SGIM Forum

Medical Education: Part I

The Medical Education Liaison: Improving Learner and Faculty Experiences in the Ambulatory Setting

Dr. Ruff (alliruff@med.umich.edu) is a clinical associate professor and medical education liaison for the Division of General Medicine, Department of Internal Medicine, the University of Michigan. Dr. James (jamesca@med.umich.edu) is a clinical assistant professor of internal medicine, pediatrics and learning health sciences, University of Michigan. Dr. Kerr (ekerr@med.umich.edu) is professor and division chief in the Division of General Medicine, Department of Internal Medicine, at the University of Michigan, and research scientist at the Center for Clinical Management Research, VA Ann Arbor Healthcare System—both in Ann Arbor, MI.

Academic general medicine physicians frequently enter practice aspiring for participation in medical education for personal and professional fulfillment, but often experience barriers to incorporating meaningful teaching in their careers. Frequently, these faculty have competing interests focusing on clinical productivity and other non-teaching roles.1 Some hesitate to engage in teaching because of limited formal training.2 Many report a lack of familiarity with proven strategies to maintain efficiency and productivity while instructing learners.3 Others have difficulty identifying teaching opportunities. Additionally, the COVID-19 pandemic, and virtual care, have created deterrents to taking on teaching responsibilities as clinicians seek stability in their clinical practice and personal lives.

The ambulatory general medicine experience remains a key component of undergraduate (UME) and graduate medical education (GME), as ambulatory learning experiences are required by the Accreditation Council for Graduate Medical Education and Liaison Committee on Medical Education. Therefore, the recruitment and development of teaching faculty is key to maintaining both professional satisfaction of faculty and the long-term viability of learners’ ambulatory general medicine experience. We present a novel approach—the medical education liaison (MEL) to support academic general internists in becoming effective and committed educators who improve the educational experiences of medical students and residents in an ambulatory setting. Two authors (AR and CJ) have served in this role for the past four years, and one (EK) has served as division chief in support of the MEL program.

Competing Priorities Detract from the Education Mission

You are a mid-career General Internist at your University position for the past six years. After residency, you wanted to be an educator, but felt it was important to establish your clinical practice first. You want to get involved in clinical education, but don’t know where to begin. Resident precepting is popular with your colleagues within the division, but you question your ability to effectively teach advanced learners. You’d love to teach medical students, but do not know how to connect with medical school programs and worry students will cause you to run behind in clinic.

The role of the Academic Medical Center has typically been defined by the tripartite mission: patient care, research, and education. Academic physicians subscribe varying amounts of time to this mission, with most physicians in academic General Internal Medicine (GIM) pursuing a clinician educator career path.4 Faculty may be further differentiated into “BIG C” and “BIG E” clinician educators: “BIG C” clinician educators see a high volume of patients while also teaching and mentoring learners. These faculty do not typically receive protected clinical effort to pursue training to improve teaching skills, or scholarly activity. “BIG E” clinician educators often lead educational programs or curricula, and actively participate in scholarly activity, including education research.4

Most GIM educators identify as “Big C” educators.   Sustaining a productive clinical practice, while simultaneously teaching in the clinic, challenges those desiring to continue down the clinician educator path. Unfortunately, many talented GIM educators stop teaching in the clinic because of the perceived unequal tradeoff between pursuing their passion for medical education and maintaining clinical productivity. This may leave learners with sub-optimal GIM clinical experiences, or worse, no GIM experience at all. Therefore, GIM division leaders must intentionally support faculty committed to the integral role of educating the next generation of physicians in van ambulatory setting.

Navigating the education landscape at a large academic institution can be daunting. Physicians may find it challenging to simultaneously keep up with medical advances affecting their practice and local and national policies and procedures at the UME and GME levels—this is especially true for “BIG C” clinician educators. Accentuating this knowledge gap, medical students and house officers often receive most of their clinical training in hospitals which are physically detached from the community-based clinics housing many GIM faculty. These are but a few factors contributing to the communication gap between academic GIM physicians and training programs. Similarly, medical school leadership, residency program leadership, and department vice chairs of education may lack understanding of both the unique circumstances at each GIM ambulatory site and the specific faculty development needs. The MEL can serve as a navigator to facilitate the development of “Big C” educators.

The Role of the Medical Education Liaison

Your reach out to your MEL who facilitates connection with the clerkship coordinator. A student is placed in your clinical site and your MEL recommends a one-hour virtual workshop on giving feedback before you start. This gives you the confidence to start teaching more regularly.

To bridge the gap between GIM faculty and local education leadership, the University of Michigan (U-M) division of general medicine developed the MEL position in 2018. The MEL ensures that the teaching and learning experiences of faculty and learners in GIM clinics are mutually rewarding, while also providing efficient and effective patient care. To this end, specific characteristics are essential for the success of an MEL. Ideally, an MEL should be a well-respected “BIG C” or “BIG E’’ clinician educator. This person should be well-connected and willing to engage regularly with leadership and staff at the UME and GME levels; therefore, excellent communication skills are essential. Specialized education training can be considered but is not essential. In addition, a MEL should be visible in educational roles in the division and respected clinically—a frontline medical educator and educational champion. Finally, MELs must be committed to diversity, equity, and inclusion to ensure that all faculty and learners feel welcomed and valued in GIM educational spaces.

U-Ms inaugural MELs were “BIG C” educators, selected to oversee GIM faculty interactions with learners and the development of the MEL role. These opportunities have influenced the careers of the inaugural MELs to become “BIG E” educators, and this role may serve as a steppingstone for other junior faculty interested in this trajectory.

In addition to serving as a link between GIM faculty and local medical education leadership, MELs facilitate education-based faculty development. For example, the U-M MELs have led conferences teaching faculty to provide effective feedback, write teaching scripts, and use precepting models. Other important contributions of MELs include maintaining a division medical education website (featuring latest medical education news, policies, and procedures, a repository of relevant medical education literature, and other useful medical education resources), recruitment of new faculty, developing scheduling templates for teaching, and identification and notification of teaching opportunities for faculty.

The MEL program has had measurable results—MELs were instrumental in securing a financial incentive for GIM faculty hosting medical students in their clinic. This departmental commitment demonstrates an appreciation for the valuable efforts of GIM clinician educators. Additionally, since beginning the MEL program, the number of faculty teaching medical students in clinic has increased, as has the number of clinical sites accepting learners for teaching. At U-M, a close working relationship with the Internal Medicine residency program allowed our MELs to play an active role in establishing a new continuity clinic site, introducing new opportunities for both faculty and resident learners.

To ensure the success of MELs, they must receive support from their division. At U-M, the MEL is a part of the divisional leadership structure. This not only increases the credibility of the MEL but also highlights the emphasis that the division places on education. MELs receive protected time for their role.

Conclusion

The MEL program gives attention to the unique needs of GIM faculty and ensures optimal educational experiences for learners in GIM clinics. While more study is needed into diversity and inclusivity in teaching as well as faculty experiences, codifying MEL programs for clinical educators in GIM can expand opportunities for quality ambulatory general medicine education for learners, encourage learner interest in primary care fields, and nurture the educational interests, professional development, and satisfaction of GIM faculty.

References

  1. Fazio SB, Chheda S, Hingle S, et al. The challenges of teaching ambulatory internal medicine: Faculty recruitment, retention, and development: An AAIM/SGIM position paper. Am J Med. 2017;130(1):105-110. doi:10.1016/j.amjmed.2016.09.0042.
  2. Steinert Y, Mann K, Centeno A, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach. 2006;28(6):497-526. doi:10.1080/01421590600902976.
  3. Chung MK. Tuning up your patient schedule. Fam Pract Manag. 2002;9(1):41-45.
  4. Chang A, Schwartz BS, Harleman E, et al. Guiding academic clinician educators at research-intensive institutions: A framework for chairs, chiefs, and mentors. J Gen Intern Med. 2021;36(10):3113-3121. doi:10.1007/s11606-021-06713-9.

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