Abstract
Volunteer clinical faculty in private practice provide important clinical teaching and mentorship to dermatology residency programs. Motivations for serving as volunteer clinical faculty in specialties such as obstetrics and gynecology, emergency medicine, and family medicine have been identified; however, there is limited data on what drives private practice physicians to volunteer to teach in dermatology residency training programs. This study examined motivators, facilitators, and barriers to serving as volunteer clinical faculty using an anonymous survey of dermatologists, Mohs surgeons, and dermatopathologists affiliated with Emory University’s dermatology residency program. Among the 38 invited participants, 26 (68%) completed the survey. The types of practices represented include general dermatology (71%), Mohs surgery (23%), cosmetic dermatology (58%), and dermatopathology (27%). Traditional lectures and impromptu teaching sessions were the most utilized teaching modalities, with 14 (54%) and 11 (42%) of respondents reporting usage, respectively. Most respondents ranked altruistic statements such as “opportunity to be helpful to others” (26, 100%), “providing service to the field of dermatology” (25, 96%), and enjoyment of teaching (25, 96%) as important motivations. In contrast, extrinsic rewards such as career advancement and increased income were rated as least important. Significant barriers included limited time for travel and teaching and credentialing. Proposed facilitators included promoting schedule flexibility, increasing teaching supplies, and streamlining credentialing. This single-center study may have limited generalizability to other residency programs with varying characteristics. The motivators, facilitators, and barriers identified by this survey can inform dermatology residency programs on how to maximize volunteer clinical faculty recruitment, retention, and engagement, thus strengthening clinical teaching and mentorship offered.
Keywords: Teaching, Survey and Questionnaires, Motivation, Dermatology, Cross-Sectional Studies, Medical Education
Research Letter:
Mentorship and clinical teaching are essential components of dermatology residency programs, promoting personal development, career trajectory, and productivity in medicine [1]. While residency core faculty primarily carry out the academic mission of their program, volunteer clinical faculty (VCF) serve as additional valuable resources for residents. Previous studies identify teaching motivations of VCF in fields such as family medicine, emergency medicine, and obstetrics and gynecology; however, there is limited data on what motivates VCF in the field of dermatology [2–4]. This study aimed to survey motivators, facilitators, and barriers among dermatology VCF.
Private practice dermatologists and dermatopathologists serving as Emory University dermatology residency VCF were anonymously surveyed from January to June 2022. The survey was approved by the Emory University Institutional Review Board. Questions were adapted from the Rosenberg Occupational Values Scale, a validated tool to evaluate one’s job-specific motives and categorize motivators into intrinsic (“people-oriented” or “self-expression-oriented”) or extrinsic “reward-oriented” values [4]. Ad hoc questions on demographics, facilitators, obstacles, and educational methods were developed. Results were summarized descriptively.
Among 38 VCF invited, 26 completed the survey (response rate 68%). Types of practice varied: general dermatology (73%), cosmetics (58%), dermatopathology (27%), Mohs surgery (23%). VCF reported educating residents more commonly through traditional lecture formats (54%) followed by impromptu teaching sessions (42%). Among six full-time dermatopathology VCF, 67% arranged virtual teaching and board review sessions, while 83% conducted slide reading sessions in their practice. Before the COVID-19 pandemic, 100% held in-person scope sessions. In the 20 VCF who do not exclusively practice dermatopathology, the most common roles were observing procedures (60%) and supervising residents (25%) (Table 1).
Table 1.
Demographics, teaching characteristics, facilitators, and barriers
| Characteristic | n (%) |
|---|---|
| Total Invitees | 38 |
| Total Respondents | 26 |
| Number of years teaching as an adjunct faculty member (Mean, STD) | 11.69 (10.24) |
| Current Role in the Department | |
| Volunteer Credentialed as Adjunct Faculty | 20 (77) |
| Current Volunteer | 5 (19) |
| Past Volunteer | 1 (4) |
| Career Characterization | |
| General Dermatology | 19 (73) |
| Mohs Surgery | 6 (23) |
| Cosmetics | 15 (58) |
| Dermatopathology | 7 (27) |
| Resident Interactions | |
| I come to an Emory affiliated site to clinically supervise routinely | 9 (35) |
| I come to an Emory affiliated site to clinically supervise on an ad hoc basis | 4 (15) |
| I organize sessions for residents at my practice routinely | 7 (27) |
| I am available for residents for sessions at my clinic on an ad hoc basis | 11 (42) |
| I give lecture(s) to residents | 14 (54) |
| Dermatopathologist Specific Resident Interactions | |
| I organize regular virtual teaching sessions or lectures | 4 (67) |
| Pre-pandemic, I would come in-person to lead resident scope sessions | 6 (100) |
| I am available for residents for virtual sessions on an ad hoc basis | 3 (50) |
| I am available for residents for in-person sessions on an ad hoc basis | 2 (33) |
| Separate from resident lectures, I organize board review sessions | 4 (57) |
| I am available to host residents in my practice to look at dermatopathology slides | 5 (83) |
| Resident Interactions with Procedural Dermatologists | |
| Residents observe while I perform procedures | 12 (60) |
| I supervise residents performing procedures | 5 (25) |
| What aspects of the program do you consider motivating your role as a volunteer faculty member? | |
| Expanding patient referrals to my practice | 0 (0) |
| Displaying Emory adjunct faculty status on website or curriculum vitae | 2 (8) |
| Personal learning | 17 (65) |
| Providing service to the field of dermatology | 25 (96) |
| Enjoyment of teaching | 25 (96) |
| Other | 5 (19) |
| Do you feel there are any barriers that prevent you from teaching or teaching as much as you would like? | |
| Travel time/distance | 13 (50) |
| Training/credentialing requirements for specific facilities | 6 (23) |
| Time needed to supervise resident documentation | 1 (4) |
| Malpractice in supervising resident procedures | 1 (4) |
| Limited capacity in taking time off from my own practice | 16 (62) |
| Not having the tools and resources that I am used to | 1 (4) |
| Navigating a different EMR system | 2 (8) |
| COVID-related safety concerns | 3 (12) |
| Other | 6 (23) |
Altruistic motivations primarily drove respondents, with 100% rating “Give me an opportunity to be helpful to others” as important and 96% of respondents identifying “Providing service to the field of dermatology” and “Enjoyment of teaching” as major drivers. Extrinsic rewards such as opportunities to increase their income or prestige were rated the least important among VCF (Table 2). Reported teaching barriers were travel time and limited time off (Table 1).VCF cited hospital credentialing as an obstacle, while facilitators included flexible schedules, increased teaching supplies, and streamlined credentialing.
Table 2.
Teaching Motivations
| Value Statement | Most Important | Highly Important | Medium Importance | Little or No Importance |
|---|---|---|---|---|
| People-Oriented Value Complex | ||||
| Give me an opportunity to work with people rather than things. | 7 (27) | 9 (35) | 7 (27) | 3 (12) |
| Give me an opportunity to be helpful to others. | 21 (81) | 5 (19) | 0 (0) | 0 (0) |
| Extrinsic Reward-Oriented Value Complex | ||||
| Provide me with a chance to increase my income. | 0 (0) | 1 (4) | 2 (8) | 23 (88) |
| Give me social status and prestige. | 0 (0) | 0 (0) | 7 (27) | 19 (73) |
| Enable me to look forward to a stable, secure future. | 0 (0) | 1 (4) | 6 (23) | 19 (73) |
| Self-Expression-Oriented Value Complex | ||||
| Provide an opportunity to use my special abilities or aptitudes. | 8 (31) | 10 (38) | 7 (27) | 1 (4) |
| Permit me to be creative and original. | 2 (8) | 7 (27) | 10 (38) | 7 (27) |
| Leave me relatively free of supervision by others. | 0 (0) | 1 (4) | 3 (12) | 22 (85) |
| Give me a chance to exercise leadership. | 2 (8) | 4 (15) | 11 (42) | 9 (35) |
| Provide me with adventure. | 1 (4) | 4 (15) | 8 (31) | 13 (50) |
Our study has demonstrated that dermatology VCF were primarily motivated by intrinsic factors, consistent with prior surveys of VCF in other specialties who derived personal satisfaction from teaching [2–4]. While previous literature has suggested that limited time, travel distance, and a perceived lack of teaching skills may deter physicians from serving as VCF, our study adds to this by highlighting that credentialing requirements also serve as a deterrent [2–4]. Residency programs can possibly facilitate VCF involvement by promoting schedule flexibility, increasing teaching resources, streamlining credentialing, and enabling virtual participation and alternative forms of engagement. Further recommendations include highlighting teaching’s intrinsic benefits, recognizing educators’ contributions, and encouraging participation in medical curriculum development [4, 5]. This single-center study may have limited generalizability to other residency programs. The motivators, facilitators, and barriers identified by this survey can inform dermatology residency programs and help maximize recruitment, retention, and engagement of VCF, thus strengthening clinical teaching and mentorship.
Declarations:
Dr Yeung is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases under award numbers L30AR076081 and K23AR075888. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or US Department of Veterans Affairs. The authors report no other conflicts of interest in this work.
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