Since Boyer’s (1) 1990 seminal report Scholarship Reconsidered, North American medical schools have considered ways to formally recognize and support the spectrum of scholarly activities in which academic clinical faculty are engaged. We found in a review of the literature that the health professional education community is still developing approaches to fulfill Boyer’s mandate to develop organizational structures that sustain and promote discovery, integration, application, and teaching within medical schools. Most common are proposals to develop meaningful ways to reward teaching and creative professional activity (e.g., professional innovation, exemplary practice, and contributions to the development of the discipline), particularly in the promotion process (2–8). Practical issues, such as how to define and measure excellence in teaching and creative professional activity and how to capture their impact effectively, have also been explored (3, 4, 7–10).
Most of the papers we reviewed, in the spirit of Boyer’s report, argued for expanding what constitutes scholarship to include knowledge translation activities, curricular or teaching innovations, and community service. They also emphasized the need to reframe what constitutes academic success by offering strategies to make teaching excellence and creative professional activities viable alternative career pathways within medical schools. Although some have written about the organizational infrastructure necessary to support educational scholarship and the challenges associated with changing existing governance structures in general (11–13), little attention has been given to the application of Boyer’s model within psychiatry specifically.
In this article, we describe the creation and 5-year progress of a unique program in education at the Department of Psychiatry, University of Toronto, the largest psychiatry department in Canada, with over 600 faculty members, 130 residents, 70 fellows, and 15 affiliated teaching hospitals and clinics. The program, called Research, Innovation, and Scholarship in Education (RISE), arose from our desire to enhance medical education and the career trajectories of faculty and students interested in education, using a model that actively integrates research with teaching and creative professional development. To our knowledge, no other psychiatry department has taken the route of formally incorporating in its governance structure an academic program in education scholarship.
When the department began exploring the creation of a formal academic program in education, it first had to take stock of its educational capacity and commit to a process of internal review and reflection. Therefore, in 1995 Dr. Sandy Fleming (psychiatrist and undergraduate education director) and Dr. Richard Tiberius (educator) organized a conference on educational scholarship and invited Dr. Susan Block from Harvard Medical School to help formulate a plan. Dr. Block noted extensive educational activity, a potential for growth, and a department chair committed to education. Her impression was that the department was well poised to assume international leadership in psychiatric education if it focused on making educational activity more visible and created opportunities for faculty to network and collaborate.
Initial efforts focused on establishing a supportive culture for teaching, educational innovation, and research in education. A number of faculty members pursued advanced degrees in education, and an unfunded educational fellowship program was created. Organizationally, in 1998, the department created the new position of vice chair for education and an education council to oversee and integrate the activities of the undergraduate, postgraduate, and continuing education programs. These changes allowed for a more systematic and coordinated approach to education, better resource allocation, and a more cohesive representation of educational training concerns at the department’s executive planning meetings.
By 2000 an array of teaching awards had been created; the undergraduate, postgraduate, and continuing education directors had become permanent members of the promotions committee; promotion criteria had been revised to create a pathway for promotion for clinician educators and to require evidence of teaching effectiveness for all promotion pathways; and the department’s educational innovations had gained international recognition (14–18). All of these developments, coupled with the appointment of a new chair whose vision included enhancing education, opened the door for the creation of a formal education program.
Rethinking the Governance of Education
As the profile of education scholarship improved, organizational issues were revisited. Prior to the creation of RISE, the department was organized into 13 “programs” that focused research activity in specific psychiatric domains such as mood disorders, schizophrenia, and child psychiatry, but also health systems, culture, and community, among others. Those engaged in education scholarship, however, had to be attached to one of these programs based on their clinical or research expertise other than education. In several ways this was becoming problematic. The education council was starting to take on the role of a pseudoprogram to promote best practices in assessment, curriculum development, teaching methods, and so on. Yet its function was primarily administrative, and its focus was on running the clinical training programs. Hence, individuals engaged in education research did not have an academic home, and education was evolving outside the department’s programmatic structure in a dispersed fashion. Further, there was no way to engage students and residents in educational research.
Harnessing Our Potential: The Creation of RISE
The RISE program was built on Boyer’s four tenets of scholarship: discovery, integration, application, and teaching. RISE became the department’s 14th academic program in 2003. Because RISE aimed to enhance the evidence base of both theoretical and applied educational activities in the department, it established two formal affiliations. One was with the University of Toronto Wilson Centre for Research in Education, a multidisciplinary, extradepartmental unit that brings together education scientists from across the faculty of medicine, and the other was the Centre for Faculty Development, which serves as the faculty of medicine’s overarching pedagogical training center, advancing the educational skills of faculty in teaching, curricular development, and program assessment (19).
The Application of Boyer’s Model
Discovery: Intensive Education Research and Innovation.
The “discovery” aspect of the program primarily focused on the needs of a small group of core education researchers who held advanced degrees in education and wanted to pursue education research. These RISE faculty members took offices at the Wilson Centre for Research in Education, thus enhancing their opportunity to interact with other education researchers working in health professional education. The majority of their time was protected through remuneration derived from university and hospital sources. Their activities over 5 years (2003–2008), including supervising students and making international presentations and publications, have served to develop a strong educational research base for the department and attract peer-reviewed funding.
Soon after the program was established, money was secured to fund a 2-year fellowship for a graduate student specializing in health professional education. To date, two fellows have been awarded this funding, pursued Ph.D. studies at the Ontario Institute for Studies in Education, and taken up residency at the Wilson Centre, where RISE faculty supervise their professional training. As psychiatry trainees, they have access to funding and resources to promote their academic training in projects specific to psychiatric education. The trainees are also fellows at the Wilson Centre with access to the multidisciplinary team of researchers, which is engaged in broader conceptual work relevant more generally to the health professional community, as well as additional resources (e.g., office supplies and a travel allowance).
RISE has also established two pathways for residents wishing to develop expertise in educational research during their training. The first is through the department’s clinician scientist program. Residents enroll in a graduate program related to education, receive supervision from a RISE faculty member, and have their residency training modified to include protected time to pursue research. To date, two residents have chosen this pathway and have had access to expertise and resources similar to that described earlier for the fellows. RISE also provides electives for two to four trainees per year who wish to develop a research project in education but who are not interested in completing a graduate degree.
To cultivate a community of practice, RISE organizes monthly educational rounds at which research projects at various levels of development are presented, allowing members to exchange ideas, receive advice, and practice talks intended for conferences (Table 1). These intimate and casual meetings are intended to be nurturing, to offer the potential for new synergies to develop as members articulate their interests and exchange experiences, and to give trainees a place in the community of educators. In addition, RISE fellows and residents take part in the Wilson Centre in-house professional training series intended to socialize students to the expectations of the broader health professional education community.
Integration: Synthesis Across Disciplines.
The RISE program has created affiliated appointments to support the many individuals engaged in educational scholarship in the department who hold a primary appointment with another program. Affiliated members are supported to undertake educational research, teaching scholarship, and innovation linked to their home program (e.g., child and adolescent psychiatry, women’s mental health, schizophrenia). Members of the RISE group collaborate with these affiliates to encourage a more integrated approach to education research that does not isolate those involved in the conceptual work from those engaged in applied research. Examples of this activity include studies of Objective Structured Clinical Examination development, simulation, and standardized patient training. RISE members have also informed the development of postgraduate and undergraduate curricula related to palliative care, assessment, advocacy, career development, policy and organization, and two programs designed to improve the integration of basic and social sciences with clinical teaching (20).
Application: Translation to Practice.
The RISE program also works to integrate the application of the new scholarship and innovation it has created into the day-to-day teaching and curriculum development activities of our training programs by involving some of the core members and RISE fellows and residents with the undergraduate, postgraduate, continuing education, and fellowship committees. As RISE grows, the expectation will be to establish a permanent position on each of the education committees. These positions will foster links between educational scholarship and program delivery.
RISE members are encouraged to teach in the department’s clinical training programs and to offer grand rounds. As a result, the whole department is exposed to broad, interdisciplinary, empirical, and theoretical research that has implications for both training and practice. This helps education researchers who are not clinically trained feel more integrated with the department.
Teaching: Pedagogical Excellence.
To enhance the pedagogical strengths of the department, RISE created the Education Scholars Program with sponsorship from the Centre for Faculty Development. Its goals are to develop scholarly health professional education, leaders and teachers, and to develop a community of practice. The program is led by a RISE member, delivered through the Centre for Faculty Development, and serves not only the needs of the department of psychiatry but also those of other departments to stimulate opportunities for interdepartmental educational initiatives and collaborations. The 2-year program consists of close to 70 sessions on topics such as educational theory and pedagogy related to health professional education, evaluation, assessment, curriculum design, leadership, interpersonal styles, conflict management, promotions and dossiers, mentoring, faculty development, and collaboration.
To date, two cohorts totaling 31 health professional educators from inside and outside the faculty of medicine have completed or are completing the 2-year training program. Because the psychiatry department is a major sponsor, 12 of the education scholars have been psychiatrists, most of whom have acquired new education leadership positions, teaching awards, and grant funding and presented or published their first academic education paper soon after graduation.
In the first 5 years, the RISE program appears to have fulfilled many of our original goals. By developing an organizational structure that integrates all four tenets of Boyer’s model, we believe we are producing careers that encompass excellence in multiple components of educational scholarship. For example, RISE provides residents and fellows with training, mentorship, professional development, and a clear sense of how to pursue a successful career in education (Table 2). Members of RISE, including the residents and fellows, have secured close to $7,500,000 (Canadian) in funding in peer-reviewed competitions. Funding has been obtained from the Canadian Institutes for Health Research and the Social Science and Humanities Research Council. The scope of projects has shifted to larger, more collaborative ventures that are not only linked to the department’s training programs. More than 100 articles have been published in peer-reviewed journals, and over 340 conference presentations, workshops, grand rounds, or invited lectures have been delivered. The same RISE members are accruing awards for teaching and educational innovation.
Within a short time, the RISE program has established itself alongside the department’s other 13 academic divisions. Growth in the academic productivity of its core and affiliate members and the visibility of the program’s fellows and resident trainees have helped increase the prestige associated with education scholarship within the department. A small but symbolic manifestation of this occurred when a RISE fellow was singled out in a blinded competition over 70 other research fellows studying basic or life science fields for the “Best Achievements of a Fellow” award, based on evidence of excellence in research, teaching, and application. Perhaps the most important achievement the RISE program can claim is the community of practice that it has nurtured.
RISE has strengthened the capacity of our educators to undertake research, teaching scholarship, and innovation that moves beyond the practical, day-to-day needs of our training programs in ways that can inform these concerns from new perspectives. RISE members are currently developing new models for evaluation and assessment, new approaches to faculty development, and new thinking around how to approach interprofessional learning and practice. Solutions developed are context specific and local, yet the development of these approaches has come from thinking broadly and drawing from multidisciplinary locations, and our educators are publishing and presenting work for a variety of audiences—not just for psychiatry educators but also medical educators in general, as well as social scientists and policy makers.
As the program grows, it is important to think about how to maintain the nurturing relationships that RISE members enjoy. Expanding the community of practice may mean developing additional layers of organization. Currently, RISE meetings and rounds take place at the Wilson Centre for Research in Education. As more members assume leadership positions across the training centers, a goal will be to cultivate communities of practice at all the teaching hospitals. Funding to increase the capacity to train fellows and residents will also be a priority.
Finally, succession plans must be developed for the program leadership, to ensure that current institutional knowledge can be engaged productively for future thinking about educational scholarship. RISE was created by a core group of educators with a vision to expand and develop the type and scope of education activities pursued within psychiatry. As new generations come and our graduates join the ranks of our faculty, this vision should be revisited and renegotiated to incorporate the experiences of the past 5 years as well as new perspectives provided by the program’s growing membership.
RISE embodies all four tenets of Boyer’s model for education. It has allowed education research, teaching, and creative professional development to flourish in the department in an integrated way. As a result, there are considerably fewer barriers to pursuing education as a productive career path in the department of psychiatry at the University of Toronto. In the words of a RISE trainee, “The core ingredient of RISE can be found in any setting” (Table 2). We hope that the story of RISE may be helpful to other psychiatry departments.