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AbstractPurposeMethods and MaterialsResultsConclusionsPhysician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work.We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together.In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program.Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators. [ABSTRACT FROM AUTHOR]

Phenomenon: The number of women who enter medical school has been on par with the number of men for almost 20 years, but parity in training has not translated to equity in professional life. To capitalize on the perspective of women faculty with established careers in academic medicine and to bring theory to the largely descriptive research on gender inequity in academic medicine, the authors used the Theory of Gendered Organizations to demonstrate how academic medical centers function as inherently gendered organizations. Approach: The authors recruited women faculty with established careers at one academic medical center based on purposeful and snowball sampling and interviewed 30 participants in Summer/Fall 2018. They coded and analyzed data inductively. In later stages of analysis they used sensitizing concepts from the Theory of Gendered Organizations to guide our focus on formal expectations of, and informal interactions in, the academic medical center. Findings: The disjuncture, i.e., "lip service", between formal expectations intended to be gender-neutral and informal interactions that advantaged men demonstrated how the academic medical center functioned as a gendered organization. Participants experienced these interactions as being treated differently than men and/or being stereotyped. As their careers progressed, participants recognized gender inequity as embedded in the organization, or as they said, "the way things were stacked". Subsequent to this recognition, they navigated this gendered organization by advocating for themselves and younger women faculty. Insights: Women with established careers in academic medicine experienced gender inequity as embedded in the organization but navigate gendered interactions by advocating for themselves and for younger women. Using the Theory of Gendered Organizations as an analytic lens demonstrates how academic medical centers function as gendered organizations; these findings can inform both theory-based research and pragmatic change strategies. [ABSTRACT FROM AUTHOR]

Background: The experience of transitioning to an academic faculty position can be improved with standardized educational interventions. Although a number of such interventions have been described, few utilize an evaluation framework, describe a robust evaluation process, and addresswhy their interventions were successful. In this article, the authors apply a logic model to describe their efforts to develop, implement, evaluate, and revise a comprehensive academic career development curriculum among pediatric subspecialty fellows. They describe inputs, activities, outputs, and outcomes using quantitative data from fellow evaluations and qualitative data from faculty interviews. Methods: Methods are described under the input and activities sections. The curriculum started with collaboration among educational leadership and conducting a needs assessment. Using the needs assessment results and targeted learning objectives, we piloted the curriculum and then implemented the full curriculum 1 year later. Results: Results are described under the outputs and outcomes sections. We present immediate, short-term, and 6-month evaluation data. Cumulative data over 3 years reveal that fellows consistently acquired knowledge relevant to transitioning and that they applied acquired knowledge to prepare for finding jobs and career advancement. The curriculum also benefits faculty instructors who gain a sense of reward by filling a critical knowledge gap and fostering fellows' professional growth. Conclusion: The authors relate the success and effectiveness of the curriculum to principles of adult learning, and share lessons learned, including the importance of buy-in from junior and senior fellows and faculty, collaboration, and designating the time to teach and learn. [ABSTRACT FROM AUTHOR]

Research is an important part of educational scholarship. Knowledge of research methodologies is essential for both conducting research as well as determining the soundness of the findings from published studies. Our goals for this paper therefore are to inform medical education researchers of the range and key components of educational research designs. We will discuss both qualitative and quantitative approaches to educational research. Qualitative methods will be presented according to traditions that have a distinguished history in particular disciplines. Quantitative methods will be presented according to an evidence-based hierarchy akin to that of evidence-based medicine with the stronger designs (systematic reviews and well conducted educational randomized controlled trials) at the top, and weaker designs (descriptive studies without comparison groups, or single case studies) at the bottom. It should be appreciated, however, that the research question determines the study design. Therefore, the onus is on the researcher to choose a design that is appropriate to answering the question. We conclude with an overview of how educational researchers should describe the study design and methods in order to provide transparency and clarity. [ABSTRACT FROM AUTHOR]

Background: Faculty development programs tend to be oriented around content, yet many have produced positive outcomes unrelated to the content. We describe a faculty development program that utilized the processes of shared reading and guided reflection espoused by narrative medicine. Description: To date, 25 preceptors in the Foundations of Clinical Medicine course have participated. The program consists of weekly seminars in which participants actively engage with text as a basis for conversation around content as well as teaching strategies. Evaluation: Using qualitative methods, we examined notes from seminars, in-depth interviews, and review of curricular documents; we used conceptual frameworks from education as interpretive lenses. Participants recognized both personal growth and transformation in relationships with each other, which created the opportunity, and the means, to address and reshape norms and teaching practices at the institution. Conclusions: Process-oriented faculty development programs may foster growth of individuals, contribute to transformation in relationships, and ultimately influence teaching practices. [ABSTRACT FROM AUTHOR]

Background: Six general competencies form the framework for accreditation of postgraduate fellowship programs and maintenance of certification for physician specialists. Fellows' perceptions of these competencies, however, remain unexplored. Aims: To examine fellows' perceptions of the importance of the competencies to medical education and the contribution of fellowship training to mastery of the competencies, and to explore the alignment of the competencies with critical learning experiences. Methods: Semi-structured interviews were conducted with 20 pediatric fellows in five divisions at one institution. Fellows recounted critical learning experiences, rated each competency for importance and contribution of training, and explained their ratings. Interviews were analyzed using standard qualitative methods. Results: Fellows assigned high ratings to medical knowledge and patient care for importance and contribution of training to mastery, referring to these competencies as 'staples of training'. They rated interpersonal and communication skills and professionalism higher for importance than contribution of training, viewing them as inherent traits or learned before fellowship. Fellows were unfamiliar with practice-based learning and improvement and systems-based practice and typically perceived them as secondary to training. Descriptions of critical learning experiences substantiated competency ratings for medical knowledge and patient care, but not practice-based learning and improvement. Conclusions: Fellows perceive traditional knowledge and skills of medical practice as fundamental to postgraduate training, but other competencies as less central. [ABSTRACT FROM AUTHOR]

AbstractPhenomenonApproachFindingsInsightsMarginalized individuals in medicine face many structural inequities which can have enduring consequences on their progress. Therefore, inequity must be addressed by dismantling underlying unjust policies, environments, and curricula. However, once these injustices have been taken apart, how do we build more just systems from the rubble? Many current strategies to address this question have foundational values of urgency, solutionism, and top-down leadership.This paper explores a counternarrative: Design Justice. As a set of guiding principles, Design Justice centers the experiences and perspectives of marginalized individuals and communities. These principles include mutual accountability and transparency, co-ownership, and community-led outcomes, and honoring local, traditional, Indigenous knowledge.Rooted in critical scholarship and critical design, Design Justice recognizes the interconnectedness of various forms of marginalization and works to critically examine power dynamics that exist in every design process. These co-created principles act as practical guardrails, directing progress toward justice.This paper begins with an overview of Design Justice’s history in critical scholarship and critical design, providing foundational background knowledge for medical educators, scholars, and leaders in key concepts of justice and design. We explore how the Design Justice principles were developed and have been applied across sectors, highlighting its applications, including education applications. Finally, we raise critical questions about medical education prompted by Design Justice. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience of meeting his mentor who helped him in his career.