Chair's Column: Unsung Heroes: Valuing our Clinician-Teachers

As a clinician-scientist, I am well aware that I could not have been successful in my research career without the front-line clinician-teachers – like those noted above – who were ensuring that sick patients were being cared for, and our undergraduate and postgraduate trainees given the skills to practice medicine. But, I don’t think I have said thank you enough to these wonderful colleagues who have enabled me (still enable me) – and others like me – to pursue my research dreams and ambitions. Let me do so now…to all of you clinician-teachers out there, thank you for all you do! Your work is hard and increasingly challenging, especially in the current healthcare climate. We really do appreciate you.

This past week the Decanal Promotions Committees held their final deliberations on our candidates for senior promotion. As Chair, I am asked to attend these final meetings to clarify issues and answer questions regarding our candidates with a view to helping the committees come to a final recommendation. This year, I was challenged to demonstrate to some non-clinicians the manner in which front-line teaching might be viewed as academic ‘scholarship,’ and thus worthy of promotion through the ranks. They were not convinced.

Currently at U of T, scholarship is defined as research (all types) and creative professional activities. Being an outstanding clinician and teacher year after year – one that is the ultimate CanMEDS role model – who inspires the next generation of outstanding rheumatologists or endocrinologists is, at least in my mind, a scholar and must be recognized. I was asked last week by a Decanal Committee member if I felt that all outstanding teachers should be promoted and my response was an enthusiastic yes!

Peer-reviewed grants, publications, and invited lectureships are the basic currencies of ‘scholarship’ in many academics’ eyes. Not that these are bad metrics, but clearly they insufficiently recognize our clinician-teachers’ efforts. For example, the Faculty of Medicine is allowed to nominate only one candidate for many national education awards. Given the size of our Department (approximately 800 full-time faculty of which 36% are clinician-teachers), let alone the size of the entire Faculty of Medicine, this is ridiculous and means that the likelihood of any one of our clinician-teachers getting formal recognition for their contributions nationally or internationally is inappropriately low.

Last week I had the pleasure of celebrating my husband’s 30 years as a pediatrician and clinician-teacher at Toronto East General Hospital (now Michael Garron Hospital). While I am clearly biased, I am pretty sure that Marty is indeed a master clinician-teacher, from what I have heard. In a brief speech, he noted that his wife (me) is regularly recognized for her academic contributions during her career, while it’s interesting that folks like him aren’t generally recognized until they retire – or die. He’s right.

Transformative change is required. Fortunately the Dean, Trevor Young, agrees! He has struck a working group to understand how we might better value the contributions of our front-line clinician-teachers. Co-chaired by Arno Kumagai, our own Vice-Chair, Education, and Alison Freeland, Associate Dean, Medical Education (Regional) at MAM, the group has been charged with developing recommendations to address the concern (see this month’s editorial by Dr. Kumagai).

From my own experience, I would suggest the following might be useful in getting us to where we want to go:

• Ensure our teachers receive sufficient numbers of teaching evaluations (and trainee exposure) to enable their personal career development as teachers but also to assist the department in identifying folks who deserve recognition through awards and other honours. Currently, we have estimated that 62% percent of the department’s teachers receive fewer than 10 evaluations per year, and 25% receive fewer than three evaluations per year. Importantly, teachers who work in ambulatory clinics or the emergency department have an especially difficult time collecting enough evaluations despite the fact that they have a great deal of “face time” with med students or residents. This lack of evaluations often poses a critical barrier to the promotion of clinician-teachers and prevents their formal recognition by the institution.
• Increase the number and types of awards at the hospital, divisional and departmental levels, as appropriate, including recognizing the unique contributions of the “Master Clinician Teacher.”
• Establish a Teaching & Education Awards Committee to proactively ensure department members are being nominated for all prestigious teaching awards, nationally and internationally. To this end, Dr. Kumagai has already invited Dr. Martin Schreiber, a legendary teacher within the department, to chair this committee with the aim of enhancing recognition of all aspects of teaching and educational scholarship within the department.
• Develop and implement new metrics by which to evaluate the ‘impact’ of our clinician-teachers. The University of Toronto is already a pioneer in establishing creative professional activities (CPA) as a means of promotion in addition to the usual metrics. However, particularly in education—in the area of curriculum design and innovation both big and small—the documentation of CPA and their use in promotions need to be much more “user-friendly,” that is, easier to use when documenting really great new ideas and activities in ways that aren’t a huge burden on busy clinician-teachers.
• Work with the Decanal Promotions Committee at the Faculty of Medicine to provide greater clarity on the criteria for promotion based on Sustained Excellence in Teaching & Education (it cannot solely be based on teaching awards!)
• Establish our very own “Academy of Master Clinicians” within the department, in addition to an annual departmental award for a master clinician. 

Establishing an Academy of Master Clinicians in the Department of Medicine:

To this end, I am looking for your involvement and would welcome volunteers to help us develop the criteria for this award and for academy nomination. My initial thoughts regarding eligibility include the following:

• The go-to person in their field regarding challenging cases – the so-called doctors’ doctor.
• Superb history, physical examination and diagnostic skills. 
• Humanist physician – puts the patient first in all they do; excellent communicator with patients and their families; excels at preference-based shared decision making.
• Evidence that the physician has inspired others to embark on a specific career path.
• Full-time clinician-teacher in the Department of Medicine over a period of at least 10 years.

What do you think? Please send your ideas to Gillian Hawker, and if you wish to participate in a group meeting to flesh this out, let me know.

Let me close by stating once again, as an academic enterprise, we are most definitely grateful to our clinician -teachers, who do the hardest work of all at the front-line of clinical care and education. We applaud your commitment and thank you for your ongoing efforts. The Department of Medicine is fully committed to ensuring that our clinician-teachers feel valued and respected. They truly are our unsung heroes!