Abstract
Following receipt of a doctorate of medicine, most physicians pursue postdoctoral training. This training is usually 4 to 8 years in duration. In most cases, it involves educational tasks with supervision for approximately 80 hours per week, didactic lectures averaging 3 to 6 hours per week (more in some programs), various intensive special courses, nationally standardized “in-service examinations” given annually, and a nationally standardized board examination.
Exceptional residents have always found time to publish and pursue scholarly activities in addition to fulfilling other residency requirements. Following residency, at least some of the best and brightest trainees will pursue careers in academic medicine, perhaps after fellowship training. However, do our residency programs, medicine in general and otolaryngology specifically, train people adequately for academic careers? In this writer's opinion, the answer is no.
Ideally, a skilled career academic physician should have a substantial knowledge base regarding teaching, evaluation, organizations involved in medical education and certification, and many other topics. At present, such special information is learned “on the job.” This takes several years and commonly results in misconceptions, misinformation, and knowledge gaps among clinical faculty nationwide.
To improve the quality of our educators, it seems worthwhile to try to identify the gaps in our present education system and develop strategies to correct them. Ultimately, it would be ideal to include additional training in education and leadership within our residency curriculum. An alternative would be the creation of new educational programs to address this problem. For example, a master of science in academic medicine has been created recently at Drexel University College of Medicine and should begin enrolling students this year (disclosure: as a member of the faculty, I have an interest in this graduate education program). A portion of the reasoning behind and content outline of this program is presented in this editorial to initiate broader discussion about what we should be teaching our teachers, and how we might do so.
The MS in academic medicine was designed for residents and faculty (especially young faculty) currently in training or practice, and it is intended to provide—in a convenient, organized fashion—information valuable in an academic setting. Details of this 35-credit-hour program will not be reviewed in this editorial. Summarizing the content of two components (core knowledge and research education) should help the reader understand how academic training may help prepare physicians better for academic careers than most residencies and fellowships do now.
One solution to the perceived problem of inadequate preparation for academic practice was the creation of a two-semester didactic course entitled “Academic Medicine: Core Knowledge.” This course provides lectures, supplemented by interactive training and targeted projects. It includes overviews of topics that are not generally addressed in detail during residency training but are important to academicians. These are intended to at least give students an introduction to selected subjects so that the students understand the topics’ scope and have some grasp of what they do not know.
Topics in the two-semester “Core Knowledge” course include, among others, principles of leadership, principles of education, techniques of assessment and evaluation, core competencies, professionalism, bioethics, politics and organized medicine, accrediting organizations (Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, the Joint Commission, etc.), legal issues in academic medicine, CV preparation, entrepreneurship, biotechnology, medical writing, medical editing, grant writing, funding sources (federal, private, and industrial), academic health center management (how to prepare a business proposal to support a capital budget request, for example), public speaking, and human research practices and regulations. These and numerous other topics included in the curriculum provide information and vocabulary that make us more effective in an academic setting but that many of us do not acquire during residency. Hopefully, we will in the future.
Research is important in academic practice, of course, but teaching research may be even more important to a career educator. Some residency programs have excellent systems for teaching and supervising resident research, but many do not. Too often, residents’ research training has involved coming up with an idea, proposing it to an attending, and being told “that is a good idea.” The research requirement in our academic medicine training program is designed not so much to result in great research (although acceptance for publication in a peer-reviewed journal is required), but rather to expose the trainee to a systematic research process.
The research project involves a thesis committee with at least one basic scientist; presentation of a proposal; revision of the proposal; preparation with men-torship of the committee, including consultation with a statistician; completion of a literature review and other requirements; progress reports to the committee; and thesis defense. This rigorous research training model is used routinely by our colleagues in the basic sciences. It seems clear that academic clinicians should advocate a rigorous training process for research preparation, execution, and evaluation. This tradition of systematic preparation and evaluation should be present in all of our training programs, not just some of the “better” ones.
Residency and fellowship training in otolaryngology are excellent in many ways, but we should always be looking for opportunities to improve. Whether we choose to educate our future academic leaders in the long run by incorporating education and leadership training into all residency curricula, through Academy courses, or through graduate programs, we should be thinking and talking about strategies to improve the academic knowledge and skills of current and future generations of otolaryngologists.