Demonstrating Clinician Educator Value

The Challenge

Clinician educators (CEs) can feel pressured by multiple institutional forces: compliance with frequently changing Accreditation Council for Graduate Medical Education (ACGME) requirements; the dynamic operational and fiscal strains of sponsoring institutions (SIs); and personal pressures for career advancement, in both academic and community settings. The value of demonstrating contributions as a CE for academic promotion via an annotated curriculum vitae and/or portfolio is well documented.^1,2 However, CEs must also find ways to continuously demonstrate value to program, clinical, and organizational leadership, regardless of the type of SI.

What Is Known

CEs should strive to align their educational priorities with the SI's clinical priorities. Two examples of aligned CE-SI goals are achieving a reputation for being a high reliability organization and providing value-based care.³ High reliability organizations strive to provide care with zero harm, and value-based systems provide high-quality patient care focused on improved outcomes, positive patient experiences, and lower use of resources.⁴

To accomplish these goals, most SIs develop quality improvement (QI) and patient safety (PS) programs that often operate independently from the sponsored educational programs.⁵ The ACGME's Common Program Requirements mandate trainee skill development to provide reliable, safe, and high-quality care. At the same time, trainee involvement in QI and PS programs often goes underrecognized by SI leadership, despite program directors reporting that resident participation in QI led to institutional-level changes.⁵

How can CEs make their SI's and program's leadership aware of their contributions to aligned priorities? Using a framework such as mattering can help. Mattering is a psychological construct which recognizes that we all want to be valued and to add value. When someone matters, they are more engaged, are less stressed and depressed, and feel like they belong. There are 4 accepted components for CEs to incorporate when creating an environment of mattering: awareness, importance, reliance, and ego extension.⁶ As a CE, demonstrating how your clinical and educational work adds value to the shared goals of high reliability and value-based patient care is vital.

How You Can Start TODAY

1. Examine the value of your educational activities. Assess each of the 4 mattering components, from the SI and program leadership perspectives, to align goals and make your work matter more. To start, have meaningful discussions with leaders to find out what motivates them and what they need to accomplish.

2. Create AWARENESS. Review each of your current activities to determine which ones best align with your SI's and program's goals. Prepare 30- to 90-second scripts that allow you to communicate effectively with leadership on how individually and collectively your activities help meet their goals. Begin and continue to collect data on outcomes for future scripts, reports, and/or portfolios to increase awareness.

3. Identify IMPORTANCE. Prioritize your existing activities as you seek ways to further align activities with SI priorities. When hearing of a new or challenging problem, offer to help create solutions through CE activities (eg, form a resident-led work group to incorporate trainee perspectives). Seek opportunities to create programs that explicitly advance priorities.

4. Increase RELIANCE. Make sure others can rely on you and your educational program. Complete tasks on time (or let others know when barriers occur), demonstrate outstanding stewardship of resources, and address challenges creatively while keeping others updated.

5. Enhance EGO EXTENSION. Highlight the importance of collaboration and teamwork within and beyond the educational program. Give credit where credit is due by including (and thanking) all team members and sponsors when they contribute personnel, time, or money. Send a short note thanking involved individuals and publicly thank them when their respective leaders are present.

What You Can Do LONG TERM

1. Continuously reevaluate each of the 4 mattering components to identify aligned and sustainable behaviors that matter in the long term. Many activities apply to more than one mattering component. For example, your team's QI initiative to reduce health care disparities in hypertension could address all 4 mattering components.

2. Awareness. Work on what you and others value. Advocate for inclusion in meetings where these issues are discussed. Attend meetings and speak up for your learners by voicing how they add value outcomes (eg, decrease harm, improve PS). Use specific examples of projects and behaviors. Create a network that keeps you in the loop to ensure your work remains aligned with changing organizational or program needs. Provide reports to leadership on a regular basis.

3. Importance. Prepare learners with skills needed to improve QI and PS by using well-designed educational programs and activities addressing institutional needs. For example, use morbidity and mortality conferences to focus on QI and PS issues facing your SI, to identify useful ways the educational program can address the issue. Measure outcomes meaningful to others and share them. Aggregate alignment and data into a portfolio as evidence of value in advancing the organization's priorities.

4. Reliance. Sustain your reputation as a “go-to” person. Build collaborative work groups within and across graduate medical education (GME) programs and the SI. When faced with urgent or emergent events, respond quickly, listen carefully, and avoid blindsiding others by always providing timely updates. Build consensus by ensuring transparency in the processes and choices you make. Become an outstanding team member through contributing practical wisdom as well as your time. Accept leadership responsibilities when able.

5. Ego extension. Ask for time to regularly present data at program, GME, and SI committees to demonstrate your impact on concerns and needs of patients and the institution, and on improving safety and patient care. Provide others with data that help them, as vital partners, advocate for your program's goals. Disseminate work (academic, clinical, and educational) collaboratively and in ways that promote institutional goals, including venues important to the SI, not just traditional academic forums. Advocate for promotion guidelines and professional society recognition to include projects aligned with high reliability and value programs.

By using the 4-part mattering framework, you can enhance how you and your program matter to your SI and program leadership. When you matter to others, they recognize your value as well as the value of your programs and activities in achieving shared goals.