Kimberly Skarupski: Welcome back to the Faculty Factory Podcast. I’m Kim Skarupski, looking at my friend Karen Moniz. So, Karen Moniz, former faculty and staff development program director for about five years in the Department of Family Medicine at the University of Alberta. She is currently an assistant professor in the Department of Family Medicine in Alberta. I’m gonna let you start leading us off on a really interesting and a new topic for us, the value of teaching and teacher identity in medical education. So thanks again, Karen. Take it away.
Karen Moniz: Thank you so much, Kim. It’s certainly my absolute pleasure to be here. It’s such an honor and I’m so excited to talk your ear off a little bit more about my favorite topics in medical education. We throw you out there in the clinic with learners and some of the learners have to teach their junior colleagues and we tell them to teach without any background. So is that valued? Some people think it’s an add-on, it’s an added-on role, it’s maybe something you do on the side, you fit it in somehow, it’s not a priority. But it does have implications for patient care, quality and safety. So I think ultimately this is one of the shared values of medical culture is patient care and safety and the quality of that and us to optimize that. And so in that sense, it’s valued, but the teachers aren’t recognized. And so we need to look at teaching and how we value that and how do we value that when your clinic is your classroom? Because it’s not a quiet room where you sit in a chair and you listen to someone talk. Everything’s going on all at once, all the time. And it’s probably like being a parent where, you know, this is happening and you need that and you need to address something else and all of these things are happening and it’s high stakes. These are people’s lives in your hands. So, it would really be helpful to have that helper on your… Guiding you along the way. So with these implications, we know that the clinicians who teach and who see themselves as teachers or identify as teachers or have a teaching identity, they are better teachers. And so I’m thinking when clinical teaching is valued, this is my question, I’m thinking everybody wins if we value this. The individual, the patients, the learners, the institutions, we get better metrics coming out, people recover, we have beds available. You know, there’s a lot of things that have a domino effect from this. So looking at this root, we’re looking at these clinicians, but not all these clinicians see themselves as teachers. You know? And so that is something that we question and it’s like, well, why not? It’s part of your job. Why aren’t we helping you with this? So when you follow the breadcrumbs back, I ended up looking at this in the literature and it looks to me like clinical teachers belong to professional cultures.
Karen Moniz: And so the answer could be somewhere in these professional cultures because cultures ensure that the clinicians are socialized to form a professional identity. So we have all this work on professional identity formation, but in addition, we don’t see much on socializing to develop that teacher identity that’s part of your job. So we have faculty development and to date, you know, we’ve been offering, not only myself, everywhere, faculty developments are regularly offering sessions that focus on teacher training and opportunities to network with other teachers so you can have this community of practice in your profession with other teachers to support each other and make a really good group. And interestingly, these wonderful things that we offer, attendance is not always optimized. So we build it, but not everybody comes. So attendance is a little low sometimes. And it’s not the individuals that don’t want to come. They, many, many love teaching, but it’s logistical things that have to do with institutional barriers. They’re enthusiastic, they want the training, they want the resources, but you’ve got heavy workload, you’ve got time constraints. It just, it’s just not feasible to drive an hour for a faculty development session, have it for an hour, and drive back somewhere to the clinic for an hour. You lost half a day and then you’ve lost, you know, a lot of appointments with your patients and care gets delayed and things like that. So there’s all these logistical things that we haven’t considered. And so we don’t necessarily enhance or make it easy, so it’s hard for an individual to embrace the role even though they want to. There’s just not enough time in the day and not enough energy. So if we are not supporting teachers, how can this be good for the learners? And these learners are going to be our future clinicians. So what kind of outcomes are we looking at down the road when it’s you and me and our families and our friends? What kind of care will we be getting if we don’t build the right foundation? So, you know, they say, you know, culture can change policy. So if we can start with our own, with our own profession, in our own communities, we can take little steps, do it in little bites, to redesign some of the workplace cultures, even on the unit level, and have that spread or have it be an example of how this can work. Pilot it, try it, see if your results are better, demonstrate better metrics.
Karen Moniz: So I think, you know, we can see what’s in it for all of us to consider these kind of little incremental changes without getting running into roadblocks ourselves. And if we can refresh these workplace cultures so that institutions can better support teacher identity development, not the doing, because everybody says, “Well, just go learn how to do curriculum, go learn how to do a survey.” That’s a technical thing. Being a physician, being a practitioner, being a teacher is more than just a checkbox. You have the wisdom, you have the judgment, and it’s part of the same thing in the teaching profession as well, especially in medical education, because they fit together so nicely. So if we consider the features of the workplace, the pressures, like you said, they’re very real pressures that are daily to show your productivity. And if we can look at those forces that enable productivity, the innovation might support your effectiveness and that could enhance the organizational value, build your talent from within, it could be strategic for your workforce planning as well, and most importantly, enhance patient safety and care.
Kimberly Skarupski: Dr. Jessica Seaman is the assistant professor for medical humanities, the co-director for Gold Track curriculum, and the Assistant Dean for Faculty Development at Creighton University School of Medicine in Phoenix, Arizona. I think we’re gonna start with your… One of your areas of expertise, and that is strategies to support learners who are stressed out. Struggling learners. Gosh, they’re under stress, right? Who knew? Who would figure that our learners are stressed out? I wonder where they’re learning to be stressed. Where do they learn stress? Maybe from us? What’s going on? And tell me how you’re addressing stress and conflict and trying to shore up the confidence and, you know, just supporting our learners.
Jessica Seaman: Absolutely. I am so glad you asked. There are things that I talk about with students, but also with faculty, about learners. And so sometimes I’ll say students, but they could be our peer learners, they could be our faculty learners, they could be our student learners. It really doesn’t matter. We’re all learning, right? We’re all learners. And that is an important piece of our faculty development and our professional development is that we’re always learning. But one of the things that I really like to emphasize is that learners, there’s some good parts of their stress, there’s some bad parts of stress, and there’s some support strategies that we can really help learners to feel supported even though they’re feeling some stress. Our learners come to us, especially our students, but also our faculty that are clinical faculty, they are coming into clinical education, academia stressed out. They are used to getting straight A’s. They are used to doing very, very well in their studies. And they get to med school and they want to do exactly the same thing. Or they’re working with a patient as a clinician and they want to do the same thing.
Jessica Seaman: They want to cure this patient. They want to make everything right. And that’s kind of what they’re used to. So a little bit of stress can be a positive motivator because it gets us off the couch. It pushes us to do well. It might push us to clean the house. It might push us to get to the next research item that we really want to delve into. It gets us out there with a little bit of stress. We think, okay, I’m gonna get over this hurdle. But if we have too little stress, it can actually keep us from reaching our full potential. We could get bored, we could be unmotivated, we could just be inactive, we could just think couch potato. And we don’t want that with our learners, right? We want our faculty out there and we want our learners out there and they usually are. But what happens is the stress gets to be so much because they’re trying to perform so well for either families or patients or themselves, and that can harm our health. It can harm us mentally, it can harm us physically. But the good news is an optimal amount of stress is really okay for us. It’s good. But if there’s unmanaged stress, it can turn into chronic stress where it’s just happening all the time, all the time, and it can turn into anxiety. And as you know, anxiety can then turn into depression, it can turn into self-harm or suicide, suicidal thoughts, that kind of ideation. We don’t want them to get to that point. We want them to feel like, yes, get up off the couch, get here to class or get to clinic on time, but we don’t want the stress to be so high that they feel like nothing is reachable. So there’s some good, there’s some bad with stress. And what we need to do as faculty and staff is really help our learners, whether they’re faculty or students, it doesn’t matter. We need to help them with some support strategies.
Kimberly Skarupski: And so what are those strategies?
Jessica Seaman: Okay, so let’s dive into some of these strategies. You know, the really great thing is we have all been students before. So all of our faculty have been students, all of our physicians have been students before, and they know what it feels like. But we’ve got to remember. We’ve got to remember what that feels like. But one of the things that I think is so important to support our learners is giving them clear expectations. So what is it we want a learner to do when they get into the hospital in the morning? Do we want them there at 5:00 AM? Do we want them there at 5:27 AM? Whatever that looks like, the expectations need to be really clear. And if a learner is not able to show up on time because for whatever reason, who do they call? Who do they text? There’s got to be some organization to these expectations. So that is super important because those clear expectations really provide the scaffolding for learner success. And if learners are confused, they get overwhelmed and they just want to give up and they’re like, well, I don’t even know who I’m supposed to call, so I don’t think it really matters that I’m showing up late. But when we have those clear expectations, learners are more able to meet any kind of learning goals. And how do we do that? We can actually provide a rubric for them. We can actually give them a criteria or milestones. Hey, these are the EPOs that you need to be working on. These are the things that I’m going to be teaching you, which is our professional objectives, right? And those educational professional objectives are what we need to be sharing with learners. The ACGME has learner expectations for our faculty. They have them for our residents. And the LCME has learner expectations for our students as well. So there are rubrics out there, there is criteria out there, there are milestones out there that can be like a checkbox, but it doesn’t have to be. They can weave in and out of, hey, we’re going to work on these first two milestones until we get them really, really good, and then maybe we’ll pick up another one and then we’re going to incorporate them into what you already know. So assimilation with those expectations, super important. Providing them with an objective, specific and actionable, giving them feedback that is actionable. Those are clear expectations. So if there is some high-quality work that’s happening, not just telling them, hey, great job, but your expectations of, here’s the next steps. I really like the suture, the way that you’re choosing to suture an opening, but next time, this is what I’d like you to try. So those expectations have got to have some steps with them.
Kimberly Skarupski: You’re back at the Faculty Factory Podcast. I’m Kim Skarupski at the University of Texas Medical Branch in Galveston, Texas, looking at Dr. Carla Spagnoletti. Hi, Carla.
Carla Spagnoletti: Hi, Kim.
Kimberly Skarupski: Folks, let me tell you who is Dr. Carla Spagnoletti, MD, MS. She’s a professor of medicine, the George H. Tabor Endowed Chair in General Internal Medicine, the Associate Dean for Faculty Affairs in the School of Medicine, the Associate Division Chief for Education at GIM, the Associate Director of Master’s and Certificate Programs in Medical Education in the Institute for Clinical Research Education, all of this at the University of Pittsburgh School of Medicine. Why don’t you tee it up and let’s get going?
Carla Spagnoletti: Kim, as you mentioned, I had recently given a keynote talk and they kind of asked me to talk about my journey thus far in my career as a clinician educator specifically. And so I went about that in thinking, well, what’s going to be helpful to the audience other than just hearing my story? And so I broke out telling that story into sort of my top five tips for successful clinician educator careers, and took it from there. And so just to provide a preview, my five tips, and I’ll go into a little bit more detail as we go on, my five tips are to proactively develop your skills, let your mission drive your career, turn everyday work into scholarship, face and embrace failure, and build and maintain relationships. So that’s kind of how I broke it out. You know, it made sense to me to put proactively develop your skills at the beginning because I think that for me is what really set me on the right path and really gave me a lot of opportunities as an early career educator that I would not have had otherwise, had I sort of just come out of residency and went to work, you know, as a clinician educator directly. And so for me, I opted to do a medical education fellowship and a master’s degree in medical education. And that was two years after my internal medicine residency. And it opened up a whole world to academic medicine that I didn’t even know existed as a trainee. And I think that that’s pretty common. It taught me not only how to be a better teacher and educator, but it also taught me leadership skills and administrative skills and medical education research and scholarship skills. And so that really set me up well for pursuing a career as a clinician educator where I still had time to see patients and enjoyed seeing patients and still do, but also be able to explore some other interests that I guess I didn’t really realize I had until I was exposed to that. It’s kind of funny that my next tip is face and embrace failure because a lot of the things that ended up turning out really good were as a result of, you know, some sort of failure, something that I tried or wanted that I didn’t get or, you know, wasn’t the right time for me. I’m a big proponent of applying for things and trying for things even if the odds are against you, even if you meet some of the criteria but not all of the criteria, even if you know that there’s someone out there that’s more likely to get the job than you are.
Carla Spagnoletti: And I tell my mentees that all the time. And so there have been a few major leadership positions that I applied for along the way as I was trying to shift my career and be a little bit more focused in the faculty development area. But the most recent one is the job of the Vice Dean for Faculty Affairs for my institution became open as our dean… Our new dean, was restructuring the office. I had been really trying to think about ways that I could get to know the dean and have the dean know me. And that’s oftentimes really hard at a huge institution where there are thousands and thousands of faculty members. And so, you know, at the time, in full disclosure, I didn’t know whether the sitting Associate Dean for Faculty Affairs was interested in the Vice Dean job or not, but I also looked at the long list of responsibilities that came with that job of Vice Dean and maybe I met half of the criteria. So I really didn’t go into that process trying or thinking that I was going to end up with the job I was applying for, but I really just did it as a way for the dean to know who I am and for some of the other leaders in the medical school to know who I am so that if and when the right opportunity came along, they would think of me. And I didn’t get the Vice Dean job and, you know, that’s good for a lot of reasons. But because I had that interface with the dean and some of the other higher-up leaders in the medical school, when the dean called me to tell me that I didn’t get that job, he offered me the job that I have now as Associate Dean for Faculty Affairs. And he said specifically that there hadn’t really been anyone in faculty affairs that was dedicated and focused on our clinical faculty and our clinician educator faculty, which is true. There have been a lot of programming and support for our research faculty and our clinician investigators, but, you know, the majority of our faculty are clinical faculty and clinician educator faculty. And so he, you know, knew who I was because of the interview process and saw a need, and I guess I kind of also convinced him that there was a need. And so that turned out, you know, obviously, hugely, hugely in my favor because now I am getting to do a lot of the work that I have really loved to do and has built my career on, but now at a much larger scale. And so that’s just an example of, you know, even if you think that you’re not going to get something or you’re going to fail, just try anyway because there are a lot of other benefits to doing that. Yeah.
Kimberly Skarupski: So smart. Super, super smart strategy to use opportunities for roles as a learning experience. To learn, I’m gonna learn about myself, I’m gonna learn about this kind of a job, I’m gonna learn about people who are in this space, I’m gonna learn about the culture and strategy and priorities at that level, and also I’m gonna get on people’s radar. And look at what happened. That is genius. Such a great application of high emotional intelligence that you don’t, yeah, leveraging opportunities as, hey, this is professional career development. What are you doing applying for a job like that? You know you’re never gonna get it. That’s not the point. I love it. How going into something saying, I just want to get the experience, I want the exposure, I want to get into these people’s brains, I want to learn that culture, I want to learn how they think, I want to be able to respond to questions, learn the questions they’re gonna ask, which will tell me something, and then any questions that they don’t ask will also tell me something, and I’m getting FaceTime with people. That is so smart. Great, great. I hope you all are listening to that. That’s great wisdom from Dr. Carla Spagnoletti.
Carla Spagnoletti: Thank you. Turning your everyday work into scholarship is probably my mantra. So I think if you ask the people that work for me and the people that I’ve mentored along the way and they said, like, you know, what’s the biggest lesson that Carla has taught you or, you know, what does she preach all the time? It’s that. As clinician educators, we are super busy with patient care. Almost all of us are super busy with patient care. And the educational work that we do doesn’t always generate money for the institution. And especially the educational scholarship that we do is very rarely funded or has enough funding to support our salaries. And yet, in order to be successful in an academic environment and get promoted, you kind of have to do scholarship and, you know, that may, whether that be solely in the form of publications or other forms of scholarship, typically you have to find the time to do it on your own time. And I think that that’s really challenging, especially now where we’re more and more busy clinically and burnout is so prevalent. And to then say to junior faculty that, you know, when you’re done doing your charts after 10 hours of work, you should reserve one or two hours, you know, late at night to work on your scholarship…
Kimberly Skarupski: Yeah, and your brain is shot.
Carla Spagnoletti: I mean, we all do that.
Kimberly Skarupski: I mean you’re physically exhausted and you’re mentally exhausted and you’re emotionally spent. And how can you even have your brain be at its best after all that?
Carla Spagnoletti: Exactly. And it’s something that I think all academic physicians and scientists do is take work home with them and do work outside of hours and so on and so forth. But I think that in order to be successful as an educational academic, you really have to pair that scholarship with the things that you are doing at work and things that you are getting paid to do. So if you’re lucky enough to get some curricular time during a residency curriculum or a medical student curriculum, you’re asked to do a course, be a course director, or teach within a course, take that time, that curricular time, for example, and not only do your job, deliver on what your job is supposed to be as a teacher, as an educator, but find a way to innovate and find a way to study what you’re doing. And so when I say turn your everyday work into scholarship, I’m constantly thinking about, okay, you have this set of responsibilities. What can you create? What’s new? Or what is a good research question that you can ask off of this everyday job that you have, and then look for ways to turn it into scholarship, whether that be submitting an innovation abstract to a national meeting about a lecture that you gave, or turning something into a workshop, or marketing a talk that you give to medical students and residents and sort of switching it up a little bit, and then trying to find people who might want you to be an invited lecturer and give that talk to grand rounds or to a set of faculty at another institution. And then, of course, the evaluating and thinking carefully about the things that you’re doing as an educator so that you can actually get data, so that you actually can publish it. And so I think that, that’s kind of where I am at with that specific tip is in order to be successful academically as an educator, you kind of have to do both at once. You have to do your job and you have to figure out how to make it scholarly.
Kimberly Skarupski: Thanks for tuning in to the Faculty Factory Podcast. We are a faculty development community sharing tools to build academic leaders in healthcare. Maybe you want to be interviewed on the podcast? Please visit facultyfactory.org/contact and send me a message there. The Faculty Factory Podcast and website is sponsored by the Office of Faculty Affairs at the University of Texas Medical Branch in Galveston, Texas.