By Riccardo Bianchi PhD, Sophia Lin MD, Jeanne MacLeod MD, Kristine Prince DNP, and Kelly Roszcynialski MD (@KRoszczynialski)
Editor’s note: This piece was written by three members of the ALiEM Faculty Incubator program (2020-2021 cohort). Read more about the program here.
In academic medicine, there are three cornerstones of responsibilities beyond clinical work: teaching, service and scholarship. This is in contrast to community-based medicine in which the primary focus is on clinical service and patient care with some administrative obligations and scholarship activities directed at maintaining knowledge and skills. Traditionally, the main branch point for deciding between an academic practice and a community-based practice occurs when a physician is completing formal training, but there are several other entry points for a physician to enter academic medicine. A physician may also make this transition after time spent working in a community-based hospital or private practice setting. Additionally, a medical student may begin preparation for a career in academic medicine even before beginning residency. From the perspectives of a medical student, graduating fellow, and community physician, we present three cases illustrating the challenges of transitioning to academic medicine and provide tips for successfully approaching the three non-clinical tenets of academic medicine: teaching, service and scholarship.
Case 1: Teaching, New Faculty
After being hired as a clinician educator at a new institution just out of fellowship, Dr. M is excited to embark on the start of an academic career. Within the first month, she is asked to help with the resident conference simulation day. Dr. M plans the conference with other faculty and residents and debriefs a session. For the next several months she pitches in when asked and teaches both resident and medical student simulations. She draws on her experiences participating in simulation sessions as a resident and teaching these sessions as a fellow, effectively reproducing what was done at her residency program. As her first year as an attending progresses, Dr. M feels increasingly stretched between her clinical load and educational efforts. This feeling is exacerbated by the challenges of adjusting to a new institution and her new role as an attending physician. Halfway through her first year, Dr. M meets with her chair who asks her about her two-year plan. This prompts Dr. M to realize she has participated in educational activities at her new institution without seeking to improve or innovate. Instead, she has been using curricula and approaches from her own training to contribute when needed. She feels she is constantly reacting rather than anticipating and planning.
Coming out of residency and fellowship, conference lectures, clinical pearls and simulation sessions are not foreign as all are integral components of medical education. In transitioning from trainee to educator, it is tempting to replicate what was done at one’s own residency or fellowship since it is what is best-known. However, just teaching is not enough. Iterative evaluation and improvement of educational efforts lead to innovation and more effective teaching. This along with course or curriculum directorship and development are important aspects of developing your teaching portfolio in academic medicine.
Teaching is a primary bucket that must be filled as an academic physician. When developing your educational portfolio, go beyond helping when asked and giving multiple isolated lectures. Take an active role in program evaluation and improvement and innovate. Pursue increased responsibilities and seek opportunities to direct courses and develop curricula. Taking on leadership roles in educational activities not only enhances your academic promotion application, but it can also lead to improved satisfaction with your impact as a medical educator.
New Faculty Tip:
As a freshly-minted attending physician, the clinical work can be challenging as you adjust to your new role as a supervising physician and continue to hone your clinical skills. While you may have significantly less clinical service time compared to residency or fellowship, departmental administrative and teaching obligations outside of your patient care responsibilities create additional demands on your time and mental facilities. Balancing these competing demands can be difficult and it is important to schedule time for and appropriately prioritize your non-clinical responsibilities.
Case 2: Service, Medical Student
Nearing the completion of his third year in medical school, DN chooses emergency medicine as his specialty. Before medical school, DN worked as an inner city schoolteacher and obtained a master’s in public health. Because of these experiences, he is committed to integrating advocacy for underserved populations into his career. DN inquires about ways to do this at an emergency medicine interest group panel discussion about emergency medicine careers. An emergency medicine attending sitting on the panel meets DN and introduces him to a colleague who has formed a multi-disciplinary medical school committee aimed at developing a health equity and advocacy curriculum for the medical school. DN is the only student on the committee and soon co-founds a student organization focused on educating the school’s community about healthcare disparities. Through these activities, DN meets physicians from other specialties and institutions involved in health equity advocacy, education, and research.
At the beginning of his fourth year of medical school, DN joins emergency medicine physician professional organizations at both the national and state levels. He joins the equity and inclusion committee of his state’s academic emergency medicine organization and through this, he applies for medical student grant funding to attend a national leadership and advocacy conference. At the conference, DN attends seminars providing overviews of several key public health issues affecting emergency medicine physicians and essentials for effective advocacy. He also networks with like-minded physicians and trainees. One physician DN meets is from his state and serves as an editor for the state’s emergency physician organization’s newsletter. This physician invites DN to write a column for the newsletter describing legislation intended to increase affordable housing within the state and the potential impact this legislation may have on improving the health outcomes of patients without housing. DN writes the column and then begins residency at an out-of-state urban academic emergency department. There, he continues his committee work on health equity issues at both the state and national levels and is mentored by a faculty member he met through medical student committee work.
Service is another primary bucket that must be filled as an academic physician. Serving on committees at the institutional, regional, and national levels provides not only a way to contribute to your institution and specialty but also creates opportunities to network and build your connections. These connections help you develop your institutional, regional, and national reputation, which is an important factor when being considered for promotion. Additionally, service through committee work and involvement in professional organizations can add an extra dimension to your professional life and result in greater career satisfaction, especially when committee goals align with your interests. While serving on a committee at the institutional level is a valuable experience, consider joining committees at the regional and national levels to broaden your network and expand your presence in your field.
While it can be intimidating and overwhelming to engage in committee work as a medical student, doing so at this stage in your training is very beneficial. As most physicians serve on committees only once they have completed training, medical student committee members stand out, and oftentimes as the sole student member, they may be offered valuable mentorship and more opportunities for further involvement. As a result, this can help you explore potential areas of academic interest. Committee service as a medical student also helps you develop a foundation of skills in collaboration, time management, and balancing service with other work-related and personal life demands, all essential skills for a successful academic career in medicine. It is never too early to begin committee service and the sooner you start doing so, the sooner you develop this essential component of your academic career.
Case 3: Research/Scholarship, Community-based Physician
Since Dr. H’s emergency medicine clerkship at a large city hospital, he has wanted to care for patients from underserved communities. His experiences during residency cemented this ambition, and after residency, Dr. H accepts an attending physician position at a county hospital serving a large urban population. Dr. H focuses on patient care and finds working with the hospital’s patient population very rewarding. Outside of clinical work, he is involved in peer review and physician management activities at the hospital. He also finds teaching residents during shifts very satisfying, and his efforts are extremely well-received. Several years into his position at the county hospital, Dr. H is content with his work but wonders if an academic position would be even more fulfilling.
Dr. H begins seeking opportunities to engage in scholarly activity. He continues his clinical work, while also intensifying his administrative and educational roles. His interest in quality improvement and patient safety leads to collaboration with colleagues from the University Hospital. This collaboration results in two peer-reviewed publications on the use of ultrasound and CT in the management of acute abdominal pain in selected patient populations. Contributing to the field of emergency medicine by engaging in research is very gratifying for Dr. H, and he is eager to further develop this facet of his career. This prompts him to apply to be an Assistant Professor of Emergency Medicine at the University Hospital and he is hired. At the end of his last long workday of his first week in his new position, while reading a resident’s proposal for a study on patient safety, Dr. H reflects on his career path. He is thrilled to be at the University Hospital where he can continue to care for patients and teach while further developing his scholarly interests.
Research/scholarship is the final primary bucket that must be filled during an academic medical career. Ongoing participation in projects leading to quality, peer-reviewed publications and dissemination of scholarly work is paramount. You may join forces with others on multiple projects on different topics, but you should focus your efforts on one area to develop an academic niche and become a nationally or internationally recognized expert in a clearly identifiable field of basic, translational, clinical, or educational research. Develop independent or collaborative research projects in which you have a central role, seek extramural funding and recruit learners to mentor as they contribute to your projects.
Community Practice Tip:
Traditional benchmarks of scholarly productivity – research grants and publications – can be challenging to achieve in a hospital-based practice. Seek collaborations with research groups at academic centers and aim to become a co-author of at least one peer-reviewed article. If you are involved in hospital quality improvement and patient safety, produce scholarly work from these experiences. Pursue medical education research or education innovation projects at your institution. Prepare for entry into academic research by participating in large team collaborations, research training courses, virtual communities of practice, and non-traditional forms of scholarship such as blogs and podcasts. Finally, find mentors who will help you develop your skills in reflective in-depth analysis.
The cases above show several pathways of opportunity for transitioning into academics within medicine. The cases also highlight the three non-clinical primary buckets that must be filled in academic medicine. It is important when transitioning to assess your background and understand the requirements needed for successful academic professional development. This foundation of knowledge and cognizance prepares you for progress and advancement in the academic world. While transitioning, it is also critical to be proactive and thoroughly search for all areas of opportunity. Ensuring that all non-clinical efforts result in recognized, tangible products is equally important for academic promotion. Understanding and implementing the recommendations described above will assist you in navigating a successful career in academic medicine.
Image via Wikimedia Commons
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