Table 5.

Qualitative Themes and Representative Quotes from Focus Group Discussions

Thematic category #1: Passion for teaching
	Theme 1a: Tug of war between clinical and teaching
	The perception that teaching efforts must be fit around clinical demands	“It’s always that tug of war between the clinical activity and doing neat things like this [early AM sessions on teaching skills for younger teachers] (that) advance your skill set”
		“So yes, you do it because it because you love it and you have to make up for it later, unless you are given some protected time. So we are having a bit of issues at our institution, too, in terms of fewer and fewer people are getting that protected time.”
	Theme 1b: Carving out time for education activities
	Educators interested in advancement need to engage in professional development on their own time	“You’re incredibly busy, overwhelmed junior faculty. But yet you decide to do the MHPE [Masters in Health Professions Education] online on your own time and you do projects. But then you sort of get to be known so that maybe you go from teaching to being a course director, and a course director is salary supported. And you may get that job without the advanced degree if you are really good, but how do you get really good? And how do you get the opportunity?”
		“So I think it’s necessary, if you want to be a clinician educator, to have some advanced credential to get some protected time. But I think absolutely in academics, if you want to succeed, you have to work on nights and weekends to get ahead, to get people to buy your time. I do not know anybody who succeeds without that”
		“I completely agree with the statement about medical degree, additional training, as in helping folks to get time, projects, whatever you are looking for, bargaining power. I think it definitely varies from institution to institution”
Thematic category #2: Institutional culture
	Theme 2a: Criteria for clinician-educator are varied
	How institutions value and support advancement of clinician educators	“...from talking to other colleagues and former colleagues that are now in other institutions, I think it’s a little bit more nebulous exactly what that means for a clinician educator than for some other tracks”
		“We have a single track promotion system…. And scholarship is very much a requirement of that track, the only track we have. There are pathways. But it’s the same big committee which is half basic scientists for promotion. So for us, what’s important, what we are doing at our institution, and I’m sure it’s true at a few others, is to enable, provide the skills to the clinician educators if they are at such a place of what it is to do educational scholarship that leads to a product that could go on the Med-Ed Portal as well as be published, how to think strategically about being in an interest group that can lead to leadership. Kind of the things we all know and mentor our faculty about. But each school has different needs.”
		“I was coming from our institution where there’s kind of a ‘you must have a master’s degree’ and you get this baseline protection time and there’s not much negotiating around that, to going to kind of smaller or less upper echelon [institution] but being given quite weighty, I would say, leadership roles within residency or medical school education”
	Theme 2b: Culture that values educators’ ongoing development
	Ways in which divisions and departments encourage professional development of CEs	“In terms of faculty development, we have a kind of protected half day, actually, and we are lucky in that. So every Friday morning, there’s a medical education journal club, a faculty development series, and other things…. it really creates this culture that teaching is important and it’s a skill that we can all continue to grow and develop together, and we are constantly learning from one another, our individual teaching styles, the things that we do well, differently, the different innovations going on, both within our department and other departments”
		“One important factor I think is also how much support the division will provide, not for protected time for work, but as to how much support they will provide…. Will the division pay for your travel to SGIM, to take the TEACH course? That’s an investment ahead of time. Not all divisions do that.”
Thematic category #3: Impact of advanced training
	Theme 3a: Getting education leadership roles
	Advanced education training is important in attaining leadership roles	“[Either] dedicating that time that was not reimbursed so that they know who you are, or maybe coming from another institution where you have a reputation and you are in the right place at the right time. So that when that role turns over, you are jumping up and saying, pick me, pick me. So I think that’s, it’s a little bit of luck….”
		“Whether the institution wants to commit the funding for people have at the time, I do not think it matters how many degrees you have”
		“At least within our institution… being recently hired without an advanced degree in medical education, I can guarantee you I would not have had a significant amount of protected time to do the work”
		“I think it gave the institution kind of a group of people who cared about education, because you had checked that box and actually taken the additional time and effort that it took to take on those additional courses. So it kind of put you in that box of people that cared about it.”
		“I had a pretty significant teaching role, even though I did not have a lot of background in teaching. I think that’s the way it used to be. Whereas now, if you are starting out and you want to have a significant role, I say big E, Clinician Educator, I think you need to have some advanced training”
		“You do not just get time because of the degree. You have to show that you are doing something with it.”
	Theme 3b: Importance of a mentor/advocate
	The importance of mentoring	“You can take as many courses, whatever, do as much as you—you do not actually have a mentor that actually guides you to see how you can use all those tools effectively.”
		“And also an advocate to give you protected time to do those things”
	Theme 3c: Building an education toolkit
	Training helps CEs build an education toolkit and apply strategies that fit the setting	“I think it’s just adding to your toolkit, so you have more things that you can go and grab and say, I’m going to use this here, use that there.”
		“I would say for me it would be more inward. It would be more just competency and versatility. Like engaging in those mentorship and teaching programs earlier in my career was about competency and versatility with the learner in front of me.”
		“It gives you a little bit of a structure. That’s what the training gave me. I do not write curriculum, but I can write like a little piece, and at least I know how to write, objective… it at least gave me structure that later on actually I’ve been using it.”
	Theme 3d: Networking and community most valuable
		“I think the med ed certificate program that I did was a lot more, I gained a lot more from the discussions with my colleagues than the content of the courses. I think the networking amongst other educators and finding kind of birds of a feather was really important, because you found other allies in the institution to move forward your educational goals and projects and ideas.”
		“The content became less important than networking and problem-solving became more important to me. And that became even more true as I’ve come further in my career.”
		“Once I built those bridges, it’s really great to learn what other institutions are doing, because I have not had that personal experience, and actually just gain by those collaborations different teaching methods and sort of cultures.”