Interest has been increasing in supporting the career advancement of faculty clinician-educators in psychiatry. This is best evidenced by the development of the Clinician-Educator Section of the Association for Academic Psychiatry in 2003. Over the past few decades, the role of the clinician-educator has grown, as have the responsibilities. Not only are clinician-educators teachers in the classical sense, but they are often called to serve as leaders in multiple realms: clinical program chiefs, residency training directors and innovators, hospital administrators, advisers to managed care organizations, consultants for legislative policy change, physician educators, and disseminators of information to the community at large (1, 2).
Despite expectations for academic career advancement being relatively clear cut for faculty dedicated to research, promotion criteria for clinician-educators are widely ill defined (3). As a result, clinician-educators often have difficulty advancing in academic rank, even though their impact on a system may be remarkable. Levinson and Rubenstein (4) highlight the problems with “the present system of recognition for clinician-educators—i.e., the requirement for regional and national reputation, the lack of reliable measures of clinical and teaching excellence, and the lack of training opportunities for young clinician-educators.” To address such issues, some major academic centers have developed clinician-educator faculty tracks that more clearly define career paths (3, 5).
Historically, psychiatric residents have not been explicitly targeted for nonresearch career paths during residency. As a result, many graduating psychiatrists are behind in developing the formal skills necessary to take on leadership roles within the academic and clinical infrastructure. This contrasts with efforts to create research training opportunities from medical school onward (6). In recent years, several U.S. psychiatric residency training programs have attempted to address this shortcoming by creating specialized residency training tracks for clinician-educators. The first of these appears to be the University of Michigan’s Clinical Scholars Track, established in 1998 (7). Likewise, Baylor’s Menninger Department of Psychiatry developed a Clinician-Educator Track, and the University of California Davis created a specialized Teaching Track. This trend is encouraging, but in general, specialized residency training tracks geared toward clinician-educators are still in the early stages of development, and it is unclear how successful these tracks have been in promoting their aims into long-term faculty careers. Furthermore, none of the existing tracks explicitly focus on developing the administrative skills crucial to the promotion of young physicians into subsequent leadership roles in academic or other care delivery settings.
In January 2008, the Department of Psychiatry at the University of Pittsburgh School of Medicine launched the pilot phase of the Academic Administrator, Clinician-Educator (AACE) Track. The AACE Track is part of an institution-wide movement to promote the development and retention of future academic leaders who are able to provide comprehensive clinical care, innovative education, and academic administration in an outstanding manner. The AACE Track leadership comprises the faculty leader for the Research Track, the residency training director, and the faculty leader for the AACE Track. They are supported by the chief resident for education as AACE Track chair and a resident vice chair. During the early stages of planning, we consulted the founders of our Research Track, a highly successful specialized residency track that has prepared young physician-scientists for careers in research over the past two decades (6). The Research Track was therefore used as a template for the general architecture of the AACE Track. During the 6-month pilot phase, we established a pattern of twice monthly meetings alternating with the Research Track meetings. During these we held open forum sessions with interested AACE Track candidates to record their personal aims and objectives in the AACE Track. In addition to this informal needs assessment, we invited various administrator and clinician-educator faculty to the meetings to outline their career progression and provide perspectives on developing the track. We were also fortunate to receive monthly input from the Western Psychiatric Institute and Clinic Faculty Clinician-Educator Committee. Through these meetings and further discussion with the department chair and former senior vice-president and chief medical officer at University of Pittsburgh School of Medicine, we formulated specific AACE goals and objectives, detailed in Appendix 1, in addition to the process for the AACE Track, detailed in Appendix 2.
The overarching role of an AACE Track mentor is to provide each AACE Track resident with a faculty clinician-educator for advice and support and to further develop meaningful professional relationships between AACE Track residents and faculty. The mentorship role can be further defined as an adviser on the AACE project, career goals, and development; an advocate, providing assistance and help with navigating the system; a role model; and a facilitator for establishing contacts and possible mentorship from the other faculty as indicated. Mentors are selected by the AACE Track leadership from faculty who have already successfully negotiated an administrator and/or clinician-educator career path and are matched with an appropriate AACE Track resident based on interests and expertise. “Metamentorship” can be defined as the oversight provided by the AACE Track senior leadership to foster and maintain the mentor/mentee relationship.
Academic Administrator, Clinician-Educator Track residents meet twice monthly with the AACE Track director, the chief resident for education, and invited faculty. Each meeting contains 15 minutes of “business” time, when opportunities, progress, and potential barriers are reviewed by the group. The remaining 45 minutes are utilized for project presentation and discussion or specific seminars, including, among other subjects, Project Design 1.01, Administrator Clinician-Educator Career Development, Writing and Submitting an Article, Ethics and Submitting an Institutional Review Board Proposal, Funding Sources and Submitting a Grant, Advanced Clinical Leadership, and Academic Administration. In addition, some sessions are led by the hospital’s chair and chief officers, introducing residents to the intricacies of hospital administration, business planning, risk management, policy development, contract negotiation, and service development.
Throughout residency, AACE Track residents engage in various clinical activities designed to hone their skills in patient management, advanced psychopharmacology, and psychotherapy in both inpatient and outpatient care. It is our intention that through these resources, targeted electives, focused didactics, resident workshops, case conferences, and their own clinical investigation, AACE Track residents gain added expertise in the etiology of mental disorders, service delivery systems, community resources, and treatment modalities.
AACE Track residents are introduced to educational roles early in their careers to set the stage for ongoing development of communication and mentorship skills. Specifically, AACE Track residents may act as preceptors for first- and second-year medical students in team-based learning groups and Observed Structured Clinical Examinations (OSCEs). They also participate as mentors through the Resident as Teacher program, in collaboration with the medical student education director. In their senior years, AACE Track residents are encouraged to facilitate case conferences and give at least one formal presentation to the resident body. They are also expected to participate in a “seniorship,” during which they provide direct supervision to residents in postgraduate year (PGY) 2 and/or PGY-3. Additionally, AACE Track residents are encouraged to take advantage of the resources and teaching from the university’s Center for Instructional Development in preparation for careers that embrace lifelong innovative education.
A key aspect of the AACE Track is the encouragement of resident involvement in administration and leadership activity. In addition to the regular AACE meetings, AACE Track residents are also encouraged to participate in a managed care elective to gain a better understanding of the role of managed care organizations in the delivery of behavioral health care. If interested, AACE Track residents can also take advantage of reduced tuition for courses through the University of Pittsburgh Business School. Furthermore, the AACE Track is flexible enough to accommodate alternative training options with proper planning. For instance, it is our intention to also encourage shadowing opportunities and additional mentorship relevant to the AACE Track resident’s areas of interest with members outside the psychiatric community (e.g., business school, school of public health, medical school, law school, managed care organizations, or hospital administration).
As part of the application process, the AACE Track resident candidate is asked to propose an academic project (e.g., quality improvement activity, data-mining project, clinical investigation, or educational initiative) that he or she will complete by graduation. Residents are encouraged to develop an individualized, mentored project.
Over the course of their PGY-3 and PGY-4 years, AACE Track residents actively participate in meetings with their peers and mentors as well as relevant medical directors, program leaders, service chiefs, and vice presidents. Each AACE Track resident would be able to protect a half day per week dedicated to his or her project, and it is likely that AACE Track residents will engage in clinical electives directly related to their projects. Upon completion of the project, the AACE Track resident is expected to disseminate the findings of his or her experience to the academic community through publications in peer-reviewed journal articles, poster presentations for regional or national conferences, resident workshops, and other appropriate venues. Through the AACE projects, we intend to develop and validate “reliable measures of clinical and teaching excellence,” indicated as a necessity (4, 8).
Through the integration of the activities and opportunities within the AACE Track, AACE Track residents learn practical leadership strategies in effective interpersonal communication, problem-based learning, professional presentation, time management, team building, networking, negotiation, and conflict resolution. Within our hospital community, AACE Track residents are offered a variety of educational programs and mentoring relationships with current leaders in the field. They are also encouraged to seek experiences outside the immediate community (e.g., leadership-skills conferences, APA Early Career Psychiatrist courses) to hone skills specific to the individual’s innate leadership style. Through the supportive environment of the AACE Track, these residents are easily recognized for leadership roles during residency, whether in residency administration (e.g., chief residents, house staff presidents, class representatives), medical school education (e.g., course instructors, mentors), community-based interventions (e.g., advisers in patient advocacy), and/or national and international association involvement.
After piloting the AACE Track from January through June 2008, we launched the track formally in July 2008. Currently there is a 2-year rolling program or “Core AACE Curriculum” of evaluated seminars during the twice monthly AACE Track meetings. This curriculum will evolve as the needs of the AACE Track residents change and the profession evolves. Around this core curriculum we will develop links with other departments at the university, within local community organizations, and nationally. As residents graduate from the AACE Track, we envisage that they will join Faculty Clinician-Educator Tracks both here and at other psychiatry departments.
Practical and Financial Issues
At our institution, we are fortunate to be designing the AACE Track within an infrastructure that is already well equipped to provide considerable resources for clinical training, education, and administration and fortunate to have a breadth of faculty supporting these pursuits. From a poll of current residents, we estimate that up to three residents per class of 17 will want to become an AACE Track resident. There is no formal funding to cover the 10% of time AACE Track residents devote to the track. It is our experience, however, that residents committed to this type of career enhancement are involved in more clinical service delivery activities than required. Additionally, the quality improvement, educational, and service development projects enabled by AACE Track residents are likely to result in increased efficiency in existing services. Faculty involvement is facilitated by their ability to count their time spent toward our institutional “Psychiatry Education Credit Units,” which results in a year-end bonus. More importantly, AACE faculty will engage in projects with the AACE Track residents resulting in potential funding and publication opportunities that they would not complete without the AACE Track resident.
Although we currently do not have any outcomes from our initiative, we will be tracking these and hope to report on them in the future. Developing specialized career paths and identifying the resources needed to support individuals with leadership potential within academic settings are crucial to the future success of psychiatry. Just as researchers are fostered from an early point in their careers so should clinician-educators. Indeed the roles are actually symbiotic. It is rare to find a successful researcher who is not an effective communicator or educator. Similarly, gifted clinician-educators are often excellently positioned to pose valid and important research questions. Pioneers from either or both such structured backgrounds are rising to positions of leadership within today’s academic centers.
The authors would like to acknowledge the help and support of Claudia Roth, Ph.D., and Frank Ghinassi, Ph.D., in the formulation of this educational initiative and for the many and varied opportunities their leadership has created at our institution.
At the time of submission, Drs. Jacobson, Travis, Solai, MacPhee, Ryan, Roth, and Kupfer reported no competing interests. Dr. Reynolds receives research support in the form of pharmaceutical supplies from GSK, Forest, Lilly, Pfizer, and BMS.