LESSONS LEARNED

From Clinical Practice to Academia Mary L. Warner, MMSc, PA-C

Feature Editor’s Note: Physician assistant (PA) education will soon be celebrating its 50th birthday. Just as the profession has matured, so have our pedagogy, the depth and breadth of medical content, educational resources, and external infrastructures. The “Lessons Learned” column is a forum to document insights and observations about PA education that challenge us to reflect on our past and relate to our future. It is fitting that this first article pays respect to one mentor who graciously provided insight early in my PA education career. This article, although meant for the new educator, highlights the responsibility senior faculty have to actively support the development of new faculty. At a time when our faculty shortage could impact the quality of PA education and be a rate-limiting factor for the expansion of new programs, we must find ways to keep new educators from returning to clinical practice as a means of protecting the lifeline of the profession. Mary L. Warner, MMSc, PA-C

As I was walking back from the classroom, I was trying to replay in my head what had just happened. The first-year students were upset about the examination, and voices rose during our discussion, including mine. Did I actually yell back at my students? If I did, then I failed to model the professionalism I had been trying so desperately to model for them. What would I say to my program director, since I knew she would hear about this from our students? My heart was pounding, and I could not figure out how I had lost my composure. Entering our office suite, I decided I would walk right into the program director’s office and apologize for what had happened. Retrospectively, her response shocked me. It also taught me one of the most important lessons I have learned about transitioning from clinical practice to academia. The program director to whom I am referring is Elaine Grant, MPH, PA-C, the well-known successful director of the Yale Physician Associate Program for nearly 3 decades, who has since retired. When I told her the story, she smiled at me, chuckled, and then said, “Well, I guess you have not developed your educational style yet.” I had no idea what she was talking about, so I asked her to explain. She challenged me to reflect on how as a physician assistant (PA) student and early in my clinical career, I developed my therapeutic approach to patients. Clearly, I had The author declares no conflict of interest. J Physician Assist Educ 2015;26(2):109–110 Copyright ª 2015 Physician Assistant Education Association DOI 10.1097/JPA.0000000000000019

June 2015  Volume 26  Number 2

solidified my method of entering a patient’s room, establishing rapport, examining them, and with patient engagement, developing a shared treatment plan. As health care professionals, we often take these competencies for granted. If we are unable to gain the trust of our patients while simultaneously exuding credibility, the patient will seek another provider. The same is true of our students and colleagues. Ms Grant encouraged me to consider that, as an educator, each of us must develop an individualized method of interacting with our students and other colleagues. This was the educational style she was talking about. Was I going to be the stern, distant almost militant educator representing one end of the spectrum? Or did I want to be the undying student advocate who tried to be their friend and confidant, believing students could do no wrong, on the other end? Analogous to developing one’s approach to patients, developing one’s educational style takes time and practice. Just as I had done in the clinical world, it was suggested that, as a new educator, I emulate others, adapt what I thought would work for me, and try different approaches until I found my own educational style. And she confided that it would take me a year to develop mine.

Transforming Our Identity There are a few important points to this story. The clinical milieu from which we come has honed our communication skills and our ability to manage patients, including those who are reticent to receive our help; it has fostered adaptation to different environments and maybe even provided us experience as an educational preceptor. But our clinical experience has not taught us how to be an educator. Patience with self and others is required as we transform our identity from clinician to educator and develop our educational style. Proficiency in the clinical realm does not translate to competence in the academic one. Giving yourself time to try different approaches will help you find a style consistent with your personal goals, ethics, personality, and academic environment. Finding a mentor to help you navigate this transition will also serve you well. Often new faculty are awed by the excitement of the opportunity to become a faculty member and pleased with the increased flexibility and autonomy that the role brings. As a counterbalance to this initial enthusiasm, faculty soon realize they lack the experience and confidence associated with being the expert they were in the clinical realm. This can lead to self-doubt and frustration, such that defining one’s credibility among colleagues and students becomes a major priority. Credibility with students develops as faculty use examples from their clinical experiences, whereas credibility among colleagues is harder to establish. Formal academic procedures and protocols are foreign to most clinicians, even those who have precepted students for years. New faculty find 109

Copyright Ó 2015 Physician Assistant Education Association. Unauthorized reproduction of this article is prohibited.

LESSONS LEARNED it difficult to ask “too many” questions of their colleagues because they are afraid of being judged as incompetent, and senior faculty often forget or lack time to adequately orient newcomers. Some new faculty felt their more established colleagues withheld information or were too busy with their own work to engage.1,2 New faculty often have misconceptions about academic life that are based on their precepting experience alone. Faculty are surprised at the level of responsibility they must assume and the time-consuming nature of their workload.2 Teaching methods used on the wards are presumed to be translatable to the classroom, and new faculty feel uneasy when they discover that methods must change to accommodate larger numbers of students and the different environment. Some feel ill-prepared to grade the students and worry that the grades are too liberal or too harsh when compared with their experienced faculty peers.3 Realization that the role of the academic is different when considering priorities contributes to the culture shock as well. Many new faculty believe, through their clinically focused lens, that a full-time faculty member spends all of his/her time teaching students.4 In actuality, rather than being solely student-centric, professors are expected to educate PA students, develop new and innovative curricula, assess student performance to protect future patients, and develop a scholarly portfolio for promotion. Some PA educators spend a significant amount of time administering the curriculum and teach very little. No matter the task, time management and the organization skills required are tremendous and are often very different from the clinical world. New faculty need orientation to these new priorities, faculty development about time management, and a road map that outlines opportunities for professorial advancement. They should be given time and encouragement as they develop their educational style. Little peer-reviewed literature on the subject of transitioning from the clinical world to academia exists. Most research is qualitative in nature and comes from nursing, which suffers from a dearth of educators, as does the PA profession. Few articles about this transition are found in the medical education literature. This is likely because during residency, physicians learn skills requisite for bedside and classroom teaching, assessment of clinical skills, and other medical education competencies. Many physicians transition to academia immediately after their residency, so academic acculturation may be a more natural progression.

One Program’s Success Despite the influence of residency education on physicians’ ability to develop educational competencies, a faculty development program developed at the University of Rochester has been found to be helpful to pediatricians in their early career as they assimilate into the academic arena.5 The program uses anticipatory guidance, defined as guidance provided in anticipation of future events, as the foundational principle of

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this program. Key to the success of the program is the clear delineation of teaching, clinical and research faculty expectations, and a corresponding mentoring committee chosen to support the new faculty member’s career. The agenda for the mentor committee meetings is set by the mentee in advance of the meeting, and outcomes are reported annually to the department chair. The advantages of this approach are the preservation of local academic culture, empowerment of the mentee to develop the meeting agenda, and the collaborative interaction of both parties. In distinction to a local approach, national faculty development activities orient those new to PA education to principles of curriculum design, development, and assessment, which provide the foundation for meaningful participation in master’s degree education.6 These courses arm new faculty members with the important educational context of PA education and provide opportunities for new faculty to meet peers from around the country. However, institutional politics, local idiosyncrasies, and program policies can only be gleaned from senior faculty at a given institution, so the University of Rochester methodology might be the best option for PA programs wishing to orient their new faculty to the local environment. Transition success from clinician to faculty requires time, focus, and persistence. Little is known about how long the transition from clinician to educator takes, although an unsubstantiated quote suggests that if one stays in PA education 3 years, full-time faculty status becomes a lifetime habit. Conversely, the majority of new PA educators return to clinical practice before the 3-year mark. We lack data on what, if any, methods increase successful assimilation of clinical PAs into PA education. Cultural orientation, mentorship, and time to develop both an educational style and confidence using multiple types of faculty development could help our profession retain its desperately needed educators. Mary L. Warner, MMSc, PA-C, is the founding program director and an assistant professor of Medicine, Boston University School of Medicine PA Program, Boston, Massachusetts. Correspondence should be addressed to: Mary L. Warner, MMSc, PA-C, Physician Assistant Program, Boston University School of Medicine, 72 E. Concord Street, L801D, Boston, MA 02118; Email: [email protected]

REFERENCES 1. Hurst KM. Experiences of new physiotherapy lecturers making the shift from clinical practice into academia. Physiotherapy. 2010;96:240–247. 2. Siler BB, Kleiner S. Novice faculty: encountering expectations in academia. J Nurs Educ. 2007;40:397. 3. McDermid F, Peters K, Daly J, et al. I thought I was going to teach: stories from new academics on transitioning from sessional teaching to continuing academic positions. Contemp Nurse. 2013;45:46–55. 4. Murray C, Stanley M, Wright S. The transition from clinician to academic in nursing and allied health: a qualitative meta-synthesis. Nurs Educ Today. 2014;34:389–395. 5. Schor N, Guillet R, McAnarney E. Anticipatory guidance as a principle of faculty development: managing transition and change. Acad Med. 2011;86:1235–1240. 6. Glicken A. Excellence in physician assistant training through faculty development. Acad Med. 2008;83:1107–1110.

Journal of Physician Assistant Education

Copyright Ó 2015 Physician Assistant Education Association. Unauthorized reproduction of this article is prohibited.

From clinical practice to academia.

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