Chair’s Column: Valuing the Clinician Teacher – Where Are We Going?
The University of Toronto Department of Medicine supports ~ 1800 faculty, of which 933 are full time & 38% clinician teachers. Based on a Needs Assessment conducted in 2018, it was clear that Clinician Teachers (CTs) are intrinsically motivated to conduct their work. They are passionate about teaching, they enjoy the dynamic work environment, and they genuinely care about the academic development of trainees. There are however challenges that continue to be worked upon with the DOM. For example, 53% of Clinician Teachers (CTs) remain as assistant professors after 11 to 20 years of hiring (average time to promotion being 10 years, compared to 7 years for a clinician scientist). The pandemic, along with increased patient volumes and complexity has resulted in tremendous moral injury, affecting workplace morale. Competing resident obligations and centralized teaching has taken the resident away from traditional opportunities for bedside teaching.
To advocate for and mentor clinician teachers, enhance the community of teaching practice, re-think the evaluation process for CTs, the DOM created the position of New Faculty Lead, Valuing the Clinician Teacher. Held by Dr. Martina (Tina) Trinkaus, a malignant hematologist at Unity Health Network and Program Director for the Adult Hematology Training Program, this position is contributing to our understanding of the many obstacles faced by our clinician teachers, and opportunities to make positive change in our workplace environment and teaching portfolio.
The emphasis on Valuing the Clinician Teacher has resulted in many recommendations for positive change, and driven the momentum towards tangible improvements in many DOM priorities. One such example is the need to improve the transparency and support for successful promotion. Recently, UofT removed its ten year requirement for academic promotion, thus simplifying the promotions process for junior faculty. This is a big win for our DOM, which should not be understated. Along with this, a new website dedicated to the CT will provide strategic resources towards the “Pathway to Promotion”, in addition to serving as a hub for awards, networking, resources and mentorship. Closely linked with the promotions process is the necessity to re-examine clinician teacher performance standards, and implementing novel encounter based teacher evaluation tools such as myTE.org.
This position also aims to improve the recognition of the CT. In addition to the re-evaluation of current awards, there is a push to create new awards focusing on resident learning, career impact and mentorship. Look out for the new clinician teacher brand highlighting our contribution to our DOM. We are also looking forward to greater online profiling of our master clinician teachers, and mentor-mentee relationships.
There is no doubt that the past 2 years have placed incredible strains on the teaching responsibilities of CTs. The DOM is committed to looking at ways of improving the bedside teaching opportunities for trainees. Efforts to improve upon housestaff scheduling on our CTUs and subspeciality services, re-evaluating resident competing interests in their training program, and providing protected and safe teaching spaces are underway. The DOM is aware of the heavy patient loads, and there is advocacy underway to help with recommendations such as increasing physician extenders in all clinical practices, increasing the administrative support for our education portfolio, and placing hard caps with resident independent units to protect our CTUs as teaching environments of priority. A great deal of discussion has also been placed on the idea that the “teaching culture” has been lost with the IPAC restrictions, the push towards centralized teaching and the necessity of focusing on resident wellness and work hours. EPAs have also changed the teacher-trainee relationship to one of transaction, and with the increased patient volume loads it is becoming harder to develop a strong teacher-learner relationship. The DOM is committed to shifting this change teaching culture, to one focused directly on patient centered care, focused on the messaging that medicine is a vocation, and focused on developing a community dedicated to staff wellness and job satisfaction.
