#KeyLIMEPodcast 238: Re-producing ourselves – when and how?

Today’s paper will be of particular interest to our blog readers as it focuses on the 21st century Clinician Educator. It takes a look at recently initiated clinician-educator tracks (CETs) that have been put in place in residency and fellowship programs to attract and train future Clinician Educators. This scoping review seeks to take a deeper look in to these CETs in order to inform future iterations of the courses as well as identify gaps in the research. Read more about it below, or listen to the hosts discuss here.

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KeyLIME Session 238

Listen to the podcast.

Reference

Friedman et. al., Clinician-Educator Tracks for Trainees in Graduate Medical Education: A Scoping Review Acad Med. 2019 Jun 4

Reviewer

Linda Snell (@LindaSMedEd)

Background

As health education evolves, a pipeline of individuals who possess the competencies necessary to develop new curricular content and deliver it via novel pedagogies is needed. Clinician educators (CEs)* are increasingly an important part of the medical education workforce.

*The 21st-century clinician-educator is defined as someone who participates in clinical practice, applies theory to education practice, and engages in education scholarship or leadership.

Programs to train CEs are becoming more common, both for current and future faculty members.  This is done with faculty development initiatives, teaching scholar programs, diplomas (e.g. at the RCPSC), advanced degrees in education for clinicians, and, for residents, ‘medical education electives or ‘rotations’. Recently, residency and fellowship programs have begun to offer clinician-educator tracks (CETs). These tracks seek to attract and develop a cadre of future clinician-educators with the needed competencies, and are becoming  increasingly prevalent in graduate medical education (GME) allowing future CEs to choose a career direction during their training.

Purpose

To ‘characterize the current state of knowledge about CETs’ structure, content, and outcomes’. Results can inform future research and program development and highlight gaps in the literature.

Key Points on the Methods

A scoping review following Arskey and O’Malley’s 5 steps.

Purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts. ‘Scoping reviews are iterative and flexible and can serve to examine the extent, range, and nature of research activity in a given field; to determine the value and appropriateness of undertaking a full systematic review; to summarize and disseminate research findings; and to identify research gaps in the existing literature’ (A Thomas)

6 data bases searched: to identify articles describing CETs in GME.

Noted evolution in definition of CE – they “defined clinician-educator as someone who possesses the competencies of direct teaching, curriculum development, mentorship and advising, leadership, assessment, and educational scholarship”

Inclusion criteria: GME learners (residents/fellows);  longitudinal (series of experiences over time). ;  primary aim of developing trainees into clinician-educators (CEs); address at least one CE core competency (direct teaching, curriculum development, mentorship/advising, leadership, assessment, educational scholarship).

Used the help of a librarian.

1,434 articles identified, after screening abstracts, and eligibility check of a few full text,  19 were included, (18 separate CETs)

For selected articles authors looked at structure, admission process, content and outcomes. (Kirkpatrick levels per the Best Evidence in Medical Education coding sheet )

Key Outcomes

301 studies found – after exclusion 19 remained – 6 US, 4 Canadian, 9 Australian
Methods – surveys, program record review, program evaluations
Mean adjusted MERSQI = 11.95
~half examined impact of rural placements influence on subsequent practice – pooled OR 3.03:
Characteristics of placements vary widely, however longer experiences had more likely positive outcomes.
There was an ‘interplay between 3 factors: rural origin, rural rotations, intent to practice rurally’.

Key Conclusions

The authors highlight the paucity of outcomes data and areas for potential standardization and future research.

Spare Keys – other take home points for clinician educators

Did not apply MERSQI scores
Only US-based data… why?

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