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Reflections from the Liminal Space: Clinician, Teacher, Scholar

By X. Catherine Tong (XC_TongMD)

As a fellow of the Royal College Clinician Educator Program at McMaster University, and a mid-career community emergency physician based in Kitchener-Waterloo, I sometimes wonder what attracts me to these vastly different roles.  In some ways the work cannot be any more different.  In the world of emergency medicine (EM) we embrace chaos.  We descend with our patients into the depth of their fear, pain, and sometimes their worst days.  We get our hands dirty.  We treat anyone for anything, any time. In the world of health professional education we carefully choose our topics of interest.  We meet during civilized hours.  We listen, we talk, we read, we research, and we write about those topics, removed from the context of human suffering. 

But long before I gazed into this theoretical and scholarly world of education, I have lived in the transitional world of clinical teaching.  EM work lends itself well to teaching activities. Learners find EM a rich context for application of concepts and skills.  Teaching activities are integrated into the practice of many EM physicians. Indeed, there is a body of literature on the expertise of EM physicians in clinical teaching1,2,3. After four years of medical school, three years of residency, and two certification exams, I began my practice as an EM physician.  Within a few months, based on no formal training or demonstration of teaching skills, students and residents started to work under my supervision, and I started my practice as a clinical teacher.

And now, two years into the Clinician Educator fellowship program, it is clear to me that compared to clinician teachers, clinician educators have a related but expanded scope of practice.  On the establishment of this fellowship program, Frank et al wrote “perhaps the primary distinguishing characteristic of a clinician-educator is that they produce scholarship related to their educational activities”4.

Boyer5 proposed that there are four types of scholarship:

While the first three types of scholarship are intuitive to clinicians from their experience with consumption and creation of clinical scholarship, the scholarship of teaching, is less intuitive5. Shulman defined the scholarship of teaching as “work that must be made public, that is subject to peer review, and can be reproduced and built on by other scholars”6.

Glassick5 conducted an analysis on the standard of excellence in scholarship, namely:

The challenge for the clinician educator, then, is to produce scholarly work in teaching that is planned with clear goals, conducted after adequate preparation, using appropriate methods, and presented effectively.  Such endeavour and expertise do not come intuitively from knowing how to resuscitate critically ill patients or staying current with stroke guidelines.  They do not come naturally from teaching a student how to do a lumbar puncture or the approach to hyperkalemia.  They come from formal training in medical education, like the Clinician Educator Fellowship Program.  And yet, the purpose of the work stays the same: to the benefit of our learners, and ultimately, our patients.  As I learn the theories, language and methods of scholarship of teaching, I look forward to making a significant impact to the worlds of clinical teaching and patient care through a new lens.

References

  1. Sherbino J, van Melle E, Bandiera G, et al. Education scholarship in emergency medicine part 1: innovating and improving teaching and learning. Can J E. 2014;15(Suppl 1):S1-S5. doi:10.2310/8000.2014.141454.
  2. Bandiera G, Lee S, Tiberius R. Creating effective learning in today’s emergency departments: How accomplished teachers get it done. Ann Emerg Med. 2005;45(3):253-261. doi:10.1016/j.annemergmed.2004.08.007.
  3. Bhanji F, Cheng A, Frank JR, Sherbino J. Education scholarship in emergency medicine part 3: a “how-to” guide. CJEM. 2014;16(S1):S13-S18. doi:10.1017/S148180350000316X.
  4. Sherbino J, Snell L, Dath D, Dojeiji S, Abbott C, Frank JR. A national clinician-educator program: a model of an effective community of practice. Med Educ Online. 2010;15(September). doi:10.3402/meo.v15i0.5356.
  5. Charles E. Glassick. Boyer’s Expanded Definitions of Scholarship, the Standards for Assessing Scholarship, and the Elusiveness of the Scholarship of Teaching. Acad Med. 2000;75(9):877-880.
  6. Shulman L. The Scholarship of Teaching. Change. 1999;31(5):11.

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About the author: X. Catherine Tong, MD CCFP(EM), FCFP, DRCPSC (candidate) is a Assistant Clinical Professor in the Dept. of Family Medicine at McMaster University

Photo via the Royal College Resident as Role Model resource

The views and opinions expressed in this post are those of the author(s) and do not necessarily reflect the official policy or position of The Royal College of Physicians and Surgeons of Canada. For more details on our site disclaimers, please see our ‘About’ page

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