Over the past three decades, the role of the clinician-educator on medical school faculties has become widely recognized as essential to both the educational mission and clinical operation of academic medical centers (1, 2). In contrast to traditional medical school faculty members, who are primarily researchers with secondary clinical and teaching responsibilities, clinician-educators devote most of their professional effort to patient care and education. These roles are sufficiently distinct to require separate faculty lines for hiring and promotion (3).

Clinician-educator tracks for faculty have thus become common in medical schools, with steady growth in the number of individuals involved rivaling those in research-focused tracks (1, 4–7). Despite the numerical success of these tracks, clinical faculty members have not kept pace in career development or promotion (8, 9). In part this represents expectations by department chairs and promotion committees of academic productivity more appropriate to researchers than clinicians and teachers (2, 10–13), and in part it reflects the absence of training in skills pertinent to medical educators (14, 15).

Specifically, clinician-educators benefit from formal training in classroom teaching, supervision, feedback, curriculum development and evaluation, education theory, and administrative skills (16, 17). Equally important are opportunities to be mentored by senior faculty, to present scholarly work through professional organizations and publication, and to form a critical mass of education scholars locally and networks with colleagues nationally (18–20). These have become the topics of several faculty development programs (21, 22) but are rarely taught in medical school or residency (16, 23). A handful of medical education fellowships are available, but these are limited in number and usually prepare graduates for fully dedicated medical education positions rather than the more general role of clinician-educator. Consequently, few residency graduates contemplating a teaching career have the knowledge or skills that would enable them to succeed in academic medicine (24).

In order to address this need within psychiatry, several residency programs have created resident educator tracks to prepare graduates for careers as clinician-educators. The goal of these tracks is to provide residents with the skills they need to excel as teachers, education administrators, and education researchers.

This article describes three institutions offering these tracks: University of Michigan, Baylor College of Medicine, and University of California Davis School of Medicine. The purpose of this review is to highlight common elements in these programs, identify pertinent differences, and provide guidelines for other residencies to assist and encourage them in creating similar training opportunities.

University of Michigan

The Clinical Educator Track at the University of Michigan opened in 1998 with a focus on teaching skills and education administration. In 2003, the name was changed to Clinical Scholars Track to emphasize the broader goal of preparing “psychiatry residents for successful careers as clinical track faculty members through development of medical education skills, academic productivity, and professional identity” (25).

Essential elements of the track include at least one faculty mentor responsible for the resident’s professional development as a clinician-educator; a scholarly project completed in conjunction with the mentor; and presentation of original work through posters, workshops, and publications. Participants attend at least two professional meetings per year and are expected to make a presentation during at least one of the meetings by the second year in the track. Weekly didactics provide instruction in research design, career development, and related topics. Residents have opportunities to develop their teaching skills with undergraduates, medical students, and other residents, as well as to create innovative curricula for these groups. They have the option of participating in an additional program of biweekly didactics in either medical education or health care administration conducted by the medical center for junior faculty and residents in all disciplines.

The program is designed to accept up to two residents per year. Residents may enter the track at any time during training, though it is most common to enter early in the second postgraduate year (PGY-2). The application consists of a letter to the Clinical Scholars Track Committee naming the faculty mentor and giving the preliminary outline of a scholarly project. Although there is no formal protected time for this work, both clinical schedules and elective rotations may be adjusted to allow the resident to participate in didactics or to engage in teaching or research activities. Residents are expected to remain in the track until graduation.

A unique feature of the Michigan program, introduced as part of the 2003 modifications, is that scholarly projects need not be focused on education but may involve any area in which the resident wishes to develop high-level expertise in preparation for an academic career. In practice, about half of Clinical Scholars Track residents have done education projects; others have engaged in more traditional research on a variety of other clinical topics. Residents who choose to engage in research outside of education have the option of selecting separate faculty mentors to oversee their experiences in teaching and in research.

Between 1998 and 2009, 18 residents graduated from the program. Of these, 11 are currently in full-time academic positions at five different institutions, two have adjunct faculty positions that involve active teaching and supervision of medical students and residents, four remain in fellowship training, and one is not involved in medical education.

Baylor College of Medicine

The Clinician-Educator Track at Baylor College of Medicine was created in 2003 “to educate residents about academic medicine and psychiatry, enhance knowledge about career opportunities in academic psychiatry, improve graduating residents’ readiness for success as clinician-educators, and broaden residents’ understanding of research and publication in the field of medical education” (26).

The track features a core didactic series and informal workshops on education-related topics such as how to prepare a lecture, alternative teaching methods, supervision skills, research methods, writing for publication, and a series on career development. Discussion topics are augmented with core readings and web-based resources. A faculty mentor assists the resident with teaching skills and with the development of a scholarly project that highlights an educational objective (e.g., a review article, collection of case reports, Grand Rounds presentation, the development of a curriculum, educational research, or a presentation at a national meeting). Interactions with faculty are facilitated by informal gatherings at faculty homes. Leadership skills are developed by resident participation, including as cochair, on the Clinician-Educator Track Committee. Residents gain experience as teachers of fellow residents, students, and the lay community. The track encourages presentations at meetings and publication of project outcomes.

The track will accommodate two to three residents per year, beginning in PGY-2 or -3 and continuing through PGY-4. Applicants submit a CV and answers to essay questions to determine the applicant’s perspective on being a clinician-educator. In order to compete for a Clinician-Educator Track position, the applicant requires approval from the training director. Drawing from information in the submitted materials, the Clinician-Educator Track Committee members rank the applicants and vote on final selections. The track is highly competitive and acceptance is seen as both a privilege and an achievement. Residents in the track continue to carry a full clinical load and are expected to complete all other residency requirements, but “allowances” are made to facilitate residents’ participation in track activities (i.e., committee meetings, lectures, and resident teaching opportunities).

Unique features of the Baylor program include its extensive didactic curriculum, opportunities for both formal and informal interactions with faculty role models, leadership training, and attention to career development skills.

In the 6 years since the track opened, 13 residents have graduated and five are currently in the program. Of the graduates, 11 entered academic positions within 3 years of graduation.

University of California Davis

The Resident Educator Track at the University of California Davis School of Medicine (UC Davis) opened in 2007 with an emphasis on developing educator knowledge and skills. The track is designed to prepare residents for “a career—academic or not—in psychiatry with a focus on teaching” (27). As in the cases of the Michigan and Baylor programs, the focus is on preparing the resident for success as a faculty member with primary expertise as a medical educator.

Participation in the track features extensive medical student teaching opportunities, including the first-, second-, and third-year doctoring courses and second-year psychopathology curriculum. Teaching experiences are supervised by experienced faculty and emphasize development of the knowledge, attitudes, and skills characteristic of outstanding educators. Residents interact with education faculty through formal mentorship as well as their participation in faculty development programs hosted by the department and the medical school to build skills in teaching and education scholarship. Participants in the track are expected to produce an educational project under the direction of a faculty mentor. Residents attend local and national education meetings and are encouraged to present their work in those venues.

The track typically has two residents per year of training, beginning in PGY-2 and continuing until graduation. Admission to the track is through a 1-page application, CV, and letter of recommendation submitted to the training director and Resident Educator Track Committee for approval. The committee is specifically looking for evidence of educational scholarship in the resident’s background. Admission to the track is competitive and it is expected that some residents will be turned down or required to bolster their credentials prior to acceptance. The track does not include protected time for teaching or the education project, but allows schedule adjustments to facilitate these activities.

Unique features of the UC Davis track include its emphasis on supervised teaching experiences and numerous faculty members with expertise in medical education. Like the Michigan program, residents participate in faculty development programs conducted by the medical school, taking advantage of the resources available to the larger institution.

There are currently four residents enrolled in the track. Although the program has not been in existence long enough to have produced any graduates, participants have been active in professional organizations, producing posters and conducting workshops at the annual meetings of Association for Academic Psychiatry (AAP) and American Association of Directors of Psychiatry Residency Training (AADPRT).

These tracks did not develop in isolation. The latter two opened with the encouragement and assistance of an established program (Michigan), mostly through information sharing beginning with an AADPRT workshop in 1999 (28) and continuing with follow-up invitations to consult and collaborate. Even so, it is striking that the essential components of the final form of the three tracks have so much in common (Table 1). Each track is built around a relationship with a faculty mentor and the completion of a scholarly project. In this regard, the tracks have more in common with scientific graduate programs than with professional schools. That is, they place greater emphasis on the establishment of independent productivity than on mastery of a curriculum.

Each program recognizes the importance of career development and works to provide residents with the tools to grow professionally after graduation. This includes skills required for academic productivity, such as curriculum design and evaluation, research methodologies, and an attitude of scholarship. The programs strongly emphasize the need to disseminate scholarly projects through formal presentations and publications (Table 2). Residents are further encouraged to begin establishing a professional identity as education scholars, to initiate collaborations, and to seek informal mentoring through education organizations.

At another level, career development includes the ability to document and effectively present one’s work to the department chair, promotion committee, and others in a way that creates a compelling record of scholarly contributions. The attention each of the tracks devotes to both the conduct and documentation of academic work reflects the experiences and values of the senior mentors who direct the programs and who recognize the challenges facing clinician educators in promotion and professional growth. This perspective forms an important component of the tracks.

As expected in the training of clinician educators, each track provides opportunities for residents to teach, develop new curricula, and participate in education administration. The tracks differ, however, in the degree to which these are emphasized, how they are taught, and whether they are formally evaluated. This has implications for whether the goal of the track (and the resident) is to make the participant a good teacher, program administrator, or education researcher.

Creation and operation of the tracks begins with initiative by a faculty educator willing to take on the challenges inherent in establishing a new training program (Figure 1, Figure 2). Support of the department, as represented by the chair and other faculty administrators, is essential to ensure that faculty time is protected, that other department resources are available, and that faculty effort in the track will be recognized and acknowledged.

Involvement of additional faculty is crucial. Each program has a faculty committee responsible for selection of residents for the track, to monitor residents’ progress through the program, and to assist with education projects conducted by the residents. Committee members often, though not exclusively, serve as individual mentors. The cooperation of faculty not directly involved in the tracks is essential to rearrange resident schedules, create additional teaching opportunities, and provide other less direct support for residents in the program.

Protected time for residents to engage in creative projects is a standard component of residency research tracks, but was not included in any of the clinician-educator tracks. In part this reflects the structure of the non-tenure-track faculty positions that most of these residents will assume, which do not typically set aside time for research. An ethos of scholarly activity as a product of individual interest and initiative fits in well with this system. The lack of protected time for residents is also a product of funding limitations. None of the programs had sufficient financial resources to pay resident salaries for extraclinical activities. No sustainable grant streams have been identified, none of the departments had adequate capital to underwrite these projects, and none of the parent institutions was willing to forego federal reimbursement for resident time on clinical services.

A small budget was, however, essential to each of the tracks primarily for travel to professional meetings and, to a lesser extent, for conduct of research projects. Sources of support for the programs included departmental funds, small grants from the institution, and transfer of funds from specific income-generating faculty activities. None of the programs sought direct industry support, but some income was derived from faculty contracts with industry, which they ear-marked for the tracks. Ultimately, each program found that a line-item in the department budget, based on the demonstration of benefit to the department from these activities, was the most secure source of funding.

The most immediate result of the tracks was the education activities conducted by residents (Table 2). These projects brought direct benefit to medical student and residency education and have been universally praised by their recipients. Many have been maintained and incorporated into the department’s teaching program.

Residents in the tracks have been active in producing posters and leading workshops for education organizations. Authorship of peer-reviewed publications has been less common, but is increasingly the goal of these activities (two authors of this article, VLB and TMcC, are clinical-educator track residents). Residents have begun the process of building teaching portfolios and a professional identity as clinician-educators.

Most graduates of the tracks have entered faculty positions and have remained productive in those positions. One long-term outcome of the training that cannot yet be assessed is whether they will successfully progress up the academic ladder through faculty promotion and administrative assignment.

For residents, the tracks have generated excitement and activity, including among junior residents aspiring to be accepted. They appear valuable for recruitment, as residency applicants are generally aware of and frequently comment on the programs as attractive features of the residency. They provide a clear entry point for residents who are considering an academic career but who are uncertain about their suitability or preparation for it.

Less anticipated were the benefits to faculty and the department. For mentors as much as residents, the firm commitment to a project has led to greater productivity. Appointment to an education track committee or assignment as a mentor provides a clear structure for faculty to identify themselves as educators in a way that their simply accepting a teaching assignment does not. These faculty members have been especially active in preparing for and seeking promotion, benefiting themselves and the department. Faculty members involved in these tracks have additionally served as mentors and consultants to faculty in other departments or institutions seeking to develop similar programs.

Several potentially negative consequences of the tracks have not occurred. For example, there is the possibility of premature career and skill specialization for residents who need to focus first and foremost on developing clinical competency. This concern was allayed by the observation that teaching psychiatry is a powerful reinforcement for the teacher of his or her own knowledge and skill acquisition. The development of a clinician-educator track may imply that teaching is an activity reserved for one group of residents and not for all. In our experience, the presence of a clinician-educator cohort in the resident group has actually encouraged and improved the teaching of residents not in the track. Finally, there was a possibility that the track could divert residents from research training that would otherwise be considered essential for an aspiring faculty member. We have seen the opposite trend; several residents started their training in the educator track and moved to more formal research training as their academic interests broadened.

The formation of clinician-educator tracks in three psychiatric residency programs has proven to be a beneficial activity from the perspectives of residents, faculties, and departments. The essential elements of these tracks—faculty mentorship, scholarly activity, teaching experience, and career development skills—have been successful in preparing residents for academic appointment and stimulating faculty to greater productivity and clearer identity as educators. It is our hope that these tracks will serve as models for creation of CETs in other programs and that these benefits will accrue to a broader group of residents and faculty.

Disclosures of editors are published in each January issue. At the time of submission, Drs. Hilty, Arlinghaus, Ball, McCarthy, Seritan, and Servis reported no competing interests.