- Email: [email protected]
Career advancement in surgical education
Surgery xxx (2019) 1e4
Contents lists available at ScienceDirect
Surgery journal homepage: www.elsevier.com/locate/surg
Career advancement in surgical education Kyla P. Terhune, MDa,*, Amit R.T. Joshi, MDb, Jennifer Choi, MDc a b c
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN Department of Surgery, Einstein Healthcare Network, Philadelphia, PA Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 18 July 2019 Available online xxx
Having been inspired by prior master surgeon educators, many seek careers as surgeon educators. However, the definition of surgeon educator has developed into a complex and exciting career trajectory that requires delineation beyond master surgeon teacher. The integration of the science of knowledge and skill acquisition into surgical training and administration has led to multiple career paths within the areas previously associated broadly with surgical education. In this article, we define the many paths of the surgeon educator and take the reader through a potential framework for establishing a mission while simultaneously taking steps in personal and professional development that promote career advancement in surgical education. © 2019 Elsevier Inc. All rights reserved.
Frequently, budding surgeons wish to make education part of their careers. This notion often arises out of the role-modeling of outstanding clinical teachers who are not only great surgeons, but have also developed the ability to teach the art and science of surgery. As the current surgeon educator encompasses much more than just outstanding teaching, excellence in clinical surgery is an absolute first step to becoming a notable surgeon educator. Thus, the first step for any developing surgeon educator is to master one's abilities as a surgeon, followed closely or simultaneously by mastering one's abilities as a teacher. Without the former though, the latter is of no use. For those who desire surgical education as a major component of their careers, we recommend being intentional from the beginning, considering both the abstract and the practical, by developing an individual mission and a portfolio. The former is a conceptual framework to facilitate direction and activities. The latter is an accounting of all aspects of output, an exercise necessary to record accomplishments and take advantage of growth opportunities.
considerations and need not be shared with anyone else. They might involve personal priorities, such as one's family's needs, consideration of professional opportunities for a spouse or partner, or geographic preferences. In addition, they might involve professional priorities, such as type of practice, workplace flexibility, or call frequency. We recommend that as readers consider developing as surgical educators, they always anchor on their priorities when making decisions about paths and pursuits. Priorities change through progressive stages of life, and surgeons should re-establish their priorities and mission every 3 to 5 years to be able to nimbly navigate their careers. An example of one author’s priorities:
The Mission: Establishing Priorities
Mission Statement: The Beacon
Creating a mission is best when built on a scaffold of priorities. Priorities should be driven by what an individual finds most fulfilling. These should incorporate both professional and personal
Once priorities are established, the next step is to establish a mission statement that supports these priorities. This should be a statement that is a generalization of the professional path that the surgeon educator intends to pursue. Although different aspects of surgical education are not exclusive of one another, there are areas of specialty within surgical education itself, and it is important to concentrate one’s efforts as much as possible while still having
* Reprint requests: Kyla P. Terhune, MD, Department of Surgery, Vanderbilt University Medical Center, 209 Light Hall, 2215 Garland Ave, Nashville, TN 37232. E-mail address: [email protected] (K.P. Terhune). https://doi.org/10.1016/j.surg.2019.07.036 0039-6060/© 2019 Elsevier Inc. All rights reserved.
1) 2) 3) 4) 5)
Be the best parent and spouse that I can be Provide the best operative and clinical care that I can Promote and mentor others, primarily residents Create innovative curricula Catalyze organizational change
2
K.P. Terhune et al. / Surgery xxx (2019) 1e4
My Ideal Learners? • Faculty • Residents and Fellows • Medical Students • Undergraduate Students • Secondary School Students • Ancillary Staff • Community Members
My Preferred Venues of Daily Dues? • Paent Care • Classroom • Administraon • Outreach • Simulaon • Coaching
My Scholarly Focus? • Technology • Educaonal Theory • Workforce • Demographics • Curriculum Development • Accreditaon • Assessment • Feedback • Diversity/Inclusion • Quality Improvement
Figure. Examples of areas to consider in developing a mission.
pivot options. Figure depicts a representative sample of the many possibilities within a surgical education career that should be considered when evaluating potential direction and fulfillment. Some of the elements depicted in Figure are easily combined (eg, educational theory, teaching, and simulation research), whereas some of them are less easily combined or would need to be more specialized because of the lack of overlap. For example, if one’s focus is on medical students and clerkship administration, faculty development might be best focused in the limited scope of medical student education and the needs of the clerkship. Because of the potentially overwhelming volume and breadth of work to be done in surgical education, the answers to specific questions will enable the mission statement to be focused. Who are one’s ideal learners? What are one’s day-to-day duties? Within research, what will be the major focus? The surgeon educator should be introspective and seek advice on his or her strengths that can be best utilized, while at the same time understanding the limits of institutional resources. For example, if the same author above were to answer the above questions, the answers would be the following: Who are the ideal learners? Primarily residents What are ideal day-to-day duties? Surgical care of patients and administration What is the planned major scholarly focus? Workforce, and the intersection of education and business in patient care The mission statement that emerges from the answers to these questions could easily be displayed on a biosketch or within a curriculum vitae. “My professional goals are to provide the best clinical and operative care I can to every patient I encounter, to advise and promote those interested in medicine (particularly surgery) through administration in graduate medical education, and to research the best methods of educating trainees to deliver patient-centered care globally.” We recommend that mission statements not be focused on a particular position (eg, program director, clerkship director, simulation center director) as one may find fulfilling opportunities or
settings that were previously not considered. This allows an individual to remain flexible throughout his or her career and maximize opportunities along the way. Priorities and mission statements should be reassessed periodically and changed whenever necessary. For example, life circumstances may necessitate a change in priorities and a new interest, discovery, or professional development opportunity may precipitate a change in a mission statement. This is acceptable and normal, and allows one to more readily adapt when external, uncontrollable circumstances change the environment or situation. 1-, 3-, and 5-Year Plans: The Roadmap Success in one’s career is built on short- and long-term wins. With the mission statement as the beacon, we next recommend creating a series of plans with measurable outcomes. One-year goals should focus on easily modifiable items, which require little or no additional resources (including capital), rely on existing personnel, and can be initiated quickly and completed within 6 months. A 1-year goal may be as simple as volunteering to lead a project that fills a need within the clerkship or residency. Following through on the project for which one volunteered is essential to gain support from leadership and other faculty for 3and 5-year goals. Three-year goals require multiple phasesdinitial planning, approval, and implementation. Although more ambitious, they should be goals, which would be relatively easily accepted within the current institutional culture and departmental goals. An example of a 3-year goal might be to serve on the medical school curriculum committee. In planning, one must determine the means for membership on the committee (election or appointment). For approval, seek permission for time away from clinical duties for the committee meetings. Once approved, implement the process identified to serve on the committee and carry out action plans of the committee. Five-year goals should be lofty and few in number. Five-year goals would be expected to require a culture shift, an intense communication phase (to recruit people to the cause), and potential pilots followed by roll-out, and could potentially require additional capital to be harnessed. An example may include identification of external funding for an education research project, development and implementation of a particular curricular element, or attendance at a substantial career development opportunity.
K.P. Terhune et al. / Surgery xxx (2019) 1e4 Table I Examples of organizations relevant to surgical educators American College of Surgeons (ACS) www.facs.org Association of Surgical Education (ASE) www.surgicaleducation.com Association of Program Directors in Surgery (APDS) www.apds.org Accreditation Council for Graduate Medical Education (ACGME) www.acgme.org Association of American Medical Colleges (AAMC) www.aamc.org The National Resident Matching Program (NRMP) www.nrmp.org Association for Academic Surgery (AAS) www.aasurg.org Society of University Surgeons (SUS) www.susweb.org
Aligned with each of the goals, one should also think about what he or she would need personally in order to best implement the goals. For example, would the distant goals require additional training, observation, or education in order to be fully successful? Ultimately, this is personal strategic planning, which leads us to the next aspect of the manuscriptdfocusing on professional development.
Professional Development: The Foundation Once mission statements and goals have been solidified, additional personal and professional development will be helpful to accomplish those goals. Frequently, surgeons assume that being a seasoned learner with years of school and training translates into being an excellent educator. Although this is important for foundational knowledge, substantially more personal and professional progress can be made by developing an understanding of the various aspects of educational development, leadership, and research. This can be accomplished locally, regionally, or even nationally via society-associated programs or advanced degrees. 1) Local opportunities: First and foremost, one should identify a mentor or group of mentors. Ideally, these should be easily accessible individuals who can meet regularly and who can help identify available growth opportunities with the department or the institution. Many institutions have established educational development opportunities in the form of lectures, seminars, workshops, and communities of educators who can collaborate on research and curricular initiatives. An ideal selection of activities and involvement should be focused on areas within the identified mission and goals, as noted above. 2) External opportunities: For those still in training, surgical education fellowships, typically connected to a simulation center at a major academic institution, can provide a foundation for a career in surgical education. Such fellowships provide the opportunity for a resident to utilize dedicated research time to obtain formal training in surgical education, often combined with research and teaching, and affording the resident the opportunity to be involved nationally in committees, curriculum planning, and academic presentations. Also for residents, the American College of Surgeons (ACS) hosts an annual Residents as Teachers and Leaders course. Mid- and senior-level residents gather to participate in didactic sessions and workshops led by successful individuals in both education and leadership.1
3
Table II Examples of education journals relevant to surgeon educators Surgery Journal of Surgical Education Journal of Surgical Research Journal of Graduate Medical Education Academic Medicine Annals of Surgery Journal of the American College of Surgeons JAMA Surgery American Surgeon
For those either in training or already on faculty, the Association of Surgical Education offers a 1-year Surgical Education Research Fellowship, which comprises coursework, mentorship, research, and networking through meetings at Surgical Education Week and the ACS Clinical Congress.2 Graduates are recognized yearly and then become part of an extensive alumni network. Once on faculty, there are several key external opportunities that one should consider for professional development. The ACS Surgeons as Educators Course is in its 26th year at the time of writing this manuscript.3 With objectives built around teaching skills, curriculum development, educational administration and leadership, and performance and program evaluation, the course boasts almost all prominent surgeon educators among its graduates. 3) Pursuit of an additional degree: As the field of surgical education has been growing during the past decade, so have those within it obtaining advanced degrees in education, including Master of Education (M.Ed.) and Doctor of Philosophy (PhD) in Education. Many programs offer on-line options, and many offer specializations in medical education, such as a Master of Health Professions Education. Also, the ACS now confers a Certificate in Applied Surgical Education Leadership that is intended to serve as preparation for a career in surgical education and may be less time-consuming than a formal degree.4 Some surgeon educators who foresee more operational administration in their careers, as program directors, designated institutional officials, or even division chiefs may find value in additional training in human resources, employment law, and organizational behavior. There is a trend in these situations towards a Master of Business Administration or a similar advanced degree in Management.
Productivity: The Output Any form of productivity as a surgeon educator needs to be documented. First we will consider elements of output and then will suggest ways to keep specific elements in a portfolio for easy access. First, it is most important to stay relevant in one’s primary position and location. Based on desired efforts within education, one should look for all local opportunities to execute the identified mission. This can be through the creation of curriculum, committee work, faculty development, etcdfocusing these efforts on the mission statement. Second, one should find a community of surgeon educators nationally and regionally and be active. There are multiple major societies where every member can participate in the network, resources, and conferences and use the societies as sources of support, information, and opportunity (Table I). Committee participation (and eventually leadership) are important avenues of networking and involvement.
4
K.P. Terhune et al. / Surgery xxx (2019) 1e4
Table III Checklist of example headings to include in a digital portfolio framework Applications (eg, for programs, awards, etc) Appointments (letters of appointments for positions, committee chairs, etc) Awards (scanned awards or certificates of accomplishments) Biographies (for quick use when asked to produce one) Certifications (Basic Life Support, Advanced Cardiovascular Life Support, Board certifications, etc) Continuing medical education earned (separate out into reported and unreported for MOC) Conferences Curriculum (store evidence of curriculum development here) Curriculum vitae (labeled each month as updated) Evaluations (save all course and lecture evaluations as evidence of teaching activity and quality) Examinations (results of any examinations taken) Letters of recommendation (especially if drafted about oneself) Meaningful interactions (meaningful electronic letters and notes from mentees or learners here) Memberships (record of memberships in organizations) Mentoring activities (mentees, related documents, their accomplishments) Missions and plans (place to save the above, easy to pull from if needed) Photos (keep easily producible stock photos for biographies here) Publications (keep easily accessible PDFs of final publications here) Reviews (store journal reviews relative to surgical education)
Finally, scholarly activity is an important element. Scholarly activity may include original research published in relevant journals (Table II), peer-reviewed curricula published on sites such as The Surgical Council on Resident Education (SCORE) and MedEdPortal, or essays on implementation published in “Resources in surgical education” by the ACS, “Perspectives” in the Journal of Surgical Education, or “Really good stuff” in Medical Education.5e7
A Solid Education Portfolio: The Record It is important for educators to fully record all of their accomplishments and pursuits as they relate to the field of surgical education. The simplest place to start is by creating one’s digital portfolio, which can be formalized when needed. One should create a routine (at least monthly) of updating the educational portfolio and the curriculum vitae, especially at the start of a career. Additionally, as certifications, continuing medical education, course evaluations, awards, and other potentially relevant information are received electronically, these should be saved immediately into the digital portfolio in order to have an updated and easily accessible track record. If not received electronically, items should be scanned in immediately and placed into the digital portfolio. Some academic programs have specific templates for portfolios in a clinical educator track, but we recommend a simple folder on one’s desktop or laptop entitled Portfolio, which can then be imported as needed and used to track widely. Potential elements (folders) to include in the educational portfolio are found in Table III. One should be able to pull from this relatively quickly and easily to then apply for awards, grants, and other opportunities.
Academic Advancement: The Reward All faculty, whether at an academic medical center or affiliate institution, should know the rubric applied at his or her institution for advancement. As soon as one is hired, we recommend reviewing the specific promotion requirements, as they vary widely. A clinical (nontenure) track is a widely utilized pathway by institutions for those in education; however, if one has the potential for funded and significant research, a tenure-track pathway is also an option. One should be certain of his or her track and then start recording (see section on portfolio) with this advancement in mind. Summary There are many different pathways in surgical education. The framework outlined above can serve as an approach to ensure career growth and advancement in surgical education. There are often unexplored avenues beyond traditional roles of clerkship director, program director, and more recently, Vice Chair for Education.8 Surgeons who thrive in the realm of education acquire experiences, perspectives, and skills that make them appealing in medical education nationally, allowing them to be leaders in broader issues in healthcare. Conflict of interest/Disclosure Dr Joshi receives salary support from SCORE (a not-for-profit American Board of Surgery subsidiary) in his role as Vice President. SCORE is noted above as a potential destination for curriculum submission for surgical educators. Dr Terhune has received stipends from the American College of Surgeons as a faculty member of the ACS Resident as Teachers and Leaders Course, noted above as a potential program for resident trainees. Dr Choi does not report any financial conflicts of interest. References 1. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. ACS residents as teachers and leaders. https://www.facs.org/education/ division-of-education/courses/residents-as-teachers. Accessed May 29, 2019. 2. The Association for Surgical Education. The Association for Surgical Education, 2019. Surgical education research fellowship overview. https://surgicaleducation. com/surgical-education-research-fellowship-overview/. Accessed May 29, 2019. 3. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. 26th Annual ACS Surgeons as Educators. https://www.facs.org/education/ division-of-education/courses/surgeons-as-educators. Accessed May 29, 2019. 4. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. ACS certificate in applied surgical education leadership. https://www.facs. org/education/program/casel. Accessed May 29, 2019. 5. The SCORE Portal. The Surgical Council on Resident Education Inc., 2009-2019. http://portal.surgicalcore.org/. Accessed May 29, 2019. 6. MedEdPORTAL. AAMC, 2019. https://www.mededportal.org/. Accessed May 29, 2019. 7. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. Resources in Surgical Education (RISE). https://www.facs.org/education/ division-of-education/publications/rise. Accessed May 29, 2019. 8. Sanfey HS, Boehler M, DaRosa D, Dunnington GL. Career development resource: Educational leadership in a department of surgery: Vice chairs for education. Am J Surg. 2012;204:121e125.
Contents lists available at ScienceDirect
Surgery journal homepage: www.elsevier.com/locate/surg
Career advancement in surgical education Kyla P. Terhune, MDa,*, Amit R.T. Joshi, MDb, Jennifer Choi, MDc a b c
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN Department of Surgery, Einstein Healthcare Network, Philadelphia, PA Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 18 July 2019 Available online xxx
Having been inspired by prior master surgeon educators, many seek careers as surgeon educators. However, the definition of surgeon educator has developed into a complex and exciting career trajectory that requires delineation beyond master surgeon teacher. The integration of the science of knowledge and skill acquisition into surgical training and administration has led to multiple career paths within the areas previously associated broadly with surgical education. In this article, we define the many paths of the surgeon educator and take the reader through a potential framework for establishing a mission while simultaneously taking steps in personal and professional development that promote career advancement in surgical education. © 2019 Elsevier Inc. All rights reserved.
Frequently, budding surgeons wish to make education part of their careers. This notion often arises out of the role-modeling of outstanding clinical teachers who are not only great surgeons, but have also developed the ability to teach the art and science of surgery. As the current surgeon educator encompasses much more than just outstanding teaching, excellence in clinical surgery is an absolute first step to becoming a notable surgeon educator. Thus, the first step for any developing surgeon educator is to master one's abilities as a surgeon, followed closely or simultaneously by mastering one's abilities as a teacher. Without the former though, the latter is of no use. For those who desire surgical education as a major component of their careers, we recommend being intentional from the beginning, considering both the abstract and the practical, by developing an individual mission and a portfolio. The former is a conceptual framework to facilitate direction and activities. The latter is an accounting of all aspects of output, an exercise necessary to record accomplishments and take advantage of growth opportunities.
considerations and need not be shared with anyone else. They might involve personal priorities, such as one's family's needs, consideration of professional opportunities for a spouse or partner, or geographic preferences. In addition, they might involve professional priorities, such as type of practice, workplace flexibility, or call frequency. We recommend that as readers consider developing as surgical educators, they always anchor on their priorities when making decisions about paths and pursuits. Priorities change through progressive stages of life, and surgeons should re-establish their priorities and mission every 3 to 5 years to be able to nimbly navigate their careers. An example of one author’s priorities:
The Mission: Establishing Priorities
Mission Statement: The Beacon
Creating a mission is best when built on a scaffold of priorities. Priorities should be driven by what an individual finds most fulfilling. These should incorporate both professional and personal
Once priorities are established, the next step is to establish a mission statement that supports these priorities. This should be a statement that is a generalization of the professional path that the surgeon educator intends to pursue. Although different aspects of surgical education are not exclusive of one another, there are areas of specialty within surgical education itself, and it is important to concentrate one’s efforts as much as possible while still having
* Reprint requests: Kyla P. Terhune, MD, Department of Surgery, Vanderbilt University Medical Center, 209 Light Hall, 2215 Garland Ave, Nashville, TN 37232. E-mail address: [email protected] (K.P. Terhune). https://doi.org/10.1016/j.surg.2019.07.036 0039-6060/© 2019 Elsevier Inc. All rights reserved.
1) 2) 3) 4) 5)
Be the best parent and spouse that I can be Provide the best operative and clinical care that I can Promote and mentor others, primarily residents Create innovative curricula Catalyze organizational change
2
K.P. Terhune et al. / Surgery xxx (2019) 1e4
My Ideal Learners? • Faculty • Residents and Fellows • Medical Students • Undergraduate Students • Secondary School Students • Ancillary Staff • Community Members
My Preferred Venues of Daily Dues? • Paent Care • Classroom • Administraon • Outreach • Simulaon • Coaching
My Scholarly Focus? • Technology • Educaonal Theory • Workforce • Demographics • Curriculum Development • Accreditaon • Assessment • Feedback • Diversity/Inclusion • Quality Improvement
Figure. Examples of areas to consider in developing a mission.
pivot options. Figure depicts a representative sample of the many possibilities within a surgical education career that should be considered when evaluating potential direction and fulfillment. Some of the elements depicted in Figure are easily combined (eg, educational theory, teaching, and simulation research), whereas some of them are less easily combined or would need to be more specialized because of the lack of overlap. For example, if one’s focus is on medical students and clerkship administration, faculty development might be best focused in the limited scope of medical student education and the needs of the clerkship. Because of the potentially overwhelming volume and breadth of work to be done in surgical education, the answers to specific questions will enable the mission statement to be focused. Who are one’s ideal learners? What are one’s day-to-day duties? Within research, what will be the major focus? The surgeon educator should be introspective and seek advice on his or her strengths that can be best utilized, while at the same time understanding the limits of institutional resources. For example, if the same author above were to answer the above questions, the answers would be the following: Who are the ideal learners? Primarily residents What are ideal day-to-day duties? Surgical care of patients and administration What is the planned major scholarly focus? Workforce, and the intersection of education and business in patient care The mission statement that emerges from the answers to these questions could easily be displayed on a biosketch or within a curriculum vitae. “My professional goals are to provide the best clinical and operative care I can to every patient I encounter, to advise and promote those interested in medicine (particularly surgery) through administration in graduate medical education, and to research the best methods of educating trainees to deliver patient-centered care globally.” We recommend that mission statements not be focused on a particular position (eg, program director, clerkship director, simulation center director) as one may find fulfilling opportunities or
settings that were previously not considered. This allows an individual to remain flexible throughout his or her career and maximize opportunities along the way. Priorities and mission statements should be reassessed periodically and changed whenever necessary. For example, life circumstances may necessitate a change in priorities and a new interest, discovery, or professional development opportunity may precipitate a change in a mission statement. This is acceptable and normal, and allows one to more readily adapt when external, uncontrollable circumstances change the environment or situation. 1-, 3-, and 5-Year Plans: The Roadmap Success in one’s career is built on short- and long-term wins. With the mission statement as the beacon, we next recommend creating a series of plans with measurable outcomes. One-year goals should focus on easily modifiable items, which require little or no additional resources (including capital), rely on existing personnel, and can be initiated quickly and completed within 6 months. A 1-year goal may be as simple as volunteering to lead a project that fills a need within the clerkship or residency. Following through on the project for which one volunteered is essential to gain support from leadership and other faculty for 3and 5-year goals. Three-year goals require multiple phasesdinitial planning, approval, and implementation. Although more ambitious, they should be goals, which would be relatively easily accepted within the current institutional culture and departmental goals. An example of a 3-year goal might be to serve on the medical school curriculum committee. In planning, one must determine the means for membership on the committee (election or appointment). For approval, seek permission for time away from clinical duties for the committee meetings. Once approved, implement the process identified to serve on the committee and carry out action plans of the committee. Five-year goals should be lofty and few in number. Five-year goals would be expected to require a culture shift, an intense communication phase (to recruit people to the cause), and potential pilots followed by roll-out, and could potentially require additional capital to be harnessed. An example may include identification of external funding for an education research project, development and implementation of a particular curricular element, or attendance at a substantial career development opportunity.
K.P. Terhune et al. / Surgery xxx (2019) 1e4 Table I Examples of organizations relevant to surgical educators American College of Surgeons (ACS) www.facs.org Association of Surgical Education (ASE) www.surgicaleducation.com Association of Program Directors in Surgery (APDS) www.apds.org Accreditation Council for Graduate Medical Education (ACGME) www.acgme.org Association of American Medical Colleges (AAMC) www.aamc.org The National Resident Matching Program (NRMP) www.nrmp.org Association for Academic Surgery (AAS) www.aasurg.org Society of University Surgeons (SUS) www.susweb.org
Aligned with each of the goals, one should also think about what he or she would need personally in order to best implement the goals. For example, would the distant goals require additional training, observation, or education in order to be fully successful? Ultimately, this is personal strategic planning, which leads us to the next aspect of the manuscriptdfocusing on professional development.
Professional Development: The Foundation Once mission statements and goals have been solidified, additional personal and professional development will be helpful to accomplish those goals. Frequently, surgeons assume that being a seasoned learner with years of school and training translates into being an excellent educator. Although this is important for foundational knowledge, substantially more personal and professional progress can be made by developing an understanding of the various aspects of educational development, leadership, and research. This can be accomplished locally, regionally, or even nationally via society-associated programs or advanced degrees. 1) Local opportunities: First and foremost, one should identify a mentor or group of mentors. Ideally, these should be easily accessible individuals who can meet regularly and who can help identify available growth opportunities with the department or the institution. Many institutions have established educational development opportunities in the form of lectures, seminars, workshops, and communities of educators who can collaborate on research and curricular initiatives. An ideal selection of activities and involvement should be focused on areas within the identified mission and goals, as noted above. 2) External opportunities: For those still in training, surgical education fellowships, typically connected to a simulation center at a major academic institution, can provide a foundation for a career in surgical education. Such fellowships provide the opportunity for a resident to utilize dedicated research time to obtain formal training in surgical education, often combined with research and teaching, and affording the resident the opportunity to be involved nationally in committees, curriculum planning, and academic presentations. Also for residents, the American College of Surgeons (ACS) hosts an annual Residents as Teachers and Leaders course. Mid- and senior-level residents gather to participate in didactic sessions and workshops led by successful individuals in both education and leadership.1
3
Table II Examples of education journals relevant to surgeon educators Surgery Journal of Surgical Education Journal of Surgical Research Journal of Graduate Medical Education Academic Medicine Annals of Surgery Journal of the American College of Surgeons JAMA Surgery American Surgeon
For those either in training or already on faculty, the Association of Surgical Education offers a 1-year Surgical Education Research Fellowship, which comprises coursework, mentorship, research, and networking through meetings at Surgical Education Week and the ACS Clinical Congress.2 Graduates are recognized yearly and then become part of an extensive alumni network. Once on faculty, there are several key external opportunities that one should consider for professional development. The ACS Surgeons as Educators Course is in its 26th year at the time of writing this manuscript.3 With objectives built around teaching skills, curriculum development, educational administration and leadership, and performance and program evaluation, the course boasts almost all prominent surgeon educators among its graduates. 3) Pursuit of an additional degree: As the field of surgical education has been growing during the past decade, so have those within it obtaining advanced degrees in education, including Master of Education (M.Ed.) and Doctor of Philosophy (PhD) in Education. Many programs offer on-line options, and many offer specializations in medical education, such as a Master of Health Professions Education. Also, the ACS now confers a Certificate in Applied Surgical Education Leadership that is intended to serve as preparation for a career in surgical education and may be less time-consuming than a formal degree.4 Some surgeon educators who foresee more operational administration in their careers, as program directors, designated institutional officials, or even division chiefs may find value in additional training in human resources, employment law, and organizational behavior. There is a trend in these situations towards a Master of Business Administration or a similar advanced degree in Management.
Productivity: The Output Any form of productivity as a surgeon educator needs to be documented. First we will consider elements of output and then will suggest ways to keep specific elements in a portfolio for easy access. First, it is most important to stay relevant in one’s primary position and location. Based on desired efforts within education, one should look for all local opportunities to execute the identified mission. This can be through the creation of curriculum, committee work, faculty development, etcdfocusing these efforts on the mission statement. Second, one should find a community of surgeon educators nationally and regionally and be active. There are multiple major societies where every member can participate in the network, resources, and conferences and use the societies as sources of support, information, and opportunity (Table I). Committee participation (and eventually leadership) are important avenues of networking and involvement.
4
K.P. Terhune et al. / Surgery xxx (2019) 1e4
Table III Checklist of example headings to include in a digital portfolio framework Applications (eg, for programs, awards, etc) Appointments (letters of appointments for positions, committee chairs, etc) Awards (scanned awards or certificates of accomplishments) Biographies (for quick use when asked to produce one) Certifications (Basic Life Support, Advanced Cardiovascular Life Support, Board certifications, etc) Continuing medical education earned (separate out into reported and unreported for MOC) Conferences Curriculum (store evidence of curriculum development here) Curriculum vitae (labeled each month as updated) Evaluations (save all course and lecture evaluations as evidence of teaching activity and quality) Examinations (results of any examinations taken) Letters of recommendation (especially if drafted about oneself) Meaningful interactions (meaningful electronic letters and notes from mentees or learners here) Memberships (record of memberships in organizations) Mentoring activities (mentees, related documents, their accomplishments) Missions and plans (place to save the above, easy to pull from if needed) Photos (keep easily producible stock photos for biographies here) Publications (keep easily accessible PDFs of final publications here) Reviews (store journal reviews relative to surgical education)
Finally, scholarly activity is an important element. Scholarly activity may include original research published in relevant journals (Table II), peer-reviewed curricula published on sites such as The Surgical Council on Resident Education (SCORE) and MedEdPortal, or essays on implementation published in “Resources in surgical education” by the ACS, “Perspectives” in the Journal of Surgical Education, or “Really good stuff” in Medical Education.5e7
A Solid Education Portfolio: The Record It is important for educators to fully record all of their accomplishments and pursuits as they relate to the field of surgical education. The simplest place to start is by creating one’s digital portfolio, which can be formalized when needed. One should create a routine (at least monthly) of updating the educational portfolio and the curriculum vitae, especially at the start of a career. Additionally, as certifications, continuing medical education, course evaluations, awards, and other potentially relevant information are received electronically, these should be saved immediately into the digital portfolio in order to have an updated and easily accessible track record. If not received electronically, items should be scanned in immediately and placed into the digital portfolio. Some academic programs have specific templates for portfolios in a clinical educator track, but we recommend a simple folder on one’s desktop or laptop entitled Portfolio, which can then be imported as needed and used to track widely. Potential elements (folders) to include in the educational portfolio are found in Table III. One should be able to pull from this relatively quickly and easily to then apply for awards, grants, and other opportunities.
Academic Advancement: The Reward All faculty, whether at an academic medical center or affiliate institution, should know the rubric applied at his or her institution for advancement. As soon as one is hired, we recommend reviewing the specific promotion requirements, as they vary widely. A clinical (nontenure) track is a widely utilized pathway by institutions for those in education; however, if one has the potential for funded and significant research, a tenure-track pathway is also an option. One should be certain of his or her track and then start recording (see section on portfolio) with this advancement in mind. Summary There are many different pathways in surgical education. The framework outlined above can serve as an approach to ensure career growth and advancement in surgical education. There are often unexplored avenues beyond traditional roles of clerkship director, program director, and more recently, Vice Chair for Education.8 Surgeons who thrive in the realm of education acquire experiences, perspectives, and skills that make them appealing in medical education nationally, allowing them to be leaders in broader issues in healthcare. Conflict of interest/Disclosure Dr Joshi receives salary support from SCORE (a not-for-profit American Board of Surgery subsidiary) in his role as Vice President. SCORE is noted above as a potential destination for curriculum submission for surgical educators. Dr Terhune has received stipends from the American College of Surgeons as a faculty member of the ACS Resident as Teachers and Leaders Course, noted above as a potential program for resident trainees. Dr Choi does not report any financial conflicts of interest. References 1. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. ACS residents as teachers and leaders. https://www.facs.org/education/ division-of-education/courses/residents-as-teachers. Accessed May 29, 2019. 2. The Association for Surgical Education. The Association for Surgical Education, 2019. Surgical education research fellowship overview. https://surgicaleducation. com/surgical-education-research-fellowship-overview/. Accessed May 29, 2019. 3. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. 26th Annual ACS Surgeons as Educators. https://www.facs.org/education/ division-of-education/courses/surgeons-as-educators. Accessed May 29, 2019. 4. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. ACS certificate in applied surgical education leadership. https://www.facs. org/education/program/casel. Accessed May 29, 2019. 5. The SCORE Portal. The Surgical Council on Resident Education Inc., 2009-2019. http://portal.surgicalcore.org/. Accessed May 29, 2019. 6. MedEdPORTAL. AAMC, 2019. https://www.mededportal.org/. Accessed May 29, 2019. 7. American College of Surgeons. Chicago: The American College of Surgeons, 19962019. Resources in Surgical Education (RISE). https://www.facs.org/education/ division-of-education/publications/rise. Accessed May 29, 2019. 8. Sanfey HS, Boehler M, DaRosa D, Dunnington GL. Career development resource: Educational leadership in a department of surgery: Vice chairs for education. Am J Surg. 2012;204:121e125.