Shreya: Hi guys, this is Shreya. Before we get started I have a very, very brief personal plug. So Adam Rodman and I are co-directors of IMED, an initiative started at Beth Israel Deaconess medical center dedicated to studying and re-envisioning digital education. We are having our very first national meeting on January 22nd. It is of course going to be a virtual CME conference and we would love to see you there. Great lineup of speakers….and many more. There’s going to be a link in the show notes where you can sign up. We hope its going to be a day that inspires to continue positively shape our virtual learning communities. And with that, let’s start the episode.
Rahul: Hi, I’m Rahul Maheshwari. I am halfway into my third year of my residency and I’ve found that I really enjoy teaching. I’m at the tail end of my fellowship interviews (I’m applying to Nephrology btw), I’ve started thinking about how to also develop a career in medical education. I’m reminded of all the role models I’ve seen over the last 8 years – educators and leaders who’ve guided me and I wonder about how they got there, how they made careers in this ever-changing field of education, and what kind of tips they would offer to somebody like me who’s just getting started.
Welcome to the second installment of Core IM’s series with the American College of Physicians on career paths. Today we’ll be talking about MedEd. Let’s get right into it.
Kimberly Manning: I thought that being a clinician educator looked a certain way. I thought it looked like the people who stood in front of the room…
Rahul: That’s doctor Kimberly Manning. She’s currently a hospitalist and professor of medicine at Emory University.
Kimberly Manning: …old white men who seemed to have, um, an endless fund of knowledge, right. And so that did not look like…I did not see myself in that. And so here were the students saying to me that I had had this tremendous impact on them.
Rahul: She was telling me how she got into med ed in the first place. She had just been inducted honorarily into AOA, At that time, she was still a resident, and she really didn’t think of herself as one of those people she describes who stand at the front of the room. It was at the ceremony where the students who nominated her spoke about why they chose her.
Kimberly Manning: …and the last thing the student who was speaking said was, she looked me in the eye and she said, I do not know what you are going to do in the future, but whatever it is, it should involve medical students and learners. And I was like wow…and that was the day that I said, well shoot maybe I should do something where I’m around learners, so that following year I did a Chief residency. And it was an awakening.
Rahul: It was only at the end of her chief year that it dawned on her. She was going to pursue a career in MedEd.
Kimberly Manning: I want to be with medical students, I want to be with residents. And even then, I didn’t know what medical education looked like. I just sort of knew that I would go to a job where there were residents and medical students around affiliated with a hospital and I would sort of show up and…teach? Haha. And that’s about all I knew in 2001 when I started my first job.
Rahul: Listening to her just try to figure it out herself just goes to show the ambiguous nature of medical education. It can kind of be unsettling for those who are just getting started in it.
Grace Huang: MedEd is such a huge heterogeneous field.
Rahul: We’ll let our second expert introduce herself.
Grace Huang: Hi, my name is Grace Huang. I’m a hospitalist at Beth Israel Deaconess and an associate professor at Harvard Medical School. My passion is career development.
Rahul: And she’s also editor in chief of MedEdPortal, a journal that publishes educational resources.
Grace Huang: You know the first thing I would say is looking at other people you assume that they got there on a very linear, deliberate path. And I find that most people had a very circuitous route to where they are. And a lot of that was related to being there in the right time or serendipity or just sheer luck.
Rahul: And Dr. Huang’s own career seems to have started in a similar way – serendipitously.
Grace Huang: I noticed that I was really opinionated about surveys. I always found something to critique about them whenever I was doing a survey.
Rahul: And she found that there were always educational projects that needed help with survey design.
Grace Huang: …maybe I should study about survey design and think about survey science. How does one word questions and figure out what scales to use.
Rahul: And so she followed her curiosity, and embarked on a self-study, acquiring skills that became quite useful to other people.
Grace Huang: And that allowed me to build a very particular niche in survey design that became the reason why I was invited to give talks. And that led to a multitude of opportunities. And so in a way I would have never anticipated I became the local survey person. And that parlayed into multi-institution opportunities.
Rahul: I think a lot about these serendipitous experiences – how Dr. Manning pursued med ed seriously only after her own student identified it for her, and how Dr. Huang somehow got into this through survey design. In some ways, medical training is so regimented and linear (with medical school… residency… fellowship), it feels so foreign to not have a specific plan and just go with whatever comes your way.
Grace Huang: I would say that’s still true, that I don’t have a five year plan. And it’s totally okay to be kind of pushed along by the current, as long as you recognize the current isn’t headed towards the rocks.
Rahul: Now that we’ve met our discussants Dr. Manning and Dr. Huang, I asked them for advice on careers in medical education. And they gave us 4 main tips to focus on. First, where do we start? Let’s say we trust ourselves enough to know that we’re not “heading towards the rocks”, as Dr. Huang put it. Aside from just staying afloat through currents, how do we get started in such a broad field?
1) It’s okay to start out broad
Kimberly Manning: When I first joined faculty, I just wanted people to like me. And, so people would ask me to do things and I would say yes to everything because I was so flattered. But then I came some time came along where I started to realize that it is actually okay for me to start to curate my own interests.
Rahul: Dr. Manning speaks to a common situation we’ve all found ourselves in – to get our foot in the door, we usually take whatever opportunities come our way, and then eventually narrow over time. But there can be one huge pitfall during this initial development stage…
Grace Huang: I actually think about not following through as one of those career killers, probably too harsh a term. I have personal stories of not following through on things. But I think what becomes dangerous is getting a reputation within your institution as one of those people who doesn’t follow through. You have to take reliability to the next level. If you’ve been delegated a task, being somebody who routinely is known as a doer is probably in my mind one of the predictors of success.
Rahul: I’ve definitely been in positions of taking up projects — to get a seat at that table And I’ve also seen where dropping the ball has set me back. But there is only so much time in a day – how do you prioritize what you follow through on? What tasks are higher stakes than others?
Grace Huang: So it might be a lit review or it might be go meet with this person. Those are the kinds of things that can be seen so visibly and so publicly that they have to be followed up.
Rahul: And other things that come up in meetings are more nebulous.
Grace Huang: Like oh yeah think a little bit more about this project. I think people can understand if that doesn’t go through because it’s a lot more vague.
Rahul: So far we’ve talked about how medical education is a heterogeneous field and how our two discussants serendipitously started their careers; we’ve learned that it’s OK to be taken up by the currents, and to say yes to opportunities that come up so long as you can follow through. But I feel like I can see myself being excited and carried away about so many different things – I asked if there was a framework that can help filter these opportunities… a sort of guiding North Star. This leads us to Tip #2 – the Educational Mission Statement.
2) Creating a MedEd Mission Statement
Grace Huang: Some of this is around the concept of defining an educational mission statement for yourself. It allows you to have a lens through which to decide about opportunities that come your way.
Rahul: So how do we create one? Dr. Huang gives us three steps to doing so. And it’s fairly straightforward – you do it by asking yourself a series of questions. First, what drives you?
Grace Huang: What topic or topics are you passionate about? And you’ll often find that theres no rational reason why people are passionate about certain things. Sometimes it is driven by personal experience, like patient or a family member. But sometimes it’s just like I’m fascinated by NOACs.
Rahul: kind of like how Dr. Huang loves survey design.
Grace Huang: And then starting to think about the learner group that you want love to spend time with.
Rahul: And thats the second question – who do I wanna teach?
Grace Huang: What learner group do I like to hang out with most? Students as learners bring their own energy and curiosity. Residents as well have a different flavor. And the third thing is what are the outcomes I care most about?
Rahul: And this is the last question you have ask yourself.
Grace Huang: For people that are interested in clinical topics, it may be that they wanna see x. Or if you’re interested in a topic in medical education like health disparities or about wellness, what outcome am I driven for? And these are essentially the three ingredients for an educational mission statement.
Rahul: This whole concept is so useful. You can use it as a filter through which you pass all these opportunities.
Grace Huang: For instance, lets say someone invites you to be on a committee, you wanna pass it through your educational mission statement and decide is that something thats gonna align with my mission or north star. That helps you decide whether that is a yes or no.
Rahul: And this whole thing kind of reads like your personal problem representation or a PICO statement Of course, there are times when an opportunity might come your way that was not a part of your mission and ends up being quite meaningful… but having this North Star can help guide us. And so just in case you missed it, here it is one more time.
Grace Huang: These are essentially the three ingredients: One is what I wanna do is teach about this topic. The second piece is to this learner group… and the third piece is so that I can enact this kind of outcome or success. So thats one way I sort of help people think about finding a niche, finding some focus to all the things you can do in academic medicine.
3) Mentors, Coaches, and Sponsors
Rahul: I think the challenge is, how do I even get those opportunities in the first place? And once I get an opportunity, how do I make sure I do a good job? This leads us to Tip #3 – The importance of coaches, mentors, and sponsors. Dr. Manning breaks it down in a way that I’ve just never heard before.
Kimberly Manning: I’m gonna break it down for you Rahul. All right. So here’s how I think of it. So I would like to, um, be an MC and I would like to, um, to rap, right? And so a mentor comes along and says, Hey, I am going to help you become a rapper. This person has rapped before this person has, you know, a few CDs out. And they helped me with my cadence. They talked to me about, you know, my ciphers and my bars and, and how to, you know, how the rhythms should go. And they work with me and I start to develop something. Now, maybe that person is also like looking after several other fledgling rappers like me. So then I get connected to a coach who is the person who gets in the booth with me. And as I’m rhyming, they are watching me rhyme. They say, run that back, do it again, run that back one more time. That was too slow. That was too fast. You weren’t on the beat. Um, and, and with practice, that person is watching you and giving you feedback. That’s your coach. And then the sponsor is the person who once you have cut your demo. They take your demo tape and they go hand it to the people that need to hear it so that you get signed. Because you need all of those things. So in medical education, what you’re going to need is I’m a need you to help me. If I say I want to be a, a medical educator and I break it down and say, I want to do undergraduate medical education. I want to teach physical diagnosis. This is just a conversation I had with a mentee recently. All right, cool. So then what do you need to do? What do we need to do? What do you know about teaching physical diagnosis, who is doing it at your institution already? What is the, what are the standards? Have you looked at the Stanford 25? What things do you know already? Right then after that, Hey, go somewhere and teach physical diagnosis and have a coach watch you and say the way you taught that was pretty good, but you could do this differently. That was a little complicated. That was a little long winded. And then you tell me, and I say, Oh, well, you know, what, who do I know around the country? Who does physical diagnosis, medical education for undergraduate medical education? Who can I reach out to, to put your name out there? So you can be on a presentation, a workshop, a paper, um, that’s really how it works. If I had known that when I first came out of residency, I mean, I would be so far ahead and not just far ahead, further ahead in, um, accomplishments, but in joy and fulfillment.
Rahul: I absolutely love this. I think we’re so used to using “mentors” as a catch all term, but I’m realizing we under appreciate the specific role of a coach … that person who’s in the booth with you. Dr. Manning gives an example of one of her own coaches, somebody who was pivotal in her teaching career.
Kimberly Manning: A man named Dr. Rick Blinkhorn, my chair of Internal Medicine. And he changed my life cause what, he changed my life through feedback, through carefully curated feedback. He taught me to think about who are my learners. He taught me if I aimed right to my learners, was I too high, was I too low, was I too self deprecating. Was I not clear? It was such a valuable thing I still do now.. when I have residents on service I give such explicit feedback… I’m like when you were teaching this you were talking to long and lost me.. for this you should have drawn out a picture.
4) Do I Need Formal Medical Education Training
Rahul: These stories go to show how important the informal day to day coaching can be. But what about formal training? – This leads us to Tip #4: Do you need formal training for a MedEd career? To answer that, thinking about what type of educator career you want – can help you think about what type of training you need. And so to take a quick detour – let’s talk about the different kinds of clinician educators.
Grace Huang: There’s obviously a lot of overlap in individuals MedEd careers. But, one way to think about it is that you can have an affinity for either innovation, leadership, and/or scholarship. For innovation, these are the individuals who love to take new ideas and figure out ways to deliver that content and roles where developing curricula and getting skills to develop curricula are well suited for them. Leaders have a desire to enact a vision. And lastly, there is a lucky category of individuals who love to measure things and think about things in a research mindset. It is important for those individuals to develop research skills to be fed with research skills and to put out the kind of original research that helps us understand the science of medical education.
Rahul: Thinking about which buckets speaks to you and your goals the most can help you decide if formal training makes sense for you. To be honest, it’s easy to get complacent and not go out of your way to further develop your skills. It’s especially hard since no one is requiring you.
Grace Huang: I would say that intuition in how to teach and how to assess is only going to get you so far. People do remarkably come organically with these teaching skills that are fantastic that I do feel like they hit a ceiling.
Rahul: The idea of potentially hItting a ceiling really requires some self-awareness. Clinical educators have to not only focus on who they’re teaching, but also recognize if they need to enhance their own skill set, and if that needs to be through formal training. One of the more accessible of these, are professional or faculty development programs at your own institution. For example, for Dr. Kimberly Manning that was through a local Woodruff leadership Academy.
Kimberly Manning: Things like how to give feedback, um, you know, how to build a curriculum, how to do grand rounds and how to prepare your slides… If you want to be an effective teacher, you need leadership skills. You need to know how to command a crowd. You need to know how to rock the mic when the mic is handed to you… One thing in our Woodruff leadership Academy that we were taught was, uh, we had these drills on giving elevator pitches. And that, that has helped me so much because there are so many times when I have an idea and I’m in front of somebody and I need somebody to get it. Um, we had these drills on giving elevator pitches and that has helped me so much. Anytime you get a chance to do faculty development even if it’s a small institutional faculty development… that can be a game changer.
Rahul: These professional development programs vary significantly from institution to institution, but are most often built to supplement someone already along a career path (medical students, attendings, and everyone in between) without extending that. On the other hand, a formal fellowship or masters degree requires more rigorous training and may require prolonging your training time.
Grace Huang: The purpose of medical education fellowships and med ed masters that really focus on the practical aspects of teaching will give you access to frameworks and a systematic way to think about innovation and about teaching and assessment. And they do this also in an intensive way that is hard to do by just professional development seminars alone. If you’re very serious about having a career in medical education, then a fellowship or a masters will get you a long way towards thinking about it in a systematic way.
Rahul: I hadn’t heart it put together that way before. A masters or fellowship really teaches you how to— think in a structured and rigorous way. And looking into programs a bit more, I do have to add a caveat – Not all formal training is the same – some of these formal training programs are more of a focus on research while others are more about maximizing teaching skills and some are a combination of both.
CHALLENGES IN MED ED
Rahul: So so far, we’ve spent some time going over advice for medical education careers. But we would be remiss if we didn’t talk about some of the challenges.
Grace Huang: You’re sort of looking for the dark side of medical education, right?
Rahul: We did go digging for the unique challenges in this field. The first challenge is the multiple hats that educators can wear but do so with very limited time.
Grace Huang: Educators are trying to be clinician, education leaders, administrators at the same time, and teach, and do scholarship, and be role models, not that nobody else is trying to be a role model but I feel like the plight of the medical educator is much more multipronged because it involves teaching. The key to success to be a medical educator and to climb to the top would sometimes mean not having hobbies or a family or all the things that actually enrich your life. It is really hard for the clinical and or the administrative work, not just overwhelm you.
Rahul: There’s this idea of sweat equity in academic medicine – you have to prove yourself, and that gets compounded in medical education when you’re try to juggle your projects with clinical and administrative work.
Grace Huang: I think we’ve long passed an era where you would get protected time just to publish and just to do projects that aren’t tied to a grant. But I think one way to make it count twice is to figure out, are there administrative aspects of my job that are publishable? So say you have to do a lit review because you’re on a committee. Well, is that maybe a seed for scoping review or something like that? Or maybe you have to get an environmental scan of what other people are doing across the country. Well, maybe you should do a national survey.
Rahul: That forward-thinking mentality to make things count twice is harder said than done. Its so easy to just do tasks and not think could I turn this into a workshop? could I create an assessment to then publish this? That proactive planning can go a long way especially since getting promoted as a clinician educator — isn’t as straight forward.
Grace Huang: One aspect of that is that it’s hard to get promoted. I think it’s such a diverse field that your standard metrics for career advancement aren’t clear, right? It’s one thing to say that the coin of the realm is peer reviewed publications… obviously can do that in med ed, but then how do you show dissemination and impact when the venue for that is teaching? So I give a lot of talks, but who’s to say, what impact any of those talks have on people? It’s really hard for me to measure that. Whereas if I were a researcher, then I might see my paper picked up or somebody might change their clinical practice or their diagnostic approach because of what I did. And those are easier to measure than me giving a talk about feedback. It’s hard to chase down those metrics. And I can see that for such a heterogenous field how hard it is to define what impact is for the purposes of promotion.
Rahul: And on top of that, the hard truth – is that academic centers are also businesses.
Grace Huang: You get research grants that are indirect to the institution, there’s nothing like that for medical educators. We’re a cost center and it takes a long sighted institution to say, this will pay off in the future. And no one is gonna pay me for something that doesnt benefit the institution. So you just have to learn to figure out how to balance that.
Rahul: Medical educators in general don’t think with this kind of business mindset. You know we assume that the investment in teaching and innovation is worthwhile, but that payoff is indirect for these academic corporations who might choose to invest more in direct payoff, such as patient care.
Grace Huang: It also depends on the priorities of the institution. You could imagine that an academic medical center wants to become a powerhouse in med ed research, then set up the infrastructure, be proud of the grants and the scholarship that arises from that. Not every institution is in a place where they can expend that many resources to create a med ed research powerhouse, because it just may not feel like it’s in line with their clinical or their research mission.
Rahul: And so the takeaway is to research the institution, especially before applying for jobs — if you care about promotion, research what counts for promotion and what doesn’t. Find out what’s important to the department leadership – do they value teaching and mentoring, or, only care about peer-reviewed publications? And so with all the challenges that come with medical education careers, it makes me wonder why are so many still drawn to it?
Kimberly Manning: When I, um, looked for jobs, I looked for things that sort of nourished my “-ings” if you will. So my “-ings” are the things that fill me back up, teaching, explaining, motivating, um, creating.
Rahul: And even on days when Dr. Manning was really busy, she still found ways to nourish her “ings”
Kimberly Manning: All teaching doesn’t look like you on a whiteboard drawing an algorithm or having a PowerPoint. Right. Sometimes it is just as simple as you standing at the bedside, talking to a patient and getting their history in front of the student. Sometimes it’s just, um, you know, standing in the hallway, talking to a nurse, explaining, um, trying to troubleshoot a situation with a patient who wishes to leave against medical advice and somebody standing next to you or all that is happening. I’ve gotten very metacognitive about that. I start to like really think about this. That was a teachable moment. And so then I will actually go and unpack it with the students, and that’s how I get my refill.
Rahul: I really appreciate hearing Dr. Manning speak about how intentional she is in recognizing the teaching moments. On those never-ending stints on the wards, what can it look like if you examine it from a teaching lens? Sometimes, it’s those small epiphanies in your learners that can go a long way.
Grace Huang: I was just thinking recently about what is the ratio of appreciation to frustration on those really hard clinical days. If the amount of pain to gratitude is too high, then its really hard to gain job satisfaction from that. So we have to find ways to experience gratitude form the people that we work with. Its just easier for learners to express wow I’m so thankful that you taught in that way, or that you gave me that feedback.
Rahul: And there is a lot of gratitude in medical education — which if I had to guess is why people love it so much.
Grace Huang: So I think some of the issues around the concept of career advancement is that you’re truly advancing, that you’re getting to the next academic rank or you’re getting to the next leadership position. And I think that’s actually not necessarily the goal. It’s really about professional vitality.
Rahul: I had never heard of professional vitality.
Grace Huang: I think of professional vitality as that which makes you alive in your job. The kind of thing that helps you get up in the morning and want to run to work. The thing that gives you a runner high at work. I think that professional vitality is what we should be taking rather than career advancement.
Rahul: So much of the hidden curriculum just reinforces careerism and getting to an externally imposed next step.. Why don’t we talk more about what will sustain us professionally?
Kimberly Manning: Forget, like how many papers, how many posters or whatever, if you can get to a place where you are fulfilled with what you are doing as a medical educator on a daily basis, um, that, that is a really great goal to work toward because there will come a point where you will get promoted to professor and then you’ll be sitting there like, well, now what, which is what happened to me this year? I’m like, I spent my whole like medical career. Like I’ve got to get this on my CV so I can get promoted to associate professor. I gotta get this paper done so that I can build my national reputation. So I could become a professor. Then I became a professor and I’m just like sitting there, like I met the Wizard of Oz, like, well now what do I do? So, so the sooner that you realize that these promotions basically, they are good and they are helpful, but ultimately you need to be aiming really for fulfillment and meaningful influence and impact…impact for the sake of impact, not impact for the sake of, that’s going to look good on your CV.
Rahul: Hearing that feels so validating and makes a career in MedEd much less intimidating – focus on whats fulfilling and meaningful. With that, we’ll leave the last word with Dr. Manning sharing her story and her biggest advice.
Kimberly Manning: And so the only thing I’d say is you’d have to know who you are. When I was getting ready to start medical school, um, and you know, I was really nervous about going from one historically black college to an historically black medical school. I was, I was telling my dad that I was like, maybe I made a mistake, maybe I should have gone somewhere else to a majority school and it’s gonna make it harder for me. And my dad was like, you know, those who are, are willing to work toward being great will be great period. I think that that started to instill in me believing that what I have to say is worth somebody’s hearing. And I think that’s the, probably the key thing that if you want to be a clinician educator, you want to be a medical educator. You have to believe that when you prepare a talk and open your mouth, that what you have to teach is worth somebody listening to. Period. And that’s where leadership development and all that comes in. And if you constantly are self-deprecating and you are always thinking that somebody else should talk, instead of you, um, when you prepare, then you sell yourself short. So you must prepare. But once you have prepared, you know, you have to get in the corner and shadow box and say, you know what, I’m about to crush this and then have somebody watching you so that if you think you crushed it and you didn’t crush it, they can say you didn’t crush it, or you crushed it, but this is how you would crush it even more. And then you take that and you apply it and then you come in and you do it again. But that, that is ultimately, I think the place where people sell themselves short, they’re waiting for somebody to give them permission to be great. And you don’t, don’t wait for that. Give yourself permission to be great because the minute that you do, you’re going to work at it. And that’s what you’re going to be… is great. And if somebody cares about you and is mentoring you, then they, they will, they will help you to keep fine tuning the very best version of you who nobody else can be. Nobody could be a better version of you that no, I can’t be the best version of you. So if you are aiming for that and not aiming to be like, Shreya, like me, like this person, like, like aim to be the best version of you. Cause nobody can copy that. And I think that’s my big advice.
Shreya: And that is a wrap for today’s episode. If you found it helpful, please share it with your colleagues, give it a rating on Apple podcasts or whatever podcast app you use! It really does help people find us. A big thankful to Dr. Michael Shen, who skillfully produced this episode behind the scenes, did the audio editing and was just an excellent coach. Thank you to Preeyal Patel for the accompanying graphic, especially because it goes over somethings we didn’t get a chance to cover like potential leadership trajectories. And thank you to our listeners. We love hearing feedback, as always, so please email us at firstname.lastname@example.org. Opinions expressed are our own and do not represent the opinions of any affiliated institutions.
- Pangaro, L. (2010). Leadership Careers in Medical Education. ACP Press.
- Pangaro, L., & Ten Cate, O. (2013). Frameworks for learner assessment in medicine: AMEE Guide No. 78. Medical Teacher, 35(6), e1197-e1210.
Tags: career development, Careers Series, clinician educator, coaching, mentors, mission statement