Medical Education: Part II
Educating beyond Training: Structure and Tools to Support Faculty Development and Lifelong Learning
Matthew Sakumoto, MD; Andrew Dunn, MPH, MD, MACP, SFHM, FRCP
Dr. Sakumoto (email@example.com ) is a virtualist primary care physician and assistant clinical professor at UCSF and co-leads the Medical Education Work Group of the Hospital Medicine Reengineering Network (HOMERuN). Dr. Dunn (firstname.lastname@example.org ) is the chief of the Division of Hospital Medicine at Mount Sinai Health System in New York.
Medical education extends beyond medical school, residency, and fellowship, and encompasses learning throughout a physician’s career. General Internal Medicine faculty need multiple drivers to support lifelong learning beyond the formal educational stage of their career. First, physicians who are not advancing their knowledge are falling behind; medical discovery and innovation requires physicians to remain current on the newest advances. Second, physicians who may become leaders need to use their knowledge and be skilled at applying it. Third, faculty can only become and remain outstanding educators by developing their own clinical and teaching skills. Lastly, faculty members who have a sense of confidence and expertise are less likely to develop burnout and more likely to find long-term career satisfaction. Despite the importance, faculty development typically does not receive similar emphasis as the education of students and trainees, and often lacks the same level of evaluation rigor as undergraduate or graduate medical educational programs.1
Start with Structure
In a recent focus group with hospital medicine leaders, we found that many centers do not provide a formal faculty development program or only provide a brief onboarding session or hodgepodge of lectures. The lack of fully developed programs stems from a lack of evidence of specific interventions or frameworks. Our recommendation is to start early with an onboarding checklist that sets the tone of development and support immediately; your department or division can use this chance to make a great first impression.
The benefit of an onboarding checklist is that it literally gets everyone on the same page. As stated in The Checklist Manifesto, “The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”2 For example, at the Mount Sinai Division of Hospital Medicine, the checklist includes elements related to clinical service logistics (e.g., how to assign new patients, how to bill) and the essentials of leading a teaching team and working with advanced practice providers (APPs) such as nurse practitioners or physician assistants. The number of items is a main hurdle to full understanding, as there are competing needs to be comprehensive and to be comprehensible.
A structured time for delivery, preferably by an experienced faculty member, is important. Getting new faculty members off on the right foot can also be facilitated by an “Early Start” system. This approach allows new faculty to pair with an attending on-service and be assigned a portion of their patients prior to their first full clinical week. Sharing a service for several days allows time for review of the checklist and hands-on learning of key facets of the service.
Competency-based Faculty Development
The authors recommend a move toward competency-based faculty development. By developing and adopting competencies and milestones in faculty development, our field can use a shared language to identify and disseminate best practices in faculty development. For example, Ripley, et al, in “A competency-based approach to faculty development” identify five key areas of competency, including Teach, Discovery (including research), Service (both clinical service as well as academic contributions), Advancement, and Leadership.3 A multi-faceted faculty development program will address each of these domains.
The lack of established tools is daunting for practice leaders but allows freedom to innovate and adapt concepts for local settings. In the authors’ experience, tools that have been developed, implemented, and found to be valuable, include the following:
Faculty development lecture series (Teach, Discovery, Service, Advancement, Leadership). A faculty development lecture series entails topics essential to early success. This can include a range of topics like billing and coding, patient satisfaction, teaching at the bedside, providing feedback to learners, working with NPs and PAs, steps towards career advancement and promotion, and other sessions crucial for local success.
Works-in-Progress (WIP) sessions (Discovery, Advancement). WIP sessions allow one or more faculty to discuss their work in an informal setting. This provides feedback to the faculty member plus allows the entire faculty to gain ideas on their own work. WIP sessions can afford opportunities for the “big tent” of hospital medicine activities, such as developing a new clinical program, a quality improvement (QI) project, research, or a new educational curriculum.
External conference and courses (Teach, Discovery, Advancement, Leadership). Practice leaders need to be selective when determining whether they can provide funding for a faculty member to attend a conference. The key determinant is often whether the conference will or can help shape their career path or will increase skills applicable to their career path. For example, a hospitalist with an interest in medical education can be supported to attend SHM’s Quality & Safety Educators’ Academy or a faculty member interested in medical consult may benefit from attending a conference on perioperative medicine.
Mentorship program (Service, Advancement). A practice leader (e.g., division chief or chair) is a de facto mentor for every member of their faculty. This is insufficient in most large groups. Motivated faculty often find organic mentors in areas in which they have an interest, such as a more senior colleague who leads a medical school course and needs someone to precept students in small group learning. Organic mentorship is an essential component of faculty growth. However, other faculty may need more encouragement in reaching out to colleagues. A structured mentorship program provides a foundation with specific roles and expectations for every group member. A structured mentorship program pairs faculty with a more senior physician (within or external to the hospitalist group) and sets baseline expectations. These may include meeting regularly (e.g., quarterly) and providing a range of possible topics, such tips on their career advancement, enhancing or problem-solving for their current project, addressing potential burnout, and facilitating connections to other faculty. It is also important to note that a mentorship program does not stop with junior faculty; even mentors need mentors. In addition to the primary mentor, identifying a roster of auxiliary mentors (QI mentor, clinical teacher, research grants mentor) can provide additional avenues to mix-and-match mentor roles and provide a personalized team approach for each mentee.
Peer observation (Teach). Given the pace of academic medicine, most physicians do not reflect and assess their educational skills. A line from Robert Burns’ poem, To a Louse, laments our inability to understand how we are perceived by others: “Oh the gift that God could give us to see ourselves as others see us.” Peer observation can help address this deficiency by pairing group members and having each assess the other. This is most used in an educational setting, such as leading teaching rounds, though it can also be applied to observation of patient care. Essential elements are to ensure the burden is minimal, such as requiring only one observation per year, and focusing on formative feedback. A structured assessment tool can be used to promote a constructive approach and ensure key behaviors are assessed in a standardized manner.
Faculty development forms a strong foundation for all medical education endeavors. Energy and attention spent growing your educators, your researchers, and your leaders are an investment in a formidable education infrastructure that learners of all stages will tap into. Creating formal programs with structure and tools will provide a visible cue to the faculty of the dedication to their success and a culture of lifelong learning.
Leslie K, Baker L, Egan-Lee E, et al. Advancing faculty development in medical education: A systematic review. Acad Med. 2013;88(7):1038-1045. doi:10.1097/ACM.0b013e318294fd29.
Gawande A. The Checklist Manifesto: How to Get Things Right. Metropolitan Books; 2009.
Ripley B, Bailey J, Warren K, et al. A competency-based approach to faculty development. Int Conf Resid Dev. https://scholarscompass.vcu.edu/medicine_dean_pubs/2/ . Published January 1, 2019. Accessed October 15, 2022.