Sunday, September 18, 2011

Love Education and Like Education

I am a Program Director for a Residency.  That means that I oversee the training of physician residents training in my field: from what material they are educated on, to how they are educated.  There are certain rules that must be followed, such as providing a minimum amount of vacation per year, designing models for appropriate supervision, how they document the number of patients they see, and the duty hour rules. 
I just finished a half-month of duty on the inpatient ward service.  I always enjoy this time, as it gets me back to why I went into medicine in the first place: to care for patients.  I was able to see firsthand how residents and students are taking histories, are interacting with patients and colleagues, and are performing physical examinations.  In addition, I feel privileged to teach “this is how one can think like a doctor.”
Suffice it to say: I “love” education.  Most of us who have part of our salary dedicated to education (all program directors must have this) would likely get lumped into this “Love Education” bucket.  Others in this category would include clerkship directors (those physicians who oversee required rotations for 3rd year or 4th year medical students), fellowship directors for subspecialties, and Deans of Student Affairs, to name just a few.  These types of physicians still constitute a small percentage of the entire faculty.
The majority of the faculty I would lump into the other bucket: “Like Education”.  These are physicians who primarily see patients and/or direct programs, or are involved in research.  Their jobs include primarily seeing patients in either the inpatient or the outpatient settings.  They may also direct certain clinical programs (e.g., Medical Director of the Cystic Fibrosis program, Director of Outpatient Dialysis Program).  In other words, they are not directly responsible for the oversight of education of residents or students, but have a key role in providing that education, by hosting students or residents in the venues where they care for patients.  They are the ones doing the majority of the actual day-to-day teaching.  They may be (and usually are) phenomenal teachers, and certainly enjoy interacting with residents or medical students. 
Here is my concern: we are losing more “Like Education”-doctors to the reality of the ever-increasing requirements such as the duty hours. 
“Well, I’m just too busy now to take a resident; gotta see more patients, you know.” 
“I enjoy having students in the office, but they slow me down, and thus I can’t see as many patients” 
“I would love to host a medical student now, but unfortunately, just cannot do so, as the documentation requirements just keep going up and up.” 
These are NOT bad people: they like educating our future physicians, but external forces (whatever they are) prevent them from being able to continue their “like” of educating the future physicians.
My concern is that these are the physicians who really make a difference for the training, who really are the ones that the trainees see interacting with patients, and who mentor the trainees.  I hope that the regulatory requirements will eventually hit a tipping point, and can eventually be lessened, so that we will have enough doctors who like educating future doctors to actually do so. 
The “Love Education” physicians will continue to educate no matter what (mostly because it is part of their job).  It is the “Like Education” physicians that need encouragement to continue to be great educators.  Let’s continue to support “Like Education” physicians, in order to keep training alive and well.  They are a necessary component of education, are truly the backbone of what is needed to educate physician trainees, and should be rewarded as such.


  1. So true! The "Like Education" group is the key for the future. We need to find ways to not only engage them but also to show them that they are valued by the program. We will never get them into the "Love Education" group, but that shouldn't be the goal. We should utilize the time that they are willing to offer as best we can and inspire them to want to give more. Otherwise, we are going to burn out the "Love Education" group as they taken on more and more and more and also push the "Like Education" group into the "Dislike Education" group. Don't preach to the choir, start a new choir!

  2. Agree! Embrace the "like education" physicians and even work to further inspire the "tolerate education" physician. And the "I can't remember having been a student" physician?

    What is the academic physician's mission? At our children's hospital we CARE... Care, Advocacy, Research AND education? and

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