Abstract
We conducted a survey of subspecialty fellows at a three-site academic institution and characterized fellows’ perception of, interest, and training in medical education. One hundred sixty-nine of 530 (31.9%) fellows responded. Most (78.2%) planned careers in academic medicine. Fellows’ conception of medical education involved supervising trainees clinically (93.5%), classroom teaching (89.3%), and providing mentorship (87.6%). While only 30.2% had received formal training in medical education, 61.5% felt it should be required for careers with strong educational components. This study provides evidence for the creation and promotion of educational training programs for trainees interested in careers involving medical education.
Electronic supplementary material
The online version of this article (10.1007/s40670-020-01007-x) contains supplementary material, which is available to authorized users.
Keywords: Medical education, Training, Fellowship
Background
Medical trainees, particularly those intending to pursue careers in academic medicine, require skills in education and teaching. Some institutions support programs to “teach the teachers” or “train the trainers” at the resident-physician level. Such programs are less prevalent at the subspecialty fellow level and, when available, generally focus on a single subspecialty training program [1–6]. Assessing the attitudes and skills of subspecialty fellows regarding medical education is particularly important, as these trainees will soon enter independent practice as clinicians and educators.
Additionally, the phrase “medical education” itself encompasses many activities including clinical teaching and supervision, mentorship, administration of an educational program, and a variety of other activities. Little research has explored what the term “medical education” means to trainees and its role in their future career. In this study, our aim was to characterize subspecialty fellows’ perception of and interest and training in medical education.
Activity
We conducted an IRB-approved, survey-based study of fellows in all subspecialty training programs at three Mayo Clinic sites (Minnesota, Arizona, and Florida) using a Google Documents online survey tool. An email invitation to participate was sent in October 2018 to all subspecialty fellows at the three sites, with assurance that participation was voluntary and all answers would be anonymous. A reminder email was sent to all fellows after 7, 14, and 21 days, and the survey remained open for a total of 28 days.
No validated survey tool for assessing interest and experience in medical education training and exposure exists. Therefore, survey questions were developed specifically for this study by the principal investigator and edited based on the input of four individuals with experience in both survey research and/or subspecialty fellowship training program leadership. Survey questions consisted of multiple-choice and Likert-scale questions and all questions are included in the Supplemental File. For the questions “What does the term ‘medical education’ mean to you?” and “What type of formal training in medical education have you received?” fellows could select more than one answer (and therefore, percentages to these responses do not total 100%). For all other questions, respondents could select only a single answer. Survey responses were analyzed using Google Docs and JMP and summarized using descriptive statistics.
Results
Of 530 fellows contacted by email, 169 responded (response rate 31.9%). Respondent demographics are shown in Table 1. Respondents were more often men (58%), and identified as white (46.4%), Asian (28.3%), or Hispanic (10.2%). Respondents were training in a variety of subspecialties, most frequently within internal medicine (49.7%) and surgery (13%). Most planned on careers in academic medicine (38.5% clinician-educator, 22.5% clinician-investigator, 17.2% academic clinician).
Table 1.
Respondent demographics
| N (%) | |
|---|---|
| Sex | |
| Men | 98 (58) |
| Women | 69 (40.8) |
| Prefer not to say | 2 (1.2) |
| Race | |
| African | 4 (2.4) |
| Asian | 47 (28.3) |
| Hispanic | 17 (10.2) |
| White | 77 (46.4) |
| Prefer not to say | 15 (9) |
| Other | 9 (5.3) |
| Subspecialty area | |
| Anesthesia | 7 (4.1) |
| Internal medicine | 84 (49.7) |
| Neurology | 13 (7.7) |
| Opthalmology | 2 (1.2) |
| OB-GYN | 7 (4.1) |
| Pathology | 11 (6.5) |
| Pediatrics | 9 (5.3) |
| Psychiatry | 3 (1.8) |
| Radiology | 6 (3.6) |
| Surgical | 22 (13.0) |
| Other | 5 (3.0) |
| Planned career path | |
| Academic medicine: clinician | 29 (17.2) |
| Academic medicine: clinician-educator | 63 (38.5) |
| Academic medicine: clinician-investigator | 38 (22.5) |
| Community/private practice | 26 (15.4) |
| Hybrid (private/academic) | 1 (0.6) |
| Non-clinical: industry/pharmaceutical | 1 (0.6) |
| Unknown | 9 (5.3) |
| Other | 2 (1.2) |
Responses to questions about medical education are shown in Table 2. Fellows reported that their conception of medical education involved supervising trainees in a clinical capacity (93.5%), teaching in the classroom (89.3%), providing mentorship for trainees (87.6%), holding leadership roles in education (63.3%), and conducting research in education (56.2%). The majority of fellows (62.7%) felt that the primary definition was supervising in the clinical capacity.
Table 2.
Responses regarding medical education
| N (%) | |
|---|---|
| What does the term “medical education” mean to you? | |
| Supervising medical students/trainees in a clinical capacity | 158 (93.5) |
| Teaching medical students/trainees in a classroom or other formal curricular setting (non-clinical) | 151 (89.3) |
| Mentorship/career development for medical students/trainees | 148 (87.6) |
| Having an educational leadership role (program director, etc) | 107 (63.3) |
| Investigating and publishing on education-related topics | 95 (56.2) |
| Which of these activities do you see as the primary meaning of “medical education”? | |
| Supervising medical students/trainees in a clinical capacity | 106 (62.7 |
| Teaching medical students/trainees in a classroom or other formal curricular setting (non-clinical) | 24 (14.2) |
| Mentorship/career development for medical students/trainees | 29 (17.2) |
| Investigating and publishing on education-related topics | 3 (1.8) |
| Having an educational leadership role (program director, etc.) | 4 (2.4) |
| Other | 3 (1.8) |
| What importance does being an educator have to you currently (during fellowship)? | |
| Not important at all | 2 (1.2) |
| Slightly important | 23 (13.6) |
| Moderately important | 81 (47.9) |
| Extremely important | 63 (37.3) |
| What level of importance do you think being an educator will have in your future career plans? | |
| Not important at all | 2 (1.2) |
| Slightly important | 20 (11.8) |
| Moderately important | 73 (43.2) |
| Extremely important | 74 (43.8) |
| Have you received formal training in medical education? | |
| Yes | 51 (30.2) |
| No | 118 (69.8) |
| What type of formal training in medical education have you received? | |
| Coursework | 51 (30.2) |
| Certificate program | 7 (4.1) |
| Graduate degree | 6 (3.6) |
| Do you think formal training in medical education should be required for those pursuing a career as a medical educator or clinician-educator? | |
| Yes | 104 (61.5) |
| No | 65 (38.5) |
Respondents identified “being an educator” as extremely (37.3%) or moderately (47.9%) important during fellowship and extremely (43.8%) or moderately (43.2%) important for their future careers. There were 30.2% of respondents who had received formal training in medical education, which was primarily coursework, not leading to a formal degree/certificate. Overall, 61.5% felt that formal training in education should be required for those pursuing a career as a medical educator or clinician-educator.
Discussion
We conducted a survey of fellows across multiple specialties at a large tri-site academic medical center and found that fellows had a wide variety of conceptions of what “medical education” means, ranging from supervising trainees and teaching in the classroom to providing mentorship, holding leadership roles in education, and conducting medical education research. Most fellows felt that being an educator would be extremely or moderately important in their future careers, but relatively few had received formal training in education. Many felt that formal training in medical education should be required for those pursuing a career as an educator.
Our findings highlight the importance subspecialty fellows place on medical education as part of their future careers and the current lack of availability of training in education. Prior research has demonstrated that positive clinical experiences and exposure to/interaction with mentors and role models impacts career choice both at the resident and fellow level [7, 8]. Medical education training programs for residents have led to increased interest in teaching and increased positive self-perception of teaching skills [1]. It is therefore reasonable to postulate that formal training in medical education may positively influence trainees’ interest in and pursuit of excellence in medical education. Additional programs at the fellowship level have the potential to elevate the importance of teaching and have a positive impact both on trainees and on patients [2, 9, 10]. Programs which focus on teaching for trainees at multiple levels from medical school through fellowship may have the potential to create a community of medical educators and expand exposure and interest at all levels [11, 12].
Unfortunately, there is a lack of formal curricula in teaching skills in most subspecialty training programs, with time, financial resources, and lack of availability of expert faculty cited as barriers to implementation [13]. A recent survey of internal medicine subspecialty fellows found, similar to our study, that most trainees had no specific teaching-focused training or feedback on their teaching skills during fellowship, but that most anticipated teaching to be part of their future careers [14]. These internal medicine subspecialty fellows expressed interest in programs that could improve their teaching skills. Our study expanded on this prior work by including subspecialty fellows from all specialties (medical, surgical, etc) and our findings support the conclusion that fellows from all specialties felt that medical education—including formal training in medical education—was important.
Our study has several limitations. The survey was conducted at a single (albeit, three-site) institution where the majority of participants reported that they planned careers in academic medicine, particularly as clinician-educators. This, along with the response rate, may reflect selection bias, such that those fellows who choose to participate may place more importance on medical education, which may limit generalizability. Additionally, we were not able to assess actual (instead, we assessed planned) career outcomes after fellowship training in order to determine how many fellows were able to actualize their planned career paths. Finally, due to relatively small numbers, particularly of non-IM subspecialty fellows, subgroup analyses were not undertaken in this study. These are areas that could be investigated further in future studies.
Conclusions
A majority of fellows in a broad range of subspecialties reported that medical education was somewhat or very important for their future career plans, and many anticipated careers as medical educators. While less than one-third of fellows completed formal training in medical education, almost two-thirds felt that such training should be required for those planning education-based careers. We hope that this survey provides further evidence of the need to broaden and promote medical education training for subspecialty trainees, particularly for those interested in careers as educators.
Electronic Supplementary Material
(DOCX 16 kb)
Authors’ Contributions
ALM formulated the study question and design, collected and analyzed the data, interpreted the data, and wrote and critically reviewed the manuscript; CAT interpreted the data and critically reviewed the manuscript; MWC interpreted the data and critically reviewed the manuscript; LER interpreted the data and critically reviewed the manuscript; and ASO oversaw the overall study process, interpreted the data, and critically reviewed the manuscript. All authors read and approved the final manuscript.
Data Availability
Data will be made available to those requesting it.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Ethics Approval
This study was granted IRB approval by the Mayo Clinic IRB, and consent to participate was deemed unnecessary (waived) by the Mayo Clinic IRB.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
Data will be made available to those requesting it.