Succeeding as a Clinician Educator: Useful Tips and Resources

Abstract

Clinician Educators (CEs) play an essential role in the education and patient care missions of academic medical centers. Despite their crucial role, academic advancement is slower for CEs than for other faculty. Increased clinical productivity demands and financial stressors at academic medical centers add to the existing challenges faced by CEs. This perspective seeks to provide a framework for junior CEs to consider with the goal of maximizing their chance of academic success. We discuss six action areas that we consider central to flourishing at academic medical centers: 1. Clarify what success means and define goals; 2. Seek mentorship and be a responsible mentee; 3. Develop a niche and engage in relevant professional development; 4. Network; 5. Transform educational activities into scholarship; and 6. Seek funding and other resources.

Dr. Young Enthusiast, a junior faculty member, arrives at work ready to start as a new Associate Program Director. Dr. Enthusiast has been on faculty in an academic medical institution as a clinician educator for three years. He works full time and has 75 % of his FTE supported by his clinical work.

As he begins his day, he finds 20 messages in his email inbox: several request coverage for resident clinics, morning report and medical student conference, and one offers a new opportunity as a departmental representative for a patient safety committee. As he starts clinic, he ponders how best to respond to these requests.

Dr. Enthusiast has a busy clinical practice which he truly enjoys. Despite being more confident in outpatient medicine, he continues to struggle with efficiency, and is often left with several hours of paperwork to finish.

After clinic, he grabs a quick bite on his way to his office. He’s working on a new sign-out curriculum with two residents as part of a residency performance improvement project. He has completed the literature review, and is struggling with the Institutional Review Board application and how best to distribute his survey. He isn’t sure how best to analyze the data or who to ask for help.

Dr. Enthusiast wonders how he is going to make time for all of his responsibilities, let alone find balance between his work and home life.

Does this scenario sound familiar to you?

Dr. Enthusiast is not alone; many of today’s junior Clinician Educators (CEs) find themselves overwhelmed by opportunities, projects, and clinical and educational responsibilities, and struggle to balance their work and family demands.¹ Academic advancement is slower for CEs than for other faculty.^2,3 Compared to basic science researchers and clinician-investigators, CEs have lower odds of being at a higher rank and of satisfaction with advancement towards promotion. CEs also report less familiarity with promotion guidelines, fewer meetings with superiors, less mentoring, and decreased direction, resources, and opportunities.^2–5 Clinical productivity demands and financial stressors at academic medical centers (AMCs) have progressively added to these challenges.⁵

This perspective seeks to provide a framework for junior CEs, and those mentoring them, with the purpose of maximizing their chances of academic success. We suggest six action areas that we consider core to thriving in today's academic world: 1. Clarify what success means and define goals; 2. Seek mentorship and be a responsible mentee; 3. Develop a niche and engage in relevant professional development; 4. Network; 5. Transform educational activities into scholarship; and 6. Seek funding and other resources.

CLARIFY WHAT SUCCESS MEANS AND DEFINE GOALS

How Can a CE Like Dr. Enthusiast Be Successful?

The first and most important step when thinking about career goals is to reflect on your personal view of success and how this success might be achieved. Consider your total view of success, personal and professional, as it is important for these perspectives to align. Consider not only “what you want to be” but also “what you love to do”. This reflective process requires devoted time and energy and must be made a priority in order for it to occur.

The next step is defining career goals that align with your view of success. The use of the “SMART” framework⁶ for writing goals may be helpful, as each goal should be specific, measurable, achievable yet aggressive, relevant (not only to you, but also to those around you), and time sensitive. These goals may not focus exactly on what you love, but may be necessary steps toward ultimate success.

SEEK MENTORSHIP AND BE A RESPONSIBLE MENTEE

Once Dr. Enthusiast Has Developed Goals, How Should He Approach Finding Mentorship? What Is His Role in this Relationship?

Mentorship is critical to career development, academic productivity, and professional success.^7–9 While recognizing the need for mentors is an important first step, identifying appropriate mentors can be challenging. Dr. Enthusiast could benefit from mentorship in clinical efficiency, educational scholarship, work-life balance, and administrative work.¹⁰ It is unlikely that he could have all his needs met from a single individual, so prioritizing and thinking strategically regarding mentorship, using his goals and his perspective of success, will be helpful.

There are several characteristics that you should consider when attempting to identify a mentor. Your mentor should be someone who has already succeeded in achieving goals you have set for yourself, such as academic promotion, manuscript publication, leading an educational study, or balancing work and home life. Mentors must dedicate time to listen to you, and provide professional insight while discussing and reviewing your work. Successful mentors are skilled communicators who can listen to what you have to say and are able to provide both reinforcing and corrective feedback in an effective manner.^11,12

There is a set of responsibilities critical to being a successful mentee. Foremost it is crucial to be honest with yourself and your mentor regarding your vision of success. Do not convey to your mentors what you think “they want to hear”.¹² Effective communication skills are vital.

An additional mentee duty is taking initiative for cultivating and managing the relationship with the mentor.¹³ This has been described as a “managing up” technique, where the mentee accepts such responsibilities and conveys them in a fashion that is effective for the mentor. Key aspects of this technique include: mutually agreed upon expectations of the relationship, carefully planned meeting agendas, fluid exchange of information, and scheduled feedback sessions. We cannot overemphasize the importance of "follow-through" as the burden to make the next step happen always remains with the mentee.¹⁴

DEVELOP A NICHE AND ENGAGE IN RELEVANT PROFESSIONAL DEVELOPMENT

Is it Important for Dr. Enthusiast to Create a Niche? What Additional Professional Development Should Dr. Enthusiast Seek Out?

A niche is defined as a position particularly well suited to the person who occupies it,¹⁵ and can become the focus of your career.¹⁶ An ideal niche fulfills personal interests and passions, while at the same time allowing you to achieve recognition and contribute to your institution, specialty, and community. In the field of medical education, rewarding niches can be found in curriculum development focused on clinical content (e.g. pain management, women's health), or skill-specific competencies (quality improvement, shared decision making), as well as purely administrative (associate residency or clerkship director) leadership roles. Regardless of whether you choose a niche, or a niche chooses you, the process of focusing your interests is instrumental to your success as a CE.¹⁷

In the early stages of your career, a niche is more likely to be broad. After 3 to 5 years, and with the insight of your mentor, you should begin to narrow your focus. Be selective, grow into the areas you find most interesting, and build on your strengths. Write out a list of your activities and look for a common thread, reflecting on what you enjoy most. Do not be afraid to say “No thank you” to opportunities that may defer time away from the activities within your niche. Look for symbiotic relationships within your division, residency program, hospital, medical school, or university. You will be better supported if others care about the niche as much as you do.

While developing a niche, a CE will often recognize the need for additional professional development. Faculty development opportunities geared towards enhancing skills related to teaching, curriculum development/assessment, research or leadership are available for junior CEs. For those with a specific interest in research, a Medical Education Research Certificate is available through a series of workshops coordinated by the Association of American Medical Colleges.¹⁸ Higher degrees, fellowships and faculty development opportunities with certificate programs (such as a Teaching Scholars Program) are available at many institutions. Working closely with a mentor and making contacts with others who have recently engaged in these opportunities will allow a junior CE to choose wisely from options.

NETWORK

How Does Dr. Enthusiast Know That He Isn’t Alone and Meet Others With Similar Interests and Complementary Skills?

Networking involves making meaningful contacts that are long lasting. Networking enhances visibility and career advancement by enabling you to meet potential future collaborators or mentors. These same individuals may review grants and manuscripts, invite speakers to meetings, and provide letters of recommendation.^19–22 Networking opportunities exist within and outside your department and institution. By presenting posters, oral abstracts, and workshops at regional and national meetings, you can meet others with similar interests. We recommend that you actively participate in committees and interest groups that are related to your niche, and consider volunteering for leadership positions within those groups as a mechanism of developing a reputation external to your institution. Academic medical societies typically facilitate this process by publicizing interest groups, mentoring options, and research networks.

TRANSFORM EDUCATIONAL ACTIVITIES INTO SCHOLARSHIP

What Is Scholarship, and Why Is it Important for Dr. Enthusiast to Produce it? Which Activities Within His Busy Schedule Could He Transform Into Scholarly Work and Be Used to Advance His Career?

Career advancement at most academic medical centers requires documentation of scholarly work. Scholarly activities should be visible and valued, and may include a spectrum of accomplishments, from personally developed course materials to peer-reviewed publications.^23–26 Keeping this in mind, meet early with your division director, and become familiar with policies and procedures for promotion at your institution so that you have an understanding of institutional definitions for scholarship worthy of promotion. If possible, review examples from more senior faculty who have been promoted to associate or full professor rank within your track or pathway. Even if your institution does not require use of an educational portfolio to document your teaching and scholarship, we recommend that you consider this tool as a way to track learner evaluations, curriculum development, and assessments and outcomes of educational interventions.^25,27

To produce scholarly work from teaching activities, you must think about scholarship from the very beginning.²⁸ It is common for a newly hired CE to emphasize clinical work or teaching and leave scholarship for later, but time will pass quickly and important opportunities may be missed. Time management skills are an essential asset in this difficult task. Set aside at least one half day a week in your schedule dedicated to scholarship, preferably not proximate to busy clinical activities.²⁹ Whenever possible, create scholarly activities from projects or tasks you are already working on. An example for Dr. Enthusiast is the new sign-out curriculum he is developing. Since he has already reviewed the literature and created a survey, he is becoming an expert in this arena. When the new curriculum replaces the prior version at his institution, he has an intervention that can be measured and presented as documentation of his scholarly work. Additional examples are preparation of a resident lecture as grounds for a review article or clinical vignette, or membership in the patient safety committee leading to new collaborative efforts that could be assessed and disseminated as a quality improvement innovation. A personal interest in the area of scholarly work will make time spent in the project enjoyable and invigorating.

Your work as a CE, if focused and channeled, ultimately creates individual expertise that can be disseminated and valued as scholarship.

SEEK FUNDING AND OTHER RESOURCES

How Could Dr. Enthusiast Look for Funding for His Performance Improvement Project?

Funding provides CEs with both the time and resources necessary for a scholarly approach to their work, and is associated with higher quality of published medical education research.³⁰ National funding for medical education is limited;³¹ however, the Institute of Medicine has advocated for increased funding of education innovation and research.³²

CEs like Dr. Enthusiast should familiarize themselves with the opportunities available.³³ Your librarian, division director and mentors can assist you in identify funding opportunities and guide you to relevant organizations and funders. If your institution has an academy or institute of medical educators, consider approaching them. The following links provide a starting point for funding resources: http://www.physicianscientists.org/careers/fundinghttp://www.niaid.nih.gov/researchfunding/ann/Pages/found.aspx.

Another valuable resource is your national specialty society, where requests for proposals may be listed on the website or sent out as part of electronic newsletters and/or on list serves. Multiple organizations and foundations offer grants that could be used for medical education if related to their particular mission and focus.

SUMMARY

Dr. Enthusiast is a valued faculty member and a precious resource to academic medicine. Like most CEs, he is pulled in many different directions while struggling to strike balance and succeed in today's academic environment. Through timely and thoughtful attention to reflection, development of a niche, scholarship, awareness of funding, and strong mentorship, junior CE faculty will continue to make significant contributions to individual institutions as well as the greater community of academic medicine. We encourage junior CEs to begin with these steps as they embark on their careers, embracing the future with confidence and assertiveness. The authors hope this conceptual framework proves useful to junior CEs, their mentors and AMCs.