Valuing Undervalued Anesthesiology Teachers
Alan Jay Schwartz, MD, MSEd, Justin L Lockman, MD, MSEd, and Aditee P Ambardekar, MD, MSEd
The summer issue of the International Anesthesiology Clinics (volume 62 (3) 2024) is devoted to medical education. We on the PAAD’s executive council are fortunate to have 3 members who have devoted their professional lives to education. I’ve asked them to review this issue of the Clinics and pick articles to review for the PAAD. Myron Yaster MD
Original article
Kinney DA, Gaiser R. Faculty as Teachers: Career Development for the Clinician-Educator. Int Anesthesiol Clin. 2024 Jul 1;62(3):8-14. doi: 10.1097/AIA.0000000000000440. Epub 2024 May 13. PMID: 3873640.
Anesthesiologists who devote their professional activities to clinical care and teaching are undervalued! This cohort comprises a large percentage of university-affiliated anesthesiologists, in addition to many others. Grant funded research faculty, despite representing a much smaller cohort, have historically had an easier time gaining academic recognition – and the necessary time to do their work. This is influenced by researchers’ easily quantified peer-reviewed publications in high impact journals. In contrast, clinician educators largely do the “silent work” of teaching, keep the academic center running, fund the non-clinical time for their researcher colleagues.
Kinney and Gaiser, in “Faculty as Teachers: Career Development for the Clinician-Educator”,1 opine upon this very dilemma that clinician educators face: How to be successful in the academic arena when not conducting externally grant funded research. They explain that the 21st century ushered in the era of mutually opposing priorities; decreasing rates of grant funding, reliance upon clinically-generated revenue to sustain financially solvent departments, and ever-increasing mandated requirements when educating anesthesiologists. Anesthesiologists who are not grant funded are the backbone of revenue generation through their clinical work, and also shoulder most of the responsibility to educate our future specialists. Anesthesiologists who generate clinical revenue and focus on teaching enable their grant funded colleagues to gain needed time for academic pursuits, but sometimes to the detriment of their own career success and satisfaction.
Kinney and Gaiser’s article1 offers guidance for clinician teachers. They note that in 2022, the Accreditation Council for Graduate Medical Education (ACGME), in a joint effort with the Accreditation Council for Continuing Medical Education (ACCME), the Association of American Medical Colleges, and the American Association of Colleges of Osteopathic Medicine, published “milestones” (just as they have for pediatric anesthesiology and other fellows) for faculty clinician-educators.2,3
“The Clinician Educator Milestones provide a framework for assessment of educational skills of faculty members who teach residents and fellows. Faculty members can use these milestones for their own self-assessment as educators, or with a trusted peer to provide feedback and assessment. The goal of these milestones is to provide faculty members with tools to help them with lifelong growth and development as educators.”2,3
The clinician educator milestones define 5 competency domains (e.g., Diversity, Equity, and Inclusion in the Learning Environment) and a total of 19 specific competencies (e.g., Performance improvement and remediation) which, when developed, serve to facilitate self-improvement of teachers and as evidence to document educational expertise.3
As anyone familiar with the ACGME’s milestones may suspect, each of the 19 competencies is a complex rubric of information, including features of the 5 levels from novice to expert.3 The idea is that teachers should use the milestones to support personal professional growth, to target professional development, and to assure the best education of their students. This is perhaps the first universal rubric against which all clinician educators, no matter the specialty, can be assessed. Academic promotion committees should employ data that quantifies a teacher’s achievement of the competencies from these milestones to guide promotion decisions.
We suspect many readers of PAAD are asking, “How does this apply to me if I’m not a clinician educator or even in academia at all?” Our answer: “Everyone in medicine is a teacher!” Clearly this is true in academic centers, where even the 80% funded researcher still spends 20% of their time teaching (a percentage which, we note, is still higher than that required by many other university professors.)
But being a teacher is also true outside of academia! In private practice, aren’t physicians always teaching patients and families about the planned care? About post-op care? Do we not teach our surgeons enough anesthesia that they can become allies in the OR? Same with the OR staff? Do we not constantly teach PACU staff what is normal and abnormal after a nerve block, or with a deep extubation, or how to recognize laryngospasm? We go back to what we have each said 1000 times before: the word doctor literally translates to teacher [Docēre, Latin verb, “to teach”] – and for good reason! Teachers, through all their professional actions, enable all categories of “others” to acquire knowledge, clinical competences, and professional values. At the heart of what we do as physicians is teach our patients, their families, our team members, and (for some of us) future physicians.
Curiously, most practicing physicians have little to no formal training or insight into the theory, methods, and practical aspects of being an effective teacher. Our students, on the other hand, have insight and easily characterize traits that embody effective teachers through providing feedback evaluations of their tutors.4-7 The characteristics students regularly cite when identifying effective teachers include:
a) “…supporting and explaining clinical decision-making
b) making teaching in the operating room a priority
c) maintaining a balance between supervision and autonomy
d) providing clear, constructive, and developmental feedback...”4
and
e) serve as a role model and transfer the teaching responsibility to our current students5
f)
We strongly recommend that you review table 5 from Haydar et al4 to grasp the summary of key recommendations based on above- and below-average evaluations by students.
These recommendations suggest that:
“It is not just about teaching the content of anesthesiology. It is about the process of the teaching that assures the learning.”7
We recommend that all PAAD readers learn from the references cited. We believe Kinney and Gaiser1 have set the stage for academics to learn about teaching and the principles they reviewed are the fundamental building blocks for all anesthesiologists to become more effective teachers. And we hope that academic departments and institutions will continue to value the many important roles that clinician educators play throughout our medical centers and beyond.
What do you think? Email Myron at Myasterster@gmail.com and he will post your thoughts in a Friday Reader Response.
References
1. Kinney DA, Gaiser R. Faculty as Teachers: Career Development for the Clinician-Educator. International anesthesiology clinics 2024;62(3):8-14. (In eng). DOI: 10.1097/aia.0000000000000440.
2. Accreditation Council for Graduate Medical Education (ACGME). Clinician educator milestones. (https://www.acgme.org/milestones/resources/clinician-educator-milestones/).
3. Accreditation Council for Graduate Medical Education (ACGME). The clinician educator milestone project. (https://www.acgme.org/globalassets/pdfs/milestones/standalone/2022/clinicianeducatormilestones.pdf).
4. Haydar B, Charnin J, Voepel-Lewis T, Baker K. Resident characterization of better-than- and worse-than-average clinical teaching. Anesthesiology 2014;120(1):120-8. (In eng). DOI: 10.1097/ALN.0b013e31829b34bd.
5. Mattern WD, Weinholtz D, Friedman CP. The attending physician as teacher. The New England journal of medicine 1983;308(19):1129-32. (In eng). DOI: 10.1056/nejm198305123081904.
6. Baker K. Clinical teaching improves with resident evaluation and feedback. Anesthesiology 2010;113(3):693-703. (In eng). DOI: 10.1097/ALN.0b013e3181eaacf4.
7. Ambardekar AP, Wortham S, Schwartz AJ. The right ingredients: essential if you want to bake the cake right! Anesthesiology 2014;120(1):22-3. (In eng). DOI: 10.1097/ALN.0b013e31829b3500.