Much like for clinician-educator faculty, dedicated academic time is crucial for a successful residency CEP. During such protected time, the trainee can gain the required skills and create their academic products, publications, and lectures. Unfortunately, radiology departments face a number of challenges in providing protected academic time.
We modeled our CEP protected time after the protected time given to those engaged in clinical and basic science research. Our department allows between one and twelve months of research over the course of a residency; didactic training, mentorship, and publication are expected. Call responsibilities remain during these months. Given the similarities between our research electives requirements and activities and our CEP requirements and activities, we simply treated CEP months as research months, i.e. the same systems for resident salary funding (usually department funds), reporting of resident time, and resident scheduling were employed thereby avoiding many of the hurdles that would have otherwise been prohibitive.
Our inaugural CEP allowed residents to take 1–3 months to work on CEP activities, all scheduled within a single academic year. These months could be taken contiguously or spaced out, depending upon scheduling availability and the needs of the project. We expect the upper limit for months of protected time may increase in future years. Additionally, we expect the program may expand to involve multiple academic years, potentially the entire four year residency. The ultimate form of this pathway is likely to be significantly affected by the upcoming radiology residency changes (17
), though the details have yet to be worked out.
When resident (and attending) physicians are asked to teach, it is often without any formal training. This disserves both the resident educator and the student. Didactic training has been extensively documented to dramatically improve teaching success (18
). A wide variety of didactic course work could be relevant for a resident CEP, including but not limited to:
- Classroom-based teaching skills
- Clinical setting teaching skills (i.e. teaching at the PACS station)
- Instruction on the creation of high-impact teaching materials
- Career planning and academic advancement
For those interested in education scholarship (research focused on educational methods or outcomes), additional course work could be relevant:
- Clinical research skills, including literature review and assessment, study design, data collection, data analysis, statistical analysis, manuscript writing, and presentation
- Sociology/psychology research methods, including surveys, assessing and measuring communication effectiveness, measurements of satisfaction
- Grant writing
Creating such course work de novo would be daunting, particularly for the relatively small number of residents likely to participate in a CEP. We elected to enroll residents in courses already available at our institution or at national conferences. Examples are listed in the Appendix
For simplicity, we required that one teaching-related course be taken, selected by the resident based on their schedule and interests. In future years, a core course may be selected, and/or core reading lists/texts may be employed.
Just as mentorship is needed for residents engaged in clinical or basic science research, mentorship is essential for those in a CEP. A mentor can guide the resident in the development of education products and publications, as well as in the development and delivery of high quality lectures. Further, the mentor serves as a role model providing exposure and facilitating the development of a network of collegial contacts.
A pre-selected list of mentors was chosen by the senior members of the CEP committee. Generally, senior faculty with well-regarded teaching skills, national recognition as a speaker, and an established record of publishing and mentorship were chosen.
A substantive education-focused project was expected from each participant. The time allowed for the CEP was primarily dependent upon the size and scope of the main project. At least one publication or presentation was expected. Abstracts, presentations, and papers were all encouraged, though a particular emphasis was placed on publication.
Examples of educationally focused projects were provided to CEP participants and included:
- Online educational modules, examples:
- Iodinated contrast reactions and treatments, with a focus on preparation for call and mastering the level of detail required by the American Board of Radiology.
- MR safety and the safe administration of gadolinium
- Procedure/technique instructional programs:
- Interventional procedures
- Studies related to residency education.
- Methods to prepare and evaluate residents on call
- Effectiveness of various “read out” styles.
- Studies regarding giving feedback and its effectiveness
- Teaching and assessing ACGME core competences
- Methods to improve communication skills
- Assessment and teaching of professionalism
The education-focused project to be undertaken was chosen and developed by the trainee with the help of their mentor. The proposed project and estimated time required was part of the application submitted to the CEP committee.
Lecture Development and Teaching
One resident-level, hour-long didactic lecture was expected from each Clinical Educator Pathway resident for each month of protected time granted. According to an accomplished, senior faculty member in our department, the creation of a high-quality didactic lecture can take up to 40 or more hours. This lecture requirement could therefore be expected to take up to one quarter of each month granted, leaving the other three quarters for work on the main education project.
Targeting the lecture to the resident level was elected for a number of reasons. The standard for completeness, usefulness, and rigor are higher when an audience shares a basic understanding of the material. Also, an audience more keenly motivated to master the material provides for a more satisfying educational setting. Clinician-educator faculty often lecture to fellow attendings (usually community-based peers), an experience that resident-to-resident lecturing can mimic.
The lecture topics were chosen and developed with the aid of the residents’ CEP mentors. The lectures were presented to the residency during regular conference times. The date was selected to ensure the CEP committee chair (the residency program director) and the mentor could attend, with the inclusion of other CEP committee members when possible.
A key component to lecture development and delivery is refinement of the presentation immediately after the talk. Each lecture created by CEP participants was therefore presented at different sites such that a lecture was given at least twice during a 12 month period, with refinements and improvements expected in between.
Participation in medical student teaching was also expected, though the creation of medical student-focused product was not a goal of the pathway. In many cases, residents gave pre-made lectures or participated in laboratories, allowing for teaching without the burden of creating additional lectures.
A formal written evaluation was completed for each trainee in the CEP. In this era of training documentation and learning portfolios (21
), proper documentation is essential. All lectures and academic projects were evaluated, both in real-time (allowing for modification of lectures, etc) and at the conclusion of the pathway. Comments from the CEP mentor and the CEP committee for each component were provided. Additional forms of evaluation were also included, for example, scores and comments from our lecture feedback system. Though confidential comments were allowed, the majority of the feedback was compiled in a comprehensive evaluation made available to the resident and uploaded as part of the resident’s learning portfolio. A final CEP interview was performed, often in conjunction with the semi-annual meetings with the program director.
The criteria upon which materials were evaluated included:
- Content/scientific value
- Critical thinking
- Evidence based practice
- Organization of material
- Quality of presentation
Written feedback from the CEP residents was collected by the committee. A self assessment was included in the learning portfolio, and comments about the pathway from the participants were used for program improvement. As the first few years of participants graduate and enter their careers, their career choices will be tracked, and participants will be surveyed on the impact of the program.