Reach to Teach: Supporting Clinician Educators in Rheumatology

ORLANDO, FLORIDA—A great teacher can change the lives of countless students, and nowhere are great teachers needed more than in the training of physicians, who, in turn, use this education to care for patients. With this in mind the ACR Education Exchange 2023 session How Division Directors Can Support Clinician Educators provided insightful guidance for directors and educators alike to ensure career success and satisfaction.

A Career Track

The first speaker in the session was Lisa Zickuhr, MD, MHPE, assistant professor of rheumatology, Washington University School of Medicine in St. Louis, Mo. She began by defining the term clinician educator. Dr. Zickuhr noted that there is a contrast between teachers and educators. Teachers are individuals who impart knowledge, including in the clinical learning environment. An educator, on the other hand, not only teaches but also has a fundamental understanding of the frameworks and best practices used for assessment, feedback, mentoring and instruction. In essence, educators understand these mechanisms and apply these frameworks to the activities in which they participate, thus making the education work that they do a form of scholarship.

Dr. Zickuhr explained that clinician educators need time to learn these frameworks and practice applying these concepts to the education of trainees. In doing so, clinician educators should seek to develop their own niche within the clinical and educational realm, and be given opportunities to discover such passions.

Division chairs can help clinician educators begin their careers and achieve growth. By supporting clinician educators conceptually and in practical terms (e.g., by providing protected time for coursework/workshops in learning theory, and by helping find other educators who can serve as mentors), division chairs can help make their clinician educators successful.

Part of promoting this success, Dr. Zickuhr explains, is seeking qualified candidates for positions. A graduating fellow hoping to become a clinician educator should have ideas about what they hope to achieve in a career and how to pursue their goals. Many fellowship programs now have clinician educator training tracks in which trainees can earn certification in pedagogy. It is also possible to pursue a master’s degree in a medical education fellowship and, while doing so, participants should seek invitations to pursue opportunities in medical education at their own institution and elsewhere.

Dr. Zickuhr described challenges that division directors may face with regard to recruiting and retaining clinician educators. These obstacles include providing enough protected time for educational activities, ensuring recruitment of under-represented minorities in faculty positions, helping faculty balance clinical responsibilities with teaching opportunities/demands and avoiding the point of saturation within a division (i.e., having too many dedicated clinician educators in a given division).

Dr. Zickuhr recommends that, whenever possible, division directors assist with finding effective mentors for young faculty and sponsorship (e.g., by nominating faculty to serve on various committees and to lead certain educational activities), and providing funding for educational initiatives.

Focus Area

The second speaker in the session was Jay Mehta, MD, MS, associate program director of the Pediatric Residency Program, Children’s Hospital of Philadelphia. He pointed out two types of clinician educators: Big C and Big E.

The former are those individuals who are passionate about specific clinical topics, such as the use of musculoskeletal ultrasound, and who seek to build clinical programs around these topics.

The latter are those who pursue training in pedagogy and learning theory and, ultimately, apply these concepts in a rigorous way to educational programs for medical students, residents and fellows.

Dr. Mehta noted that being a clinician educator is a very specific position, one with an academic path for success and clear metrics by which to gauge this success. One key issue facing clinician educators is balancing time between being a busy clinician and an active educator. As Dr. Mehta explained, academic departments are lean and people are expected to do more whenever possible. So how does one fit in time for education and training?

One solution is to find micro-moments to build in teaching along the way and to think about clinical pearls and teaching scripts that can be deployed at a moment’s notice. Put another way, clinician educators should ask themselves: What little nuggets of information may I give to the learner in any given situation? Because trainees, especially interns, residents and fellows, rarely have more than a few minutes between clinical duties, it may be helpful to have five- or 10-minute chalk talks prepared on specific scenarios that occur frequently in practice.

Dr. Mehta also discussed how to define success as a clinician educator. This includes building an area of expertise, improving on the basis of constructive criticism through teaching evaluations and working with division chiefs to be nominated for teaching awards. Clinician educators may benefit from seeking roles that will allow them more protected time, such as serving in leadership positions in residency and fellowship training programs. Ultimately, the success of a clinician educator may be measured in terms of goals that each educator sets for themselves.

There is an inherent satisfaction in seeing a message hit home with a trainee, and this realization may support success that can be appreciated day by day. Over the long term, clinician educators should seek opportunities for invited talks locally, nationally and internationally whenever possible.

Offer Support

The final speaker in the session was Randy Cron, MD, PhD, professor of pediatrics and medicine, University of Alabama at Birmingham. As a division director, Dr. Cron noted that clinician educators are the lifeblood of most programs and serve as an important resource for helping fellowship training programs grow and flourish. To support his own clinician educators, Dr. Cron has hired full-time nurse practitioners to work together with these educators in the clinical environment, thereby offloading some work and preventing burnout. More senior faculty members can assist junior colleagues by passing on clinical lecture materials to them and helping guide them in their development as lecturers and small group leaders.

Some venues that may be ideal for new clinician educators include continuing medical education lectures and teaching sessions for general providers in the community. These create opportunities for outreach to other clinicians, exposure to teaching in a new environment and the chance to build a curriculum vitae.

Dr. Cron notes that division directors should grade their own success by how well they are able to assist their faculty members in achieving promotions. Efforts to increase name recognition can begin regionally and then can expand to national and international opportunities. It is important for clinician educators to collect data on their teaching, including through electronic evaluations, which can then be analyzed and be made part of a learning portfolio. Having an electronic teaching portfolio can be helpful in giving tangible examples of teaching materials and products, which can then be evaluated by promotion committees. In addition, directing a medical school or residency course can allow for advancement, particularly if learning outcomes can be measured and the positive effects of a new curriculum can be demonstrated.

In Sum

With the number of clinician educators on the rise in divisions across the country, it was a breath of fresh air to hear how these educators can and should be supported and what will allow for this positive trend to continue in the years to come.