RAMS Medical Education Roadmap

Medical Education Medical education encompasses many career pathways including clinical teaching, classroom education, and educational administration.

The field is for those interested in education innovations, educational research or medical education in Emergency Medicine in formal medical education, training of other health providers, and provision of continuing education to EM colleagues.

MED STUDENT (MS3/4)

JUNIOR RESIDENT

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Senior RESIDENT

Resources

AUTHOR: Daniel N. Jourdan Contributors: Kaushal H. Shah, MD and Arlene S. Chung, MD Welcome to the Emergency Medicine Education Roadmap, your definitive step-by-step guide on how to succeed in Medical Education at every training level. Don’t know where to start? Click on “Background” or select your training level above. A full list of fellowships, conferences, and podcasts can be found in “Resources.” For pearls of wisdom from faculty and residents in the trenches, click on “Insider Advice.”

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insider Advice

1 - SENIOR MEDICAL STUDENT MS3/MS4

Congratulations on already having an interest in an Emergency Medicine (EM) educational pathway! While there isn’t a ton you can accomplish as a medical student to prepare for a career in education, there are a few tasks students can complete: • Identify the residencies that will best prepare you for a role in medical education and work towards strengthening your candidacy for those programs.

• Talk to EM residency leadership at your school. Chat with them about their career path and ask if you can assist on any educational projects.

• Become a tutor.

• If possible, assist with or even spearhead your own medical education project. This can be as simple as a suturing lab or simulation, or as complex as a structured tutoring program for a specific course.

• Whatever you do, be sure to collect pre- and post-intervention data to complete a write-up on the project such as a poster presentation or even a manuscript.

Choosing a Residency

Because no definitive pathway into medical education exists, there is no exact science to choosing a residency to best prepare for a career in medical education. That said, there are some considerations one should keep in mind based on their future career path.

Residency Directories

• S AEM’s Residency Directory • E MRA’s Residency Directory

3 Year Versus 4 Year Residency

The annual question facing those applying to EM residencies: should I do a 3 year or 4 year residency? Unfortunately, here again, no definitive answer exists. Some will tell you it is easier to get an academic position directly out of a 4 year residency than a 3 year based on the extra training and further developed skill set. Others within the field advise this is not necessarily true as evidenced by the plethora of educational staff that completed 3 year programs. Furthermore, as most Continued

academic faculty complete a fellowship following their residency, those completing a 3 year residency plus a fellowship are often considered equivalent or higher trained than those doing solely a four year residency. That said there are some considerations regarding this choice.

• A 4-year residency offers extra time for electives. No matter where you go to residency, to land an educational position somewhere you need to have completed educational work of some sort during residency. The definition of the education work is varied and is covered more in the residency portion of this pathway, but suffice to say the extra elective time of a 4 year program allows more flexibility in bolstering your credentials towards education.

• Most 4 year programs will not allow a 3 year graduate to teach during your first year post residency. This is straightforward - you can’t be expected to teach residents who have completed the same level of training as you. This doesn’t mean you cannot obtain a job at a 4 year program - it just means you won’t be in an educational role during your fourth year.

• 4 year programs are more likely to include the option for an education “track” or “focus.” Most four year programs currently utilize the last year for residents to begin to focus on a specific area to include education. Some have even established a specific curriculum to aid students in developing the skills of a medical educator known as distinction tracks. As distinction tracks expand however, more and more 3 year programs are beginning to add them.

Academic versus Community Program

Many people believe that a residency at an academic program is necessary to secure a role in medical education going forward.

However, this is not necessarily true. While academic centers have traditionally provided more opportunities for teaching due to the presence of an undergraduate medical education program, many academic centers are now sending their students to community sites, including during their pre-clinical doctoring courses. Furthermore, what matters most is obtaining educational experience such as developing an EKG program for your fellow residents, not necessarily having taught a medical student.

Presence of an Educational Distinction Track/Focus

Lots of residency programs have begun offering their residents the option of focusing on a specific area to include education.

Programs with a Distinction Track or Focus have developed a specific curriculum for students to complete that helps provide the skills necessary to become a medical educator. While certainly not necessary to obtain a role in medical education, structured systems with developed curricula and faculty focused on developing you as a educator are not a bad idea in helping develop one’s education skill set. That said, in attending a program without a distinction track or focus, it is certainly possible to create your own track and not be constrained by established standards.

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2 - JUNIOR RESIDENT While the most important focus is definitely ensuring your success as an intern and a resident in Emergency Medicine (EM), there are some steps you can consider taking to help bolster your prospects of obtaining a medical education position.

Identify a Mentor

Begin working with your residency staff to identify possible mentors for a career path in medical education. Establish an outline for your time in residency that best prepares you for a career in education. Work with them to identify research and teaching opportunities as you progress.

In addition to your house staff, consider finding mentors outside your program to offer advice and guidance. • EMRA Mentorship Program

Become involved in an Education Project

This doesn’t have to be an extensive educational course, just begin to evidence your interest and bolster your skills. You can lead a journal club, teach an EKG course or assist house staff during educational conferences.

Educational Research

Work with your mentor to identify educational research you can assist with or even lead. Conducting research early is important as it becomes easier the more you do it. Further, research largely serves as the currency for promotion so beginning to obtain that currency early is helpful.

3 - SENIOR RESIDENT Congratulations! You’re almost done with residency! As you become more comfortable in your role as a Emergency Medicine (EM) physician, now is the opportunity to really begin to bolster your educational credentials. Work with your mentor to establish a plan to help set you up for future success. Below are some other tips to help increase your chances of landing the dream education opportunity.

Networking

Continue to network by attending regional and national conferences. National meetings such as SAEM’s or CORD’s annual meeting or SAEM’s regional meetings are an excellent way to meet residency program administrators. In addition, most other conferences have educational committees you can sit in on.

Continue working/Become involved in an Education Project

Continue expanding your educational experiences. Again, this doesn’t have to be extensive. You could lead a repeating journal club, teach at your monthly educational conference or even establish a simulation to correlate with a QI project.

Work with your mentor and the program staff to identify opportunities.

Educational Research

Continue to work with your mentor to identify and complete educational research projects. It would be especially beneficial to tie one of these research projects into your own educational project to show you have complete understanding of the entire process.

Become an Effective Teacher/Mentor to Your Junior Residents and Medical Students

Check out the SAEM Clinician-Educator Series for a list of resources on how to teach, including adult learning theory, the basics of giving didactics, and much more. You can also find similar resources at EMRA or other large professional societies, as well as peer-reviewed journals in medical education. See the Resources section for a full list of our recommendations.

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Consider Pursuing One or More of the Following: ACEP Resident’s Teaching Fellowship Consider completing ACEP’s new Resident Teaching Fellowship. This course allows residents the opportunity to explore a career in academic EM or determine if education is right for them. It provides participants skills and tools to enhance one’s academic career as well as serves as a great mentoring/networking opportunity.

Medical Education Research Certificate (MERC) Program Offered by the AAMC, this certificate program requires your participation in six workshops of three hours each. The workshops are held on a rotating basis regionally allowing the certificate to be obtained over an extended period of time. The program focuses on educational research and allows residents to demonstrate their interest and dedication to a career in education.

No application needed.

The Teaching Course Offered by Rebel EM, this course is focused on revolutionizing medical education including reimagining the use of powerpoints and discussing the use of podcasts as an education venue. The course offerings vary as do the location but further information can be found on the website above.

Harvard Macy’s Program for Post-Graduate Trainees: Future Academic Clinician-Educators Consider applying to Harvard Macy’s three day intensive program for residents and fellows focused on enhancing skills and scholarship aas future academic clinician educators.

The course is built around the applicant’s individual project, so you must apply with a project in mind and the support of a faculty member. The course focuses on two major themes: skills in teaching and learning as well as developing scholarship in medical education. Completion of this course holds wide regard within the field.

Application consists of a biosketch (CV in essay form), a description of your project and a letter of support from a faculty member.

ALiEM Chief Resident Incubator Offered by Academic Life in Emergency Medicine (ALiEM), this program for chief residents provides a year-long leadership and career development curriculum. The course offers many opportunities for mentorship from some of the leaders in EM education.

ACEP Teaching Fellowship This fellowship consists of an eleven day training course split between the spring and the fall. The course is designed for faculty of residency programs to improve their skills, however, residents interested in an academic career are eligible to attend. This is often taught by leaders in the field of academic EM and is a great networking opportunity.

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4 - FELLOWSHIPS Fellowships:

While not a necessary requirement to land a role in medical education, fellowships can offer aspiring educators a leg up on landing a position in medical education. Furthermore, as the field develops obtaining some of the bigger educational roles such as program director may begin requiring completion of a fellowship or masters.

Most medical education fellowships are one year long. The fellowship essentially makes you an Assistant/Associate Program Director so that you can learn the annual routine of a residency program. As well, it doesn’t necessarily need to be a medical education fellowship. Fellowships such as simulation or ultrasound are also good launching platforms to obtain a education position. Most fellowships are one year, however some allow for a two year program that often includes obtainment of a masters degree.

• SAEM’s Fellowship Directory • EMRA’s Education Fellowship Directory & Fellowship Guide

Masters:

Much like a fellowship, a masters is not viewed as necessary to land a role in medical education though they do offer a way to strengthen one’s educational credentials. They are especially helpful for those seeking more involvement in undergraduate medical education, especially at the Dean or Assistant Dean level.

A variety of relevant Masters are available: Masters in Education, in Health Professional Education, in Academic Medicine, etc. Most programs do not look for a specific degree, though they do allow for different focuses.

Many of the education fellowships offer two year options which include receiving a Masters. Otherwise, Masters can be obtained from many local institutes at night. In addition, many programs are beginning to offer Masters programs in education online.

Harvard Macy Institute Program for Educators in Health Professions This renowned program for medical educators consists of a 10-day winter session and 6-day spring session. The program focuses on six themes: the science of learning, teaching skills & strategies, inquiry and evidence in education, curriculum design, leadership development, and innovations in education.

Applicants must include a biographical sketch as well as a project proposal. The application process is fairly selective and many attendees are repeat applicants.

ALiEM Faculty Incubator Offered by Academic Life in Emergency Medicine (ALiEM), this year long professional development program for educators offers a limited enrollment of only 30 people. The structured, extensive curriculum is built upon an experiential model and includes advanced training in medical education and scholarship development. Each month focuses on a different topic lead by nationally renowned educators. The program includes unique opportunities to speak at national conferences, book clubs and journal clubs.

5 - BACKGROUND Pursuit of the medical education pathway allows one to develop expertise in clinical teaching and education resulting in career opportunities in academic Emergency Medicine (EM) as a clinical or classroom instructor or educational administrator.

Within the medical education track, students and residents may focus on one or more of the following areas: bedside training, classroom teaching, curriculum design and evaluation, medical education research, residency administration or medical simulation.

Why a Medical Education Pathway?

Medical education appeals to those who have a desire to teach. As a medical educator you have the opportunity to train future emergency physicians and help shape the future culture of medicine.

While a desire to teach is inherently necessary within the field, professionalization of medical education now requires a more focused set of skills. Educators must be able to identify and assess groups in need of knowledge and develop interventions to help them learn. This encompasses a focus on both how the target group learns and how to motivate them to remember.

History of Academic Emergency Medicine

The development of medical education within EM is inherently the history of the development of EM as a primary specialty.

Initially, EM was conducted by physicians from other specialties especially surgery, internal and family medicine. With recognition of EM as a standalone specialty in 1979, academic institutions began setting up EM programs with curricula focused solely on EM. The first full-time EM practice was established in Alexandria, Virginia under the direction of Dr. James D. Mills, Jr. This group was ground breaking at the time but their early practice model largely reflects EM as a field today: they referred all patients for admission or outpatient care, they practiced exclusively in the emergency department, and they saw all patients regardless of ability to pay.

Hospitals across the country quickly began implementing the Alexandria model. The resultant rapid growth in the field of emergency medicine exposed the gaping deficiency in education specific to EM; practicing physicians at the time were trained in internal, surgical or family. As a result, the American College of Emergency Physicians (ACEP) was founded and began work towards recognition of EM as an independent specialty. In 1979, the American Board of Emergency Medicine (ABEM) was

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formally recognized. With this recognition, EM programs became established and emergency physicians became responsible not only for determining the body of knowledge constituting EM, but training future physicians within the role.

Rapp, M & Podgorny, G. “Reflections on Becoming a Specialty and Its Impact on Global Emergency Medical Care: Our Challenge for the Future.” Specialty Status and International EM Development.

Current Academic Track

Individuals pursuing this track have an ever-expanding field of career options open to them. Traditionally, this track leads to careers in either undergraduate or graduate medical education or research. This can include positions as associate professors, residency program leadership, assistant or associate deans of medical schools or a dedicated institutional officer for GME at any institution.

Positions in national health education are also available. In addition, educators can become involved in specific educational opportunities such as simulations, CME opportunities, and training of other health providers (RN, NP, PA, CRNA, EMT, etc.).

• P ositions: Roles available to those interested in academic EM are readily available and continuing to expand. Not only are numerous positions open within teaching institutions and research projects, but the versatile nature of EM opens opportunities outside of EM resident education including simulation training, disaster education, ultrasound education and allied health provider training.

• S alary: While compensation varies dependent on location, experience, credentialing, etc., EM physicians who focus their nonclinical time in education are no different than academic EM practitioners in that they generally receive less annual pay than their counterparts working exclusively in private practice. While no hard and fast rule exists, educators generally receive salaries approximately 2/3rds of their non-academic counterparts, though this has to be balanced against the other rewards that come with being a part of an academic faculty and its respective setting.

Fellowship salaries accredited through the ACGME are dependent on being considered as adjunct faculty or a PGY 4 - 5 positions.

• G eography: Educational opportunities within residency training programs are as geographically dispersed as medical schools.

Most are located in urban areas, though many community hospitals are beginning to incorporate emergency residency programs as well. Outside of traditional UGME and GME roles, education positions are ubiquitous.

• W ork hours: Work hours typically mirror those of non-academic emergency physicians, however, academic tracks often incorporate some level of time split between clinical, administrative and scholarly activities. That said, educators often report working more hours than contracted which can include such tasks as a journal club or dinner with residency program applications.

• R esearch requirement: Dependent on institution as well as position - requirement can range from none to a significant amount.

• F uture of the Academic EM: The need for EM physicians to fill academic positions is expected to continue to grow alongside the expanding need for physicians as well as health educators.

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6 - RESOURCES SAEM Clinician-Educator Series

Grants & Scholarships for Academic EM Research:

Clubs and Memberships:

SAEMF/Resident and Medical Students (RAMS) Research Grant • Eligible: Student, Resident • Award: $5,000 (maximum) • Deadline: August 1

These include a series of summaries, articles, and podcasts with advice, guidance, and evidence-based strategies to help medical students and residents become successful clinician educators.

• Adult Learning Theory • Feedback • Specific Teaching Strategies • Online Resources • Mentorship and Podcasts • S ociety for Academic Emergency Medicine (SAEM) • S AEM Residents and Medical Students (RAMS) Education Committees • SAEM Residents and Medical Students (RAMS) • E M Resident and Student Association (AAEM/RSA) • A merican Academy of Emergency Medicine (AAEM) • A merican College of Emergency Physicians (ACEP) • E mergency Medicine Residents’ Association (EMRA)

Journals and Publications: • • • • • • •

A cademic Emergency Medicine A cademic Emergency Medicine Education and Training J ournal of Education and Teaching - Emergency Medicine M edical Teacher A cademic Medicine J ournal of Graduate Medical Education W estern Journal of Emergency Medicine

Conferences:

• S ociety for Academic Emergency Medicine: Annual Meeting – Annually every May • Council of Emergency Medicine Residency Directors (CORD) Academic Assemblies – Annually late March/early April

• Th is is not considered to be a comprehensive list by any means but rather an example of the many different possibilities present in Medical Education. For additional guidance reach out to your institutional Emergency Medicine mentors for more guidance.

Education Fellowship Grant • Eligible: Senior residents • Award: $50,000 per year for 2 years fellowship • Deadline: August 1 EMF/SAEMF Medical Student Research Grant • Eligible: Medical Student • Award: Maximum $5,000 towards EM research • Deadline: February 16 EMRA Simulation Research Grant • Eligible: Student, Resident, Fellow • Award: $500 (maximum) towards simulation research • Deadline: July 15 Scholarship: Emergency Medicine Basic Research Skills (EMBRS) Workshop • Eligible: Student, Resident or Fellow • Award: Registration fees & $500 travel costs to attend EMBRS • Deadline: January 15 EMF-ACEP Teaching Fellowship Scholarship • Eligible: Graduating resident or completed residency within last 5 years • Award: Tuition ($1615) to attend ACEP Teaching Fellowship • Deadline: January 15 Emergency Medicine Interest Group Grant • Eligible: Medical Student EMIG’s • Award: $500 to support educational endeavor of EMIG • Deadline: January 5

7 - INSIDER ADVICE Dr. Kaushal H. Shah, Emergency Medicine Program Director, Mount Sinai “Emergency medicine is rapidly becoming more competitive and sophisticated. Research is more intense and well thought out. Everything is more sophisticated. Keep this in mind as you build your resume.

What may have sufficed yesterday, may not be enough going forward.”

“Research has become the currency for promotion within academic medicine.”

Dr. Arlene S. Chung, Emergency Medicine Assistant Program Director, Mount Sinai “While not necessary at this time, I envision a future where some of the higher level positions such as program director will require a fellowship, a masters or some equivalent.”

Dr. D. Mark Courtney, Emergency Medicine Associate Professor/Director of Research, Northwestern University — Past President, SAEM Board of Directors “The bottom line is you will largely not be paid for education endeavors unless you are a program director or associate/assistant program director. Department chairs only fund “protected time” for educators in as much as they have funds to do so from the medical school or graduate education office, or from grants that individual educators apply for. This makes career planning, fellowship, possible grant writing and productivity in the education domain all the more important.”