Introducing medical students to careers in medical education: the student track at an annual medical education conference

Fostering the clinician as teacher: A realist review

BACKGROUND

Clinician-teachers, physicians with educational responsibilities in either classroom or clinical setting, are assumed to add value by virtue of their dual role. The clinical responsibilities are often prioritised over the educational tasks. How and under which circumstances clinician-teachers are able to perform their educational role and create added value for different stakeholders is currently unclear.

OBJECTIVES

To identify for whom, how and under which circumstances educational activities executed by CTs by virtue of their dual role add value to others.

SCOPE

CTs activities linking the system of education and clinical practice beyond direct patient interactions and purposefully executed.

METHODS

A realist review was conducted. Databases were searched in two stages: a narrow conventional search, followed by a comprehensive artificial intelligence-aided search. Studies concerning clinician-teachers' dual role were included. Realist analysis was applied to identify in which contexts resource mechanisms triggered reasoning mechanisms, which led to specific outcomes for different stakeholders.

RESULTS

Sixty-six studies were included. In contexts where clinician-teachers' dual role was formally recognised and valued, clinician-teachers benefitted from the credibility and legitimacy bestowed on them, making the transfer of domain-specific knowledge more impactful. In contexts where sociocultural differences between both systems existed, CTs were able to mediate and adjust recommendations aligned with stakeholders' perceived relevance. Also, contexts organised to support both roles made resource mechanisms more impactful. Clinician-teachers added value to students' clinical competency and learning environment, and to educational organisations' curricular innovation. In their clinical workspace, clinician-teachers added value by enhancing colleague physicians' teaching expertise, implementing educational innovations and recruiting students for scarce specialisms.

CONCLUSION

Clinician-teachers add value to students, colleague physicians and the clinical and educational contexts at large. Domain-specific knowledge of both systems was important to gain credibility and achieve added value. Openness, formal recognition and allocated time for both roles in educational and clinical contexts towards the dual role are important to strengthen the impact of the dual role.

Medical students' academic satisfaction: Social cognitive factors matter

PURPOSE

Academic satisfaction (AS)-the extent to which people enjoy their role or experiences as medical students-has important implications for well-being and career development. This study explores the relationships between social cognitive factors and AS in a Chinese medical education context.

METHOD

The social cognitive model of academic satisfaction (SCMAS) was adopted as the theoretical framework. Within this model, AS is assumed to be related to social cognitive factors-environmental supports, outcome expectations, perceived goal progress and self-efficacy. Demographic variables, financial pressure, college entrance examination scores and social cognitive constructs in SCMAS were collected. To explore the relationships between medical students' social cognitive factors and AS, hierarchical multiple regression analyses were performed.

RESULTS

The final sampled data consisted of 127 042 medical students from 119 medical institutions. Demographic variables, financial pressure and college entrance examination scores were first entered in Model 1, explaining 4% of the variance in AS. Social cognitive factors were entered in Model 2, explaining an additional 39% of the variance. Medical students would report higher levels of AS when they (a) held strong confidence in their skills needed for success in studying medicine (β = 0.20, p < 0.05), (b) had optimistic beliefs about the outcome of studying medicine (β = 0.40, p < 0.05), (c) felt that they were making good progress in studying medicine (β = 0.06, p < 0.05) and (d) believed that they received adequate environmental support (β = 0.25, p < 0.05). The outcome expectations showed the strongest correlation with AS, and each 1-point increase was associated with 0.39 points on the AS score, controlling for all other factors in the model.

CONCLUSIONS

Social cognitive factors play an important role in medical students' AS. Intervention programmes or courses aiming to improve medical students' AS are advised to consider social cognitive factors.

Impact of a Regional Grant Program Through the Lens of Social Cognitive Career Theory: A Mixed-Method Evaluation

PURPOSE

Evaluations of educational grant programs have focused on research productivity, with few examining impacts on grantees or effective program characteristics. This evaluation examined the regional grant program sponsored by Group on Educational Affairs to examine if and how grantees' careers were affected by funding, and if these experiences aligned with program goals.

METHOD

In this concurrent, mixed-methods theory-driven evaluation, quantitative and qualitative data were analyzed independently and then integrated to examine complementarity. Quantitative data examined differences among 4 geographic regions and included proposal and grantee characteristics abstracted from administrative records of 52 funded proposals from 2010-2015 grant cycles. Qualitative data from 23 interviews conducted from 2018 to 2019 explored the impact on grantees, with Social Cognitive Career Theory (SCCT) serving as a framework for deductive thematic analysis. To facilitate integration of findings, quantitative data were layered onto each interview to permit exploration of associations between the 2 data types.

RESULTS

Although significant regional differences existed in project length and amount of funding, there were few regional differences in grantee experiences. Despite small funding amounts, grants were perceived as career launching pads. The SCCT framework accounted for grantee experiences, including researcher identity formation and subsequent research, but did not capture collaboration phenomena. Integration of the 2 data types identified experience patterns unique to different groups of grantees (e.g., more or less research experience). The diversity among grantees suggests that clarification of program goals and stronger alignment with criteria for funding may be warranted.

CONCLUSIONS

This evaluation illuminates why small educational grant programs may or may not impact interest and productivity in research. Implications exist for funders, including clarifying program goals and providing support for less experienced grantees. Future research should explore grantee subsets (e.g., underrepresented in medicine) to further identify what fosters or inhibits careers of medical education scholars.

Evaluating the Impact of Early Career Academic Medicine Workshops on Medical Students' Interest

Introduction Academic medicine is an important field that has had a notable decline in physician interest. The aim of this study was to introduce academic medicine to medical students early in their careers with a workshop in the medical school setting, beyond conferences, to promote even greater interest in the field. Methods This workshop consisted of (1) an informational didactic session using a Microsoft PowerPoint presentation, (2) small-group breakout discussion sessions to review case scenarios, and (3) a faculty panel to provide personal anecdotes and advice to students. The authors administered online pre- and post-workshop surveys to the students. One workshop was presented to first-year medical students and another to second-year medical students at California University of Science and Medicine. Data were analyzed using the IBM SPSS Statistics 27.0 for Windows. Pre- and post-workshop survey question means were compared using a paired t-test. Results There were 104 pre-clerkship student attendees, 83 of whom were in their first year and 21 in their second. Within each class year, there was a statistical significance in pre- and post-workshop survey responses for questions one through four (p < 0.001, p < 0.001, p < 0.001, p < 0.001), but question five responses were not statistically significant (p = 0.78). Conclusion Academic medicine workshops held early in medical students' careers are an effective way to foster interest in the field. Implementing academic medicine scholars' programs, in addition to these workshops, can help provide guidance and resources for students who want to pursue a career in academic medicine.

Development and Evaluation of an Experiential Career Planning Assignment to Train Students to Assess Organizational Fit

Determining if an employment opportunity will be a good match can feel daunting, especially for veterinary graduates entering the workforce. To ease this transition, veterinary educators traditionally have attempted to provide career support through interspersed didactic lectures on career options and the preparation of employment documents. While well intended, this approach fails to address the multiple dimensions of effective career planning or the reality that career planning is a lifelong endeavor. For a career planning teaching modality to be effective, it must address all stages of career planning and provide a framework that can be adapted throughout a career. Here we describe how a four-stage career-planning model, utilized throughout higher education, was employed to create a career planning assignment for guiding students in assessing organizational fit. We describe how student feedback was used to inform revisions, resulting in an improved educational experience as measured by students' perceptions of the utility of the assignment. Additional recommendations based on instructor reflection are provided to guide creation and implementation of future assignments. Given the growing support for professional skills training in veterinary medical education, we view incorporation of such learning activities as essential to preparing students to enter the modern veterinary workplace.

The pipeline starts in medical school: characterizing clinician-educator training programs for U.S. medical students

In the past forty years, clinician-educators have become indispensable to academic medicine. Numerous clinician-educator-training programs exist within graduate medical education (GME) as clinician-educator tracks (CETs). However, there is a call for the clinician-educator pipeline to begin earlier. This work aims to identify and characterize clinician-educator track-like programs (CETLs) available in undergraduate medical education (UME). We developed an algorithm of 20 individual keyword queries to search the website of each U.S. allopathic medical school for CETLs. We performed the web search between March to April 2021 and repeated the search between July and September 2021. The search identified CETLs for 79 (51%) of the 155 U.S. allopathic medical schools. The identified CETLs commonly address the clinician-educator competency of educational theory (86%, 68/79), are formally organized as concentrations or analogous structures (52%, 41/79), and span all four years of medical school (37%, 29/79). The prevalence of CETLs varies with geography and medical school ranking. We provide an overview of the current state of CETLs as assessed from institutional websites. To create a future with a sustainable output of skilled clinician-educators, UME must continue to increase the number and quality of CETLs.

How Do Clinical Electives during the Clerkship Year Influence Career Exploration? A Qualitative Study

Problem: Although many students begin medical school with some idea of their specialty interest, up to 80% of these students choose a different specialty by their final year. This pivot tends to happen in the clerkship year, when students are immersed in the clinical environment, gaining a practical understanding of the day-to-day work in different fields. Yet, in this year students have limited experiences with specialties. Clinical electives during the clerkship year may aid students in career development. The authors examined student career exploration through the lens of social cognitive career theory (SCCT). SCCT posits three variables that influence career development: personal goals, self-efficacy, and understanding outcome expectations. With this framework, the authors sought to understand how a program of clinical electives during the clerkship year influences students' perceptions of their career exploration. We aimed to: (1) describe an innovative clerkship elective program designed for career exploration, and (2) explore how this influenced students' career exploration using qualitative analysis. Intervention: Beginning in 2018, students at our institution were required to participate in three 2-week clinical electives during their clerkship year, called Clinical Immersive Experiences (CIExes). CIExes were categorized into four different types: apprenticeship, clinical skills building, integrative (multi-disciplinary), or subspecialty. Authors invited fourth year students to participate in interviews (January to March 2019) about how they selected electives and how these electives contributed to their career exploration. Interviews continued until reaching information sufficiency. Authors coded and analyzed transcripts using template analysis. Context: This curricular intervention took place in the context of large-scale curricular redesign. Students began clerkships partway into their second year of medical school. The family and community medicine clerkship, which was previously a 6-week core clerkship, was changed to a longitudinal format, thus freeing up 6 weeks for electives. Other core clerkships included anesthesia (2 weeks), medicine (8 weeks), neurology (4 weeks), obstetrics and gynecology (6 weeks), pediatrics (6 weeks), psychiatry (4 weeks), and surgery (8 weeks). Impact: From 15 student interviews, we identified three major themes. First, CIExes facilitated personalized career exploration. All students felt that at least one elective helped them solidify their decision about a specialty choice. Second, CIExes promoted focused learning and skills development that complemented core rotations. They noted the benefit of positive relationships with supervisors, particularly attendings, during these electives. Third, students highlighted how these electives fostered a positive learning environment and enhanced wellbeing. SCCT clarified how the CIEx program helped students advance their personal goals, self-efficacy, and outcome expectations during a pivotal time in medical school. Lessons Learned: We learned that from the student perspective, the inclusion of clinical electives in the clerkship year benefited students' career exploration by helping them develop and refine their career goals, increase self-efficacy, and test outcome expectations in a meaningful way as anticipated from SCCT. In addition, we found that CIExes created a positive learning environment that allowed deep relationships to develop in fields of interest and that supported a strong sense of wellbeing. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1891545.

Is health professional education making the most of the idea of 'students as partners'? Insights from a qualitative research synthesis

Students as partners is a movement which is gaining momentum in higher education, yet disciplinary perspectives are underexplored. Using a qualitative synthesis approach informed by Major and Savin-Baden (2010), we systematically investigated how health professional education has taken up the practice of working in partnership with students. Fifty-five publications were identified in our search from 2011 to -mid 2018. The majority of literature came from North America and medicine was the most frequently represented health profession. Our three stage analysis identified five key themes: (1) framing (i.e. ethos) of the partnership; (2) drivers for partnership; (3) sustainability; (4) inclusion of student voice; and (5) understanding of partnership and its benefits and challenges. Health professional educators are well equipped to enact partnership opportunities due to their clinical skills in person-centred care. However to gain the most from student-staff partnerships, health professional education would benefit from greater awareness of the field's theoretical understandings of partnership and its key principles of reciprocity, respect and responsibility.

Pilot study: undergraduate sports & exercise medicine conferences: what role do they play?

Objectives

Sports & exercise medicine (SEM) is a specialty encompassing the management of medical problems and injuries related to physical activity through means such as exercise advice and prescription. The field of SEM has been recognised in the UK since 2005 yet there is inadequate exposure of SEM in medical curricula. Conferences may be a way to increase exposure where students meet SEM professionals, gaining greater understanding of SEM career pathways. We therefore carried out a pilot study to assess this.

Methods

The King's College London Sports & Exercise Medicine Society organised a student-led conference consisting of six lectures. Seventy-five delegates were given questionnaires on their views on SEM before and after the conference, assessed using the 5-point Likert scale. Results were analysed using a Wilcoxon-Signed Rank statistical test.

Results

Questionnaire feedback showed 67.4% of delegates (n=46) had received SEM related teaching in their current degree. Results of our statistical analysis showed an increase in SEM career interest (p=0.0359), an increase in understanding of what a career in SEM involves (p=0.0009) and an increase in delegate's understanding of what is required to pursue a career in SEM (p=0.0004) after our conference.

Conclusion

The study showed issues regarding poor exposure to SEM in medical curricula and highlighted the value of student conferences. Students felt they learnt more about the roles within the SEM specialty, aiding future career progression. Thus, we suggest that student-led conferences are a good platform to bridge this gap while medical schools introduce more SEM into their curricula.

Effect of a national focused course on academic medicine for UK candidates applying for a Clinical Academic Programme

Background Academic medicine is crucial for healthcare advancement. However, recruitment of junior doctors into academia remains an area of concern globally. In the UK, a national integrated clinical academic pathway was developed to address these issues, with the Academic Foundation Programme as the 'first opportunity for research'. We aimed to evaluate whether a focused course on academic medicine could enhance knowledge, confidence and preparedness of candidates wishing to apply for an academic programme. Methods UK medical students attended a national course conducted by current UK Academic Foundation Programme doctors that comprised lectures on academic medicine and various aspects of the Academic Foundation Programme. An online questionnaire-based cross-sectional study was conducted with participants rating measures including knowledge, preparedness and confidence related to Academic Foundation Programme applications. Outcomes were measured using Likert scales (1=low; 5=high). Results In total, 103 out of 155 attendees from 11 different UK medical schools responded to the survey (66% response rate). Pre and post-course data showed increase in participants' knowledge (median score 2 vs 4, p < 0.0001), understanding of the application process (median score 2 vs 4, p < 0.0001), confidence (median score 2 vs 4, p < 0.0001) and preparedness (median score 2 vs 4, p < 0.0001) in applying for the Academic Foundation Programme. Conclusion To our knowledge this is the first study in the available literature that demonstrates a focused course on academic medicine may enhance UK medical students' knowledge, confidence and preparedness in applying for a clinical academic programme. Further research will ascertain whether such courses can augment trainee numbers undertaking and remaining within academic medicine.

Leadership and Academic Medicine: Preparing Medical Students and Residents to Be Effective Leaders for the 21st Century

Introduction

Physician leadership positions have evolved from autonomous roles in clinical medicine to those of leaders in interdisciplinary teams managing population-based care in a value-based care-delivery system, to C-suite administrative roles in hospitals and other health care systems. Unfortunately, many practicing physicians are ill prepared to take on these new roles.

Methods

In response to the evolution of the role of the physician leader in the 21st century, an educational workshop consisting of didactics and interactive case discussion was developed to introduce medical students and residents to the concepts and practices of physician leadership. During the workshop, trainees were: (1) introduced to leadership terms and theories, (2) provided examples of leadership opportunities during medical training and upon entering medical practice, and (3) given instruction and resources on how to become more effective leaders.

Results

Results of a paired-sample t test of learner responses (pre- and postworkshop) showed a statistically significant increase in participants' perception that a career in academic medicine would allow them to serve in a leadership role at their medical school or community of interest. Over 90% of participants agreed that the workshop gave them a greater appreciation of leadership terms and theories, leadership opportunities, and ways to become a more effective leader.

Discussion

Participants gained specific knowledge regarding leadership styles and the scope of leadership roles available to physicians. They also recognized their lack of knowledge regarding physician leadership roles and opportunities, and expressed their interest in pursuing leadership opportunities in their current educational programs.

The Health Professions Education Pathway: Preparing Students, Residents, and Fellows to Become Future Educators

PROBLEM

Training the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner.

INTERVENTION

The University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation.

CONTEXT

Through course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice.

OUTCOME

From 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment).

LESSONS LEARNED

Learners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator communities of practice. Also important for learner success was alignment of their projects with the goals of the local educator community of practice. Our community of practice approach to educator career development has shown promising early outcomes by nurturing learners' passion for teaching; expanding their interest in educational leadership, innovation, and scholarship; and focusing on their identity formation as future educators.

Introducing Trainees to Medical Education Activities and Opportunities for Educational Scholarship

INTRODUCTION

The growth of medical schools, faculty attrition, and reports of student disinterest in academia all stress the need to cultivate the next generation of academic physicians. Because medical educators serve as the largest segment of faculty, heightening diverse students' awareness of opportunities to engage in various educational roles and scholarship may help them consider future academic positions.

METHODS

We implemented a workshop utilizing didactics and a small-group case discussion to help students learn how to (1) define educational scholarship and portfolios, (2) recognize the value of educational scholarship, and (3) identify how to get started with educational scholarship.

RESULTS

One hundred and fifty-six learners participated in the workshop at 11 regional conferences. Of learners from conferences 1-6, 100% (69/69) responded to the statement "The workshop INCREASED my confidence in achieving the following - Performing educational scholarship." Among these learners, 39 (56.5%) strongly agreed and 20 (29.0%) agreed with this statement. Of learners from conferences 7-11, 98.9% (86/87) responded to the question "How much confidence do you have in your ability to succeed along a clinician-educator track and publish your education-related work?" Using a paired-samples t test, a statistically significant increase in learner confidence was noted (p < .01) before and after the workshop.

DISCUSSION

Diverse learners appreciated a heightened awareness of educational roles and scholarship, which may help them gain confidence, interest, and experience in becoming future medical educators.

Beyond the Clinic: Physician Assistant Student Perspectives on Careers in Physician Assistant Education

PURPOSE

Professional training programs for physician assistants (PAs) have been rapidly expanding. The profession therefore needs to develop a sufficiently robust teaching workforce.

METHODS

This study surveyed current PA students from all Physician Assistant Education Association member programs to ascertain their level of interest in and understanding of careers in PA education, including faculty and precepting roles.

RESULTS

The study revealed that interest was greatest in precepting roles. A higher level of education before attending a PA program correlated with a higher interest in PA education roles, although an education-related degree did not show a significant relationship with such roles.

CONCLUSION

These and other study findings are important to consider as the profession continues to develop a pipeline to education careers for students and clinicians.

How we launched a developmental student-as-teacher (SAT) program for all medical students

INTRODUCTION

Teaching is a necessary skill for medical trainees and physicians. We designed and launched a developmental Student-as-Teacher program for all students, beginning with the class of 2016.

METHODS

A task force of faculty and students designed the program. The goal is to enable all students to acquire basic principles of teaching and learning at different stages in their four-year medical school career. Upon completion, students will achieve twenty-eight learning objectives grouped within four competency domains: (1) Adult and Practice-Based Learning; (2) Learning Environment; (3) Instructional Design and Performance; and, (4) Learner's Assessment and Evaluation. The program combines online learning modules and a field teaching experience.

RESULTS

The entire class of 2016 (N = 200) completed the first online module. Students found the module effective, and 70% reported an increase in their level of knowledge. Although most students are expected to complete their field teaching experience in fourth year, twelve students completed their field experience in first year. Reported strengths of these experiences include reinforcement of their medical knowledge and improvement of their adult teaching skills.

CONCLUSIONS

The program was successfully launched, and students are already experiencing the benefits of training in basic teaching skills in the first year of the program.