The Association of American Medical Colleges defines early career professionals (ECPs) as those within 6 years of starting a faculty position (1). Others describe ECPs as faculty at the Instructor or Assistant Professor level (2), whereas the National Institutes of Health define ECP clinician-scientists as investigators within 10 years of their terminal degree (3). Despite the lack of a consensus definition, there is a broad acknowledgment that ECPs in academic medicine face unique professional and personal challenges (4). In the field of critical care medicine (CCM), ECPs may struggle to define a career path, find adequate mentoring, meet productivity expectations, or achieve work–life integration (5–7).
Extramural professional societies provide opportunities to develop clinical, research, educational, and administrative skills that may be foundational for society members in early career stages (8). Various professional organizations have instituted a range of programs to recruit, support, and develop their ECP members in these areas (7). For example, the American Thoracic Society (ATS) Assembly on Critical Care (CCA) ECP Working Group aims to support the professional and personal development of junior ATS members over the evolution of their careers in critical care. The CCA created the ECP Working Group in 2009 in response to a direct request from ATS Assembly leadership for increased engagement of early career members. Initially under the name “Young Academicians in Critical Care,” the Working Group collaborates directly with CCA leaders. It runs several CCA-sponsored programs, including Mentorship and Apprenticeship, designed to foster society involvement and professional development of all ECP members in the greater CCA (Figure 1).
Figure 1.
Organization of the American Thoracic Society (ATS) Assembly on Critical Care (CCA) Early Career Professionals (ECPs) Working Group. Describes the organization of the CCA ECP Working Group and relationship to CCA leaders and ECP CCA members. Arrows represent specific programs and initiatives created by the ECP Working Group or other ATS groups to benefit ECP members.
After 10 years of experience within the CCA, in this piece, our group of current and former ECP Working Group leaders and members discusses ECPs’ needs within academic CCM. As published career development guidelines in clinical medicine are scarce, we use a more general framework established by the National Career Development Association (NCDA) (9). In this manuscript, we highlight the efforts of the ECP Working Group, CCA, and ATS at large to support ECP career development within an international professional organization. Although the ECP Working Group is broadly inclusive of all professions within critical care, here we focus on physicians to frame an initial discussion around specific challenges and opportunities within CCM. We aim to offer guidance and insight to current and future ECPs and mentors in CCM, as well as specialists and professional organizations in other fields who wish to apply these concepts to their careers or to expand their ECP member development efforts.
Challenges for the Early Career Intensivist
Careers in CCM comprise an array of specialties (7, 10). Not only do multiple prespecialty training pathways make CCM uniquely diverse, but individual fellowship programs produce graduates with substantially different experiences and professional, clinical, and research competencies (6, 11). Previous work highlighted professional development needs and training efforts for CCM, but primarily focused on fellows (5, 6, 11). None exclusively described the needs and challenges of early career CCM faculty across specialties. A convenience sample of ATS-affiliated ECP individuals in critical care who opted to participate in a Working Group–sponsored database identified a diverse range of career and research interests, encompassing clinical care, quality improvement, and medical education (Figure 2; see also Table E1 in the online supplement). However, the search for opportunities to fill these needs can be difficult for ECPs to navigate without support and guidance.
Figure 2.
Career interests among early career members of the American Thoracic Society (ATS) Assembly on Critical Care (CCA). Responses from ATS CCA Early Career Professionals (ECP) Working Group database participants from May 2016 to January 2019. Respondents were able to select up to two career focuses. Denominator (n) is the number of respondents in each training level. Trainee group includes residents, fellows, and Ph.D. students. Other group includes ECPs who did not specify their faculty level or trainee status. Basic/Translational = basic and translational research; Clinical/HSR = clinical and health services research; Med Ed = medical education; QI = quality improvement
ECPs in CCM experience substantial challenges that often extend beyond those experienced by academics in other clinical specialties (7). For example, because of differences in pre-fellowship and fellowship training requirements and experiences, ECP intensivists may find themselves insufficiently prepared to work independently in their new clinical environments, which may be run by other specialty departments or require collaboration across specialties. New fellowship graduates may encounter highly specialized or heterogeneous case mixes that require the ad hoc development of additional clinical skills at the expense of academic productivity. They may also face differences in models of leadership and care delivery, intensive care unit culture, and interpersonal challenges that require adaptation. Different departments and institutions have different academic productivity expectations, research infrastructures, and institutional resources, all of which may lead to additional stress. CCM ECPs also face intellectually and emotionally demanding clinical work in the intensive care unit and other settings, factors that increase susceptibility to burnout (12, 13). Moreover, they must adapt to a broad range of dynamic operational challenges, which include reorganization of critical care services across specialties (14), changes to intensivist staffing models (15), and integration of advanced practice providers into care teams (16).
The NCDA’s Career Development Guidelines Framework, developed for use by career counseling and development professionals across education and industry, provides a model for organizing three major domains of career development applicable to intensivists: Career Management, Educational Achievement and Lifelong Learning, and Personal and Social Development, with mentorship facilitating achievement in all three (Table 1) (9). Each domain includes two to five specific goals that illustrate career development needs and skills relevant to the diverse spectrum of early career intensivists. In the following sections, we discuss each NCDA domain, demonstrate its relevance to early career intensivists, and describe the efforts of the ATS CCA ECP Working Group to address these challenges.
Table 1.
Domains and goals of professional development for the early career intensivist
| Domain | Goal | Resource(s) Offered by ATS |
|---|---|---|
| Career Management | CM1. Create and manage a career plan that meets your career goals |
|
| CM2. Use a process of decision-making as one component of career development | ||
| CM3. Use accurate, current, and unbiased career information during career planning and management | ||
| CM4. Master academic, occupational, and general employability skills in order to obtain, create, maintain, and/or advance your employment | ||
| CM5. Integrate changing employment trends, societal needs, and economic conditions into your career plans | ||
| Educational Achievement and Lifelong Learning | EA1. Attain educational achievement and performance levels needed to reach your personal and career goals |
|
| EA2. Participate in ongoing, lifelong learning experiences to enhance your ability to function effectively in a diverse and changing economy | ||
| Personal and Social Development | PS1. Develop understanding of self to build and maintain a positive self-concept |
|
| PS2. Develop positive interpersonal skills including respect for diversity | ||
| PS3. Integrate growth and change into your career development | ||
| PS4. Balance personal, leisure, community, learner, family, and work roles | ||
| All domains | • CCA Mentorship Program* |
Definition of abbreviations: ATS = American Thoracic Society; CCA = Assembly on Critical Care; CM = Career Management; EA = Educational Achievement and Lifelong Learning; ECP = Early Career Professional; MITT = Members in Training and Transition Committee; PS = Personal and Social Development.
Content and programming generated by ATS CCA ECP Working Group members.
CCA program or initiative. See Table E1 for additional details.
Adapted from Ref. 9.
Career Management
The NCDA framework includes five Career Management goals, which encompass skills mastery for career advancement and career exploration, planning, and decision-making. For intensivists, these translate to a knowledge of and adaptation to diverse and changing practice environments, refinement of clinical skills, leadership in clinical care and quality improvement, and academic scholarship. As leaders of their clinical care teams, CCM ECPs are responsible for a breadth of clinical problems requiring complex care coordination between specialists and multidisciplinary staff (17). They may also be expected to develop and implement quality improvement initiatives (e.g., spontaneous breathing trial protocols and sepsis management bundles), conduct staff education and training, and supervise medical technologists or laboratory personnel. Even without formal leadership titles, effective intensivist physician leaders require a working knowledge of data science, revenue generation, and hospital priorities to meet institution-specific and national performance metrics (18).
The ECP Working Group facilitates Career Management through exposure to diverse career paths and pathways for involvement and graduated leadership within ATS. In the Working Group member database, the majority of trainees and early-stage faculty (at the Instructor or Assistant Professor level) expressed interest in multiple aspects of Career Management, with networking and professional development the most common request (n = 156, 71%). Others reported interest in career mentorship (n = 91, 33.5%; Figure E1). ECPs pursuing leadership roles may cultivate specific management skills through institutional and professional society development programs (19, 20). The ECP Working Group is intentionally structured to facilitate Career Management by providing incrementally increasing leadership roles on established projects, professional interactions with ATS leaders, and opportunities for advancement within the CCA. For example, a new Working Group member may spend 2–3 years working on the Mentorship Program under a project leader before taking over that leadership role. After a few years as a successful project leader, she may be nominated by other Working Group members to become Co-Chair. The CCA Apprenticeship Program is similarly structured to provide selected ECP members mentorship from senior ATS leaders. After a year of guided mentorship focused on committee work, apprentices become voting members of key CCA committees.
The Working Group also provides opportunities for academic scholarship and skills development. Two previous ECP Working Group Chairs have contributed to official ATS documents: intersociety practice guidelines for mechanical ventilation in acute respiratory distress syndrome (21) and an official ATS systematic review of nighttime intensivist staffing models (22). ATS ECP members in and outside of the Working Group generate significant conference and web-based programming (including conference symposia and workshops [23], webinars, podcasts, and the @ATSCritCare Twitter feed), used by other CCM ECPs to explore career tracks and keep apprised of changes in the field. ATS members also have informal opportunities to create extramural peer groups that offer exposure to varied professional roles, clinical care models, practice settings, and sources of research funding. In addition, the ATS Members in Transition and Training Committee separately provides career exploration and professional skills development programming across all assemblies.
Educational Achievement and Lifelong Learning
Early career intensivists complete rigorous undergraduate and graduate medical education programs before starting their careers, but require further training for advancement within a diverse and changing field. The NCDA domain of Educational Achievement and Lifelong Learning identifies steps for achieving career goals and activities to broaden experience and foster expertise. For CCM ECPs, the domain may include self-directed learning and experiential training for clinical subspecialization and knowledge dissemination. Among the three NCDA domains, Educational Achievement and Lifelong Learning may be easiest for ECPs to understand and independently execute. Mechanisms for continuous learning required for state medical licensure and specialty board certification (e.g., Continuing Medical Education and Maintenance of Certification programs) have clear requirements for attainment (24). Beyond these requirements, ECPs may seek additional clinical, research, or management experience necessary for other career roles. Although successful career development often requires intentional and self-directed learning, ECPs may sacrifice significant time and effort needed for scholarly productivity and subsequent academic promotion in the setting of pressure to assume additional clinical responsibilities and leadership roles. Local and cross-institutional mentors can substantially mitigate this loss of focus by serving as a guide for academic advancement and linking their mentee to opportunities for educational growth and accomplishment.
Educational Achievement is a significant focus among CCA ECPs, with increasing interest over successive career stages. Among respondents in the CCA mentor program participant survey, those at the Instructor or Assistant Professor level were most likely to describe Educational Achievement as their primary interest for mentorship (n = 35, 79% of group) (Figure 3). Members of the ATS CCA ECP Working Group have opportunities to develop international conference programming (23) and durable clinical and policy resources published in ATS journals (21, 22) and on the ATS website. In doing so, ECPs increase both content expertise and knowledge dissemination skills. The ATS CCA also recognizes ECP members in and outside of the Working Group with an annual Early Career Award, ATS Foundation research grants, and ATS Fellow designation. Such achievements provide verifiable evidence of international professional society participation required by many institutions for promotion. Society participation at all levels may also generate extramural collaborators and mentors willing to write essential letters of support. Society-sponsored lifelong learning activities include annual conferences delivering Continuing Medical Education credits, as well as CCA-sponsored podcasts, web-based journal clubs, and workshops on a variety of topics relevant to clinical care, research, and education.
Figure 3.
Areas of requested mentorship among American Thoracic Society (ATS) Assembly on Critical Care Early Career Professionals, stratified by career stage. Data represent 183 individual mentees between 2016 and 2019. Mentees could choose two domains for mentorship; n is the number of respondents in each training level. Career Management domain includes requests for mentorship in “career development and promotion” and “clinical practice.” Educational Achievement and Lifelong Learning domain includes request for mentorship in “writing and publishing,” “science and scholarship,” and “grant funding.” Personal and Social Development domain includes requests for mentorship in “networking and navigating ATS,” “work–life integration,” and “women in medicine.”
Personal and Social Development
Previously underemphasized, the Personal and Social Development domain is essential for successful career development, especially in CCM. The NCDA Personal and Social Development domain goals are individualized valuations of self-knowledge, interpersonal skills, respect for diversity, and work–life integration. Although these goals are fundamental to career success and longevity, effective facilitation of this domain during residency and fellowship training is poorly understood (25). After completion of clinical training, ECPs may prioritize other career development goals over this domain, which are unstandardized and not captured by current promotion metrics, like the curriculum vitae. However, this choice may have consequences, such as burnout, that directly affect performance in other domains (12). Unfortunately, critical care physicians have one of the highest rates of burnout among specialties (12), and ECPs have a higher risk of burnout compared with their senior colleagues (13). The issue has been addressed explicitly in CCM by the ATS and the Critical Care Societies Collaborative (12).
Personal and Social Development also encompasses support for diversity, which, in CCM, includes a wide range of groups and perspectives. Some forms of diversity are inherent to CCM, such as differences in physician training pathways, clinical practice environments, and shared decision-making models that present both opportunities and challenges for CCM ECPs (7, 10). Other forms of diversity include clinical care of and advocacy for underserved populations, as well as inclusion and support of traditionally underrepresented groups in training and leadership roles, all of which require intentional program development. Despite gains in medical school enrollment, women remain outnumbered in academic medicine (26) and even more so in CCM (27). Ethnic and racial minorities are more significantly underrepresented among U.S. medical students (28), academic faculty members (29), and pulmonary and critical care trainees (30). In this environment, underrepresented early career intensivists may struggle to find personalized mentorship, and may face other career development challenges.
Active society participation and exposure to peer and senior members can help ECPs develop professional identities and explore their diverse community (8). ATS offers several opportunities to network with peers and senior society leadership via collaboration on Working Group efforts, structured social events, and mentoring programs. In addition to annual conference programming focused on diversity, ATS actively promotes diversity through policies (e.g., Diversity and Inclusion Policy), committee activities (e.g., ATS Women in Critical Care Interest Group, ATS Health Equality and Diversity Committee), an annual Diversity Forum, Minority Trainee Development Scholarships, global health care delivery and research development programs, and collaborations with other professional societies and peer organizations in the United States and around the world. The ATS Wellbeing Collaborative and ATS peers and mentors can also offer resources and perspectives on Personal and Social Development goals. Up to 30% of CCA Mentorship program participants requested specific advice on elements of this domain, selecting responses that included “work–life integration,” “network and navigate ATS,” and “women in medicine.” Mentorship program mentors are encouraged to provide holistic guidance to mentees that considers personal career aspirations and work–life integration.
Mentorship
Mentorship plays an integral role within each of the NCDA domains, influencing early career development and the success and satisfaction of ECPs in academic medicine (31). Mentor advocacy and sponsorship can encourage new collaborations, open career paths, and promote diversity (32). Effective mentors balance encouragement and correction, guiding the mentee to strategically identify and achieve value-consistent career goals compatible with career durability (33). The longitudinal nature of most mentoring relationships permits the mentor–mentee pair to revisit and adapt career goals over time. Mentorship often serves as a fulcrum for research training, but is not consistently formalized for ECPs in clinical or educator roles (34). Many ECPs benefit from multiple mentors (or a mentorship team) to meet the full spectrum of career development needs, but engaged and experienced mentors may not be readily available (7, 34). When ECPs find that their home institutional resources are insufficient for their unique needs, extramural mentors can provide perspectives on the national landscape of CCM outside of the ECPs’ local practice and offer balanced advice about career advancement or job changes.
Professional societies are well positioned to promote extramural and interdisciplinary mentorship (8). The CCA ECP Working Group started a well-received mentorship program in 2014 to increase ECP involvement in ATS activities. Members of the Working Group manually match trainees and junior faculty to more experienced mentors based on shared personal and scholarship interests. Among CCA’s 316 mentor–mentee matches to date, requested areas for mentorship crossed all three NCDA domains (Figure 3). One Working Group member produced a podcast, The Art of Mentoring, available on the ATS website (35). Intending to cultivate future mentors, the CCA plans to extend the mentorship program by guiding senior faculty to mentor junior faculty in session moderator roles during ATS conference poster sessions. This new program element will offer opportunities for longitudinal relationships and mentorship on mentorship.
Conclusions
ECP intensivists follow a variety of training and career paths that require personalized goal setting and career building. The breadth and diversity of opportunities within CCM are fundamental strengths of the specialty, but it can be difficult for ECPs to navigate without mentors and peer networks. The NCDA career development domains of Career Management, Educational Achievement and Lifelong Learning, and Personal and Social Development organize and illustrate the breadth of career development challenges faced by CCM ECPs. ECP-focused interest groups or committees within professional societies offer distinct yet wide-ranging potential benefits for active Working Group members, ECPs within the society, and the organization as a whole.
Although the NCDA framework used in this article was not created or validated for use in academic CCM, it offers a starting point for understanding the breadth of career development needs both during and after fellowship training. ECPs may use the framework to identify individual needs and to plan and prioritize their career development efforts. Society leaders may use it as a resource to guide future programming that fosters ECP development and active integration. Looking forward, the CCA ECP Working Group will use the NCDA framework as a tool to assess the evolving needs of its members and to develop sustainable and flexible solutions to changing career development needs. In the short term, planned efforts include formal tracking of Working Group outcomes, expansion of the ECP member database to capture the diversity of member and society needs, and the establishment of longitudinal mentorship opportunities.
Professional society membership offers avenues for ECPs to develop extramural support, explore the broad landscape of academic CCM, and achieve individualized goals in all career development domains. Professional CCM societies, including ATS, fulfill an obligation to deliver resources, including extramural mentorship, which allow its members to thrive in a rapidly changing and heterogeneous field. In the decade since the establishment of the ATS Young Academicians in Critical Care group, the practice of CCM has changed, and ECPs’ needs have grown. Although there is always a need for program expansion and increased support, the organization has demonstrated that ECP Working Groups (and similar programs) are feasible and sustainable mechanisms for career development by professional societies. These organizations are not limited to CCM; 13 different ATS Assemblies now include ECP Working Groups. Such efforts have the potential to strengthen the viability and longevity of the CCM workforce and to improve the care of critically ill patients.
Acknowledgments
Acknowledgment
The authors thank Nicole Feijoo, Melinda Garcia, Hayley Gershengorn M.D., Amal Jubran, M.D., Patricia Kritek, M.D., Ed.M., Eileen Larson, Nuala Meyer, M.D., M.S., Hallie Prescott, M.D., M.Sc., Jeremy Richards, M.D., Miriam Rodriguez, Christopher Seymour, M.D., M.Sc., Benjamin Singer, M.D., and Renee Stapleton, M.D., Ph.D.
Footnotes
The views expressed in this article are those of the Assembly on Critical Care Early Career Professionals Working Group, and do not necessarily represent the position of the American Thoracic Society as a whole.
Author Contributions: study conception and design—E.A.V., N.R.N., S.K.S., and K.S.M.; data acquisition, analysis, and interpretation—E.A.V., N.R.N., S.K.S., L.K.V.V., and K.S.M.; manuscript drafting and revision—E.A.V., N.R.N., S.K.S., L.K.V.V., A.J.W, V.L., and K.S.M..
This article has an online supplement, which is accessible from this issue’s table of contents at www.atsjournals.org.
Author disclosures are available with the text of this article at www.atsjournals.org.
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