The role of the clinician educator in rheumatology

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review

BACKGROUND

Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards.

METHODS

We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature.

RESULTS

We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers.

CONCLUSIONS

The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.

Teacher training for rheumatology fellows: a national needs assessment of fellows and program directors

INTRODUCTION

Teaching is an integral part of what we do as physicians, and exposure to training on how to effectively teach is not consistently implemented in the curricula within medical training.

METHODS

We administered anonymous, in-person surveys to fellows and program directors (PDs) at the 2017 American College of Rheumatology national conference to evaluate fellow and PD attitudes regarding development of programs dedicated to teaching fellows on how to teach.

RESULTS

One hundred seven of 150 fellows returned surveys (response rate 71%). About 60% demonstrated interest in pursuing a teaching-focused career. About 97% felt their teaching skills can be improved; 88% felt improved teaching skills will be valuable for their career. With 61% response rate (57/94 PD surveys), most PDs agreed their fellows could use additional instruction in teaching. About 90% noted this would be an asset for fellows' careers. When compared, 56% of fellows reported no structured training in education during fellowship, while 64% of PDs said this type of training was available. All agreed fellow teaching skills can be improved but significantly more fellows than faculty felt confident in the fellows' ability to give feedback (p = 0.03). Both groups identified time constraints and other faculty interest as barriers.

CONCLUSION

There is significant need to develop effective fellow-as-teacher programs aimed at enhancing fellows' teaching skills, with focus on giving feedback and working within fellow and faculty time constraints. The program can help address a curriculum gap identified by fellows as well as PDs before fellowship-to-faculty transition.Key Points• There is a notable gap between faculty physicians' expectations to teach as clinician-educators and the lack of training dedicated to learning how to teach during medical training. Despite the fact that past clinical educators have identified instructional design and assessment as low-confidence areas, there is a paucity of structured program dedicated to developing these teaching skills during fellowship training.• With 97% fellows and 84% program directors, both groups agreed fellows could use additional instruction in teaching skills, but there was a significant discrepancy between fellow and program director perspectives regarding fellows' ability to give feedback.• Consistent with past needs assessments in other medical specialties, lack of time and potential faculty interest were recognized as potential barriers, calling for a structured training program dedicated to education on didactics that takes into account trainee and faculty time constraints.• Our needs assessment can direct future research on analyzing effectiveness of fellow-as-teacher program implementation by focusing on improvement of fellow teaching and feedback skills.

Building a Rheumatology Education Academy: Insights from Assessment of Needs During a Rheumatology Division Retreat

Objective.

To implement a rheumatology department education retreat to systematically identify and address the key factors necessary to improve medical education in our division in preparation for developing a rheumatology academy.

Methods.

The Hospital for Special Surgery organized a retreat for the Rheumatology Department aimed at (1) providing formal didactics and (2) assessing participants’ self-reported skills and interest in education with the goal of directing this information toward formalizing improvement. In a mixed-methods study design, faculty and fellows in the Division of Rheumatology were surveyed online pre- and post-retreat regarding various aspects of the current education program, their teaching abilities, interest and time spent in teaching, divisional resources allocated, and how education is valued.

Results.

Enthusiasm for teaching was high before and rose further after the retreat. Confidence in abilities was higher than expected before but fell afterward. Many noted that the lack of specific feedback on teaching skills and useful metrics to assess performance prevented the achievement of educational excellence. Most responding felt lack of time, knowledge of how to teach well, and resources prevented them from making greater commitments to educational endeavors and participating fully and effectively in the department’s teaching activities.

Conclusion.

While most rheumatology faculty members want to improve as teachers, they know neither where their educational strengths and weaknesses lie nor where or how to begin to change their teaching abilities. The key elements for an academy would thus be an educational environment that elevates the quality of teaching throughout the division and promotes teaching careers and education research, and raises the importance and quality of teaching to equivalence with clinical care and research.

Promotion as a clinician educator in academic radiology departments: guidelines at three major institutions

Faculty promotion within an academic department of radiology may place emphasis on scientific research, administrative contributions, educational contributions, or a combination of all endeavors that enrich the department and further its academic mission. For those departments considering the establishment of a promotion pathway that emphasizes teaching talents and education-oriented research, the authors provide examples of three different clinician-educator faculty appointment and promotion schemes. Faculty development and defining scholarly work as a clinician-educator, as well as documentation of academic productivity within this pathway, are discussed.

Clinician-educator pathway for radiology residents

Faculty clinician-educator tracks have become increasingly common at US academic medical centers. Although many radiology faculty members belong to such tracks, there is little training in radiology residencies to prepare residents to take on these roles. The authors present a summary of a novel radiology residency clinician-educator pathway developed and piloted at their institution. The key components of the pathway include protected time to work on a substantive education project and a small number of high-quality didactic lectures. Publication or presentation in some form is expected. The pathway includes regular mentorship from highly regarded clinician-educators, as well as didactic training in education techniques and skills. A formal application process was established, as were methods of evaluation during and after the experience.

Creating an academy of clinical excellence at Johns Hopkins Bayview Medical Center: a 3-year experience

Academic health centers (AHCs) are committed to the tripartite missions of research, education, and patient care. Promotion decisions at many AHCs focus predominantly on research accomplishments, and some members of the community remain concerned about how to reward clinicians who excel in, and spend a majority of their time, caring for patients. Many clinically excellent physicians contribute substantively to all aspects of the mission by collaborating with researchers (either through intellectual discourse or enrolling participants in trials), by serving as role models for trainees with respect to ideal caring and practice, and by attracting patients to the institution. Not giving fair and appreciative recognition to these clinically excellent faculty places AHCs at risk of losing them. The Center for Innovative Medicine at Johns Hopkins set out to address this concern by defining, measuring, and rewarding clinical excellence. Prior to this initiative, little attention was directed toward the "bright spots" of excellence in patient care at Johns Hopkins Bayview. Using a scholarly approach, the authors launched a new academy; this manuscript describes the history, creation, and ongoing activities of the Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center. While membership in the academy is honorific, the members of this working academy are committed to influencing institutional culture as they collaborate on advocacy, scholarship, and educational initiatives.

Clinical excellence in academia: perspectives from masterful academic clinicians

OBJECTIVE

To better understand and characterize clinical excellence in academia by exploring the perspectives of clinically excellent faculty in the top American departments of medicine.

PARTICIPANTS AND METHODS

Between March 1 and May 31, 2007, 2 investigators conducted in-depth semistructured interviews with 24 clinically excellent Department of Medicine physicians at 8 academic institutions. Interview transcripts were independently analyzed by 2 investigators and compared for agreement. Content analysis identified several major themes that relate to clinical excellence in academia.

RESULTS

Physicians hailed from a range of internal medicine specialties; 20 (83%) were associate professors or professors and 8 (33%) were women. The mean percentage of time physicians spent in clinical care was 48%. Eight domains emerged as the major features of clinical excellence in academia: reputation, communication and interpersonal skills, professionalism and humanism, diagnostic acumen, skillful negotiation of the health care system, knowledge, scholarly approach to clinical care, and passion for clinical medicine.

CONCLUSION

Understanding the core elements that contribute to clinical excellence in academia represents a pivotal step to defining clinical excellence in this setting. It is hoped that such work will lead to initiatives aimed at measuring and rewarding clinical excellence in our academic medical centers such that the most outstanding clinicians feel valued and decide to stay in academia to serve as role models for medical trainees.