE) and have observed, over the past two decades, the changes occurring in the organization of our academic institutions and in the modernization of the medical curriculum. Changes in both the organization and the curriculum have had significant implications for the vitality and success of key members of the medical faculty, including science educators. Our intent in this article is to discuss the importance of foundational sciences in medical training, highlight the unique contributions of science educators in medical schools, and provide a strong case for why the professional identity of medical science educators should be investigated and why elements that contribute to their professional identity be identified, understood, and carefully planned.

Importance of Foundational Sciences to Medicine

The sciences form the foundation of clinical practice. If you ask a healthcare professional to explain the causes that underlie a patient’s disease or condition, why their patient is exhibiting a specific set of symptoms, or what the basis for their patient’s treatment is, the answers to all of these questions have their roots in the foundational sciences.

The importance of foundational sciences to the study of medicine is reflected in the United States Medical Licensing Examination’s (USMLE) Step 1 that is designed to measure basic science knowledge. The USMLE examination “assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine” and “ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning” [3]. A similar objective is stated for the COMLEX-USA Level 1 examination used for osteopathic medical students [4].

The concept of integrating science and clinical medicine in undergraduate medical education goes back as far as Flexner’s Medical Education in the United States and Canada in 1910, where the author argued for the integration of scientific knowledge into the care of patients [5]. This call for incorporating science into medical education has resonated in every subsequent major report on medical education. For example, the Association of American Medical Colleges (AAMC) report on Physicians for the Twenty-First Century argued in 1984 that “basic science and clinical education should be integrated to enhance the learning of key scientific principles and concepts and to promote their application to clinical problem solving” [6]. The joint report from the Howard Hughes Medical Institute and the AAMC on the Scientific Foundations of Future Physicians in 2009 stated that the undergraduate “medical school curriculum should be integrated across disciplines” [7]. Finally, one hundred years after the original Flexner report, the report of the Carnegie Foundation for the Advancement of Teaching entitled, Educating Physicians: A Call for Reform of Medical School and Residency, concluded that medical curricula should “connect formal knowledge to clinical experience” and “integrate basic, clinical, and social sciences” [8].

Despite these calls for integration between science and clinical medicine, for most of the Flexnerian era, the foundational sciences and clinical practice were often separated in undergraduate medical education in the USA. Most medical schools were built on curricula that strongly emphasized classroom-based sciences for the first two years (pre-clerkship phase), followed by a strong emphasis on workplace-based medical learning in the last two years (clerkship and post-clerkship phases) of undergraduate medical education. Historically, many of the individuals who taught biomedical sciences in medical school completed a doctoral degree in one of the foundational sciences (anatomy, biochemistry or molecular biology, genetics, immunology, microbiology, neuroscience, pathology, pharmacology, or physiology) and held a faculty appointment in a basic science department in their schools. These PhD scientists played a major role in the early, pre-clerkship phase of the medical curriculum, teaching the foundational sciences to medical students largely through lectures. This role was well aligned with the professional identity of scientists, whose careers were often built on research and passing along foundational science knowledge to trainees [9, 10]. Furthermore, these faculty were usually part of stand-alone departments identified by the disciplines in which they taught and researched. Over the ensuing years, as biomedical research became more cellular- and molecular-focused and similar research tools were utilized by biomedical researchers across disciplines, departments merged and often gave way to centers and institutes [11]. The realignment of basic science departments was also exacerbated by the rise of integrated medical school curricula, which no longer depended on individual basic science departments to provide discipline-based courses to medical students.

The move of medical school curricula away from discipline-based courses and toward integrated courses in the pre-clerkship years also had other ramifications [12]. As medical educators learned more about adult learning, the approach to teaching medical students changed radically over the past two decades. Many medical schools modernized their curricula by moving to make explicit causal connections between foundational sciences and clinical practice [13, 14]. Experimental studies have provided strong evidence that when students are taught the sciences that underlie disease states simultaneously with their learning about the disease, they retain the information better and display superior diagnostic accuracy as compared to learners who are taught the disease and underlying sciences separately and without the causal links [15, 16]. Moreover, novice learners who are taught in a causal manner are better able to diagnose complex cases [17], transfer learning to new presentations [18], and display enhanced learning of novel related content [19].

In order to teach in a manner that causally links science and medicine, modern integrated curricula have minimized the separation between foundational and clinical sciences, viewing them more on a continuum of “biomedical sciences.” Features of these modern curricula are the shortening of the pre-clerkship “science” phase, the re-introduction of foundational sciences during the “clinical” phases of medical school, and the move away from lectures to more active learning modalities. The changes brought on by curricular revision have led not only to profound changes in the way that scientists present their materials, but what they teach as well. Gone are the days when biochemists or physiologists could confine their lectures to their disciplines, which they knew well. Modern curricula based on organ systems or clinical presentations necessitate the integration of all scientific and clinical disciplines.

A significant result of these curricular changes is that scientists who currently participate in medical education have become a more specialized and dedicated workforce. In many cases, medical science educators have moved away from their discipline-based research and toward a specialty in medical education (that often includes education-focused research). The need for medical science educators to understand and practice new educational approaches, theories, and teaching/learning modalities means that these scientists are responsible for much more than imparting foundational science information. The modern roles of the medical science educator include teaching, facilitating, assessing, mentoring/coaching, and designing curricula, as well as leadership, and educational scholarship [20].

In recognizing the increased specialization and complexity involved in teaching the sciences fundamental to medicine, many medical schools identified the need for medical science educators and began recruiting faculty to fill full-time teaching positions. In some cases, medical science educators are being recruited to departments of “biomedical sciences,” “foundational sciences,” or simply “medical education.”

An unintended consequence of these curricular shifts and organizational restructuring has been the impact on the professional identity of medical science educators. In many cases, the movement away from discipline-based scientific research and teaching for these individuals was no longer aligned with the professional identity that came with their graduate training. Faculty with doctorates in scientific disciplines found themselves without a clear connection to their discipline, either in the courses they taught or in their home departments.

Unique Contribution that Scientists Provide in Teaching Foundational Sciences to Medical Trainees

Before discussing the development and identity of the medical science educator, it is relevant to explore whether there is a unique perspective that medical science faculty provide to the teaching of foundational sciences. Stated differently: is teaching science to future practitioners different than teaching graduate students in a PhD program, and if so, are faculty with doctorates in one of the biomedical sciences the appropriate group to conduct this teaching?

Virtually all of the articles in the literature that address the role and value of foundational sciences in the medical curriculum focus on the importance of the content to medical training, rather than the role of the teacher [18, 19]. As stated earlier, in addition to providing scientific knowledge that is essential for health practitioners, there is general consensus that learning the foundational sciences as part of their medical training provides students with opportunities to cultivate curiosity and develop discipline and rigor in their thinking, sharpen critical reasoning and problem-solving skills, increase the ability to assess the quality of evidence, and critically analyze medical interventions (evidence-based medicine) and processes in healthcare delivery [21–24].

The optimal approach embraced by many educational leaders and schools with regard to teaching medical students foundational sciences is for the material to be clinically relevant and integrated both horizontally (across disciplines) and vertically (between the pre-clerkship and clinical years). This also means that teaching medical students is a different task than educating graduate students [25, 26]. However, the loss of departmental autonomy in managing their disciplinary courses, and the reluctance by some foundational science faculty to support this trend because of their lack of clinical knowledge, creates challenges in curricular integration [27]. This has led to the call for partnering clinicians with foundational scientists in both the pre-clerkship and clinical phases [26, 28], and finding opportunities where the two groups of faculty members could synergize their teaching [29, 30].

While some have suggested that foundational science teaching in medical school be limited to clinicians [31], or even eliminated from the classroom and moved totally to online learning [32], most medical educators recognize the value medical science educators, especially when they are paired with clinicians to co-lead courses or curricular blocks [28, 33]. As stated by Fincher et al. [28], “teams of scientists and clinical faculty should work together to promote scientific, evidence-based education. We must recognize and value a core of outstanding clinician-educators, clinician-scientists, and basic scientists, and reward effective collaboration in education.” The message is that medical science educators provide a unique value to the teaching of science, which needs to be embedded in the medical curriculum.

However, as pointed out by Hopkins et al. [34], efforts at curricular integration have been challenged because of a lack of focus, not on structure of the curriculum, but on the individuals central to the integration, namely the medical science educators. They recommended studying the experiences of medical scientists during the process of curriculum reform to determine what elements are necessary to support these teachers, individually and collectively, as the curriculum is periodically renewed. This call has been heeded in some respects. In the past decade, there has been a significant increase in interest by foundational scientists to obtain additional training in medical education as evidenced by enrollment in faculty development courses offered by the IAMSE, Association of Medical Education in Europe (AMEE) and other academic societies, the rising popularity of online Master’s degree education courses, and the robust attendance at medical education conferences [35, 36]. The emergence of the medical science educator as a professional in medical school bodes well for the quality of teaching and for providing additional expertise in curricular and institutional planning. However, it also requires an understanding of the elements that form the professional identity of this key group of faculty. Until recently, this is an area in which we have faltered [37].

Importance of Understanding the Pathways that Scientists Take to Becoming Medical Educators

In the “old” days, most scientists in allopathic medical schools in the USA were hired to conduct research and secure extramural funding. Teaching medical students was often necessary for promotion and tenure but secondary to the faculty member’s main responsibilities.

Advances in medical education have provided the medical science educator with roles that go beyond knowledge transfer. Medical science educators today need the knowledge, skills, and attitudes to facilitate integration among foundational science disciplines and with clinical medicine; promote the adoption of pedagogical principles supporting active learning and competency-based assessment; and drive innovation and curricular reform. Indeed, Harden defines eight roles of the medical teacher, from information provider and coach to scholar and researcher [20].

With the increasing number of new medical schools, both allopathic [38] and osteopathic [39], the profile of the medical science educator has been refined. This has included an explicit acknowledgement and commitment to compensate medical science educators for their educational effort, and without the expectation to secure salary support from extramural research. In fact, recruitment is often focused on medical science faculty whose primary mission, identity, and compensation are based on the education of medical students.

Yet, as reported in a recent study by Brooks et al. [37], most medical science educators describe that they arrived at their current position by happenstance. Many factors have driven some foundational scientists to focus on education and teaching, including early or positive teaching experiences and supportive mentors, satisfaction for and rewards from teaching, and a community of like-minded people. However, help to sustain them in this transition and provide a new professional identity as a medical science educator is paramount [37, 40, 41].

Academic institutions cannot simply hope that individuals will stumble into a career as a biomedical educator and find satisfaction in this work. There must be a coherent plan within academic medicine to train, nurture, support, and develop these individuals who play key roles in advancing the educational mission of medical schools. There is considerable evidence that medical science educators are intrinsically motivated to improve the quality of their teaching and facilitation skills [42] and formal training efforts supporting professional faculty development in education have increased over the years. These include seminars, courses, certificate programs, fellowships, and degrees for the development of the skills and competencies needed for the modern-day medical educator [35, 43]. However, considerably more work remains to be done.

As part of these efforts, institutions must do more to promote a sense of belonging and professional identity for medical science educators, no less so than what they do for science researchers. There must be increased recognition of the value provided by skilled medical science educators and proper alignment of incentives and pathways for faculty advancement. There must also be mechanisms to establish and provide support for this “community of educators” [36, 44–46]. In terms of academic appointment and promotion, a report from the AAMC indicates that most newly hired medical science faculty are being placed on tracks that are not eligible for tenure. In 1984, 60% of newly hired full-time medical school science PhD faculty were on tenure-eligible tracks; in 2013, that percentage declined to 44% [47]. According to a 2022 survey conducted by the AAMC, nearly 7 in 10 (68%) MD-granting medical schools in the USA offered educator-specific tracks for faculty appointment and promotion [48]. This trend especially impacts medical science educators, many of whom are being appointed to non-tenure eligible educator tracks. Why are tenure track positions for science (and clinical) educators the exception, not the rule? Why not encourage the development of educational pathway programs to recruit and train medical science faculty to be skilled educators?

In summary, foundational scientists are an essential component of the medical education workforce and provide unique skills and valuable perspectives to the medical curriculum. Unfortunately, an unintended consequence of curricular revision and organizational restructuring that accompanied the move to a modern integrated medical curriculum has been the impact on the professional identity of these individuals. An imperative for academic medicine is to understand the factors that underpin the professional identity formation of medical science educators and to invest in training and nurturing this group of faculty that are vital team members educating the next generation of medical and health professionals.

Funding

A.H. is supported in part by funding from the Kern National Network for Flourishing (KNN) through an investment from the Kern Family Foundation. N.O. is supported in part by National Institutes of Health grants R01 GM126363 and R01 AI170546.

Declarations

Conflict of Interest

The authors declare no competing interests.