Faculty members with an interest in medical education scholarship often lack both local mentorship1,2 and a local discipline-specific community of collaborators.3 Early- and midcareer faculty may feel isolated from other educators, and this isolation impedes their academic development and scholarly productivity.4 Specifically, inadequate mentorship within the institution or a paucity of local mentors with similar interests may limit early- and midcareer faculty.1,4–6 Additionally, these relatively new faculty members often face competing demands (e.g., clinical productivity, scholarly activity, teaching, mentoring).4,5
Aside from formal medical education certification programs and fellowships,2 few programs address the needs of the “beyond-beginner” educator. Many programs either emphasize improving teaching skills or developing introductory scholarship/research skills,2 rather than acknowledging and enhancing current skills by applying a project-based approach. Many fellowship and certification programs are episodic, and few facilitate entry into a community of practice (CoP). Given the needs for faculty development in education scholarship, especially among early- and midcareer faculty, we aimed to develop and implement an innovative professional development program, housed within a virtual CoP.7
Academic Life in Emergency Medicine (ALiEM) faculty leaders including T.M.C., M.G., and L.M.Y. developed (November 2015–February 2016) and piloted (March 2016–February 2017) the Faculty Incubator. ALiEM is a social entrepreneurial, not-for-profit, grassroots learning institution with a mission to transform emergency medicine (EM) through innovation. The Faculty Incubator is one of many initiatives created to further this aim.
We designed the incubator to follow a longitudinal, asynchronous curriculum, focusing on education scholarship skill development in early- to midcareer clinical educators (“incubatees”) via a virtual CoP.7 Based on the findings of a literature review and a survey of other faculty development programs, we designed a yearlong curriculum with 12 modules, intentionally blending elements of a CoP with more traditional course-based programming. The Faculty Incubator included only three in-person sessions during the year—all embedded within national EM conferences. The rest of the time, scholars engaged in continuous, asynchronous discussion. Table 1 presents the longitudinal curriculum, including the topics presented in each of the 12 modules. Topics comprise developing one’s educational philosophy, team collaboration, education theory, consulting for educators, instructional technology, competency-based medical education, peer review, study design in education research, program evaluation, grant writing, scholarly dissemination, and work–life balance. Incubatees engaged in various individual projects (e.g., developing a personal teaching philosophy) and group projects (e.g., writing a chapter for a book on the practical application of education theories) throughout the year.
Incubatees benefited from two types of mentors: core and guest mentors. Core mentors (n = 8) served as the primary instructors, responsible for fulfilling the curricular objectives and supervising projects. The core mentors led the various asynchronous discussions (e.g., journal club) and helped to advise various incubatees in their longitudinal project groups using both synchronous meetings (e.g., via Google Hangouts) and asynchronous methods, including e-mail and Slack, a closed social media platform (Slack Technologies, San Francisco, California). We recruited core mentors from various geographic locations, based on referrals from Faculty Incubator leaders (T.M.C., M.G., L.M.Y.) and ALiEM board members. Although their experience in medical education varied, all faculty members had published at least 10 peer-reviewed articles, which was important to us considering our focus on education scholarship. We initially recruited core mentors without offering any incentive, but after they agreed to participate, we offered each core mentor a small teaching honorarium.
Guest mentors (n = 10), recruited on the basis of their subject matter expertise (e.g., expertise in one of the curricular topics), were interviewed by core mentors during live, recorded presentations, during which incubatees could ask questions via Twitter or Slack in real time. We archived the presentations for future viewing by those who could not attend synchronously.
Funding and costs
The annual tuition was $1,500 per incubatee, providing an operating budget of $45,000. We secured one sponsor, the Council of Residency Directors of Emergency Medicine, which allowed us to subsidize the costs for some incubatees. We used the funds for operating costs and events/materials. We allocated approximately 25% of the budget to teaching honoraria for core mentors.
Curriculum and online platform
To facilitate learning, core mentors acted as central members of a CoP, engaging the incubatees and encouraging them to discuss issues and exchange ideas. The goal was for incubatees, as initially described by Lave and Wenger3 and extended by Dubé and colleagues,7 to develop their identity as legitimate members within our virtual CoP.
We housed our virtual COP on Slack, a communication platform with capacities beyond organizing an e-mail group or listserv; rather, Slack allowed scholars to engage in various forums, private discussions, and direct messaging (see Figure 1). For instance, core mentors used the forums to host a weekly journal club, highlighting influential articles relevant to the monthly theme.
Initially, the Faculty Incubator depended heavily on faculty member scaffolding. Core mentors facilitated conversations and engaged incubatees through planned question prompts (see Figure 1), as well as through questions based on trends in the discussions. By the second week, incubatees began posing their own questions, requesting assistance, or seeking advice. This increased initiative eventually led to incubatees providing each other with insights or advice and helping one another solve problems across geographic borders and time zones.
Another key aspect of the curriculum was the development of thematically aligned assignments, through which groups of three incubatees worked together to learn about a specific given subtopic and then apply the new knowledge to solve a problem and educate the rest of the incubatees. This approach is based on Kolb’s theory of experiential learning8 which suggests that learners apply the theories they have learned in simulated or real practice and emphasizes active experimentation. We linked assignments to realistic education problems and challenged the incubatees to create solutions. We did not formally assess these assignments, but we did provide formative mentor/peer feedback to the scholars to support their continued growth. To provide synchronous face-to-face interactions, mentors offered webcam-based office hours during which the scholars could “drop in” and ask questions or for advice or guidance. Interestingly, the uptake of this was poor; incubatees seemed to prefer asynchronous communication (e.g., direct messaging).
We recruited incubatees by posting an advertisement on the ALiEM website and through a concurrent Twitter campaign. Applicants had postresidency experience ranging from 1 to 13 years (median 4 years; interquartile range 2–8 years). We required applicants to demonstrate that they had prior medical education training (e.g., completion of medical education fellowships, master’s degrees in education, teaching courses run by national organizations, local faculty development courses). We also required the endorsement of their department chair or division chief. We received 35 applications, and after a rigorous review process, we invited the top 30 applicants to participate.
The Hamilton Integrated Research Ethics Board granted approval for us to conduct an online mixed-methods survey to evaluate the Faculty Incubator after the inaugural scholars completed its first iteration. Using a retrospective pre–post methodology,9 we asked the scholars to rate their perceived baseline medical education knowledge prior to starting the ALiEM Faculty Incubator and their perceived final medical education knowledge upon completing it. We also asked, via open-ended questions, about their perceptions of and experiences with the program.
In our inaugural year (March 2016–February 2017), we selected 30 incubatees. One of the 30 was from Chile, and the other 29 were from, collectively, 15 different U.S. states. Twenty-nine scholars completed the ALiEM Faculty Incubator curriculum.
During the inaugural year, participants (including incubatees, core mentors, and guest mentors) sent a total of 22,665 messages via Slack (62 messages/day; see Figure 2). Of these, 3,036 (13.4%) were via open channels (i.e., directed to the whole network, and open to all individuals to view and read), 5,483 (24.2%) were via groups (i.e., discussions within small groups whose members shared goals, usually group projects), and 14,146 (62.4%) were via direct messages (i.e., between individuals and small groups, hidden from others). Participants also shared a total of 1,081 files during this time. We feel that these numbers are a useful and measurable surrogate metric for engagement within our virtual CoP.
The incubatees each coauthored posts for an open peer-reviewed blog series (“Educational Theory Made Practical” on the International Clinician Educator blog), which was subsequently edited into a peer-reviewed textbook.10 The scholars also received opportunities to work on scholarly articles, and 21 of the 30 incubatees coauthored a published article or a manuscript accepted for publication. A total of 13 peer-reviewed articles and 1 book10 resulted directly from Faculty Incubator assignments. Incubatees also reported ongoing work on local projects (e.g., curriculum design) that they began over the course of the curriculum. Although publications are not the only measures of academic success, these metrics suggest that our program may be useful in fostering scholarly output.
Of the 30 inaugural incubatees, 24 (80%) completed the evaluation survey at the end of the program.
The incubatees’ average self-reported retrospective preparticipation medical education knowledge level was 4.3 (standard deviation [SD] 1.5) on a 9-point scale (where 1 = “Nothing,” 9 = “Enough to feel competent and confident working with seasoned educators”). Their postparticipation knowledge level was 7.0 (SD 1.1). The increase in the incubatees’ perceived medical education knowledge was statistically significant (analysis of variance F[1,46] = 52.2; P < .0001).
In their open-ended responses on the evaluation survey, incubatees noted that the ALiEM Faculty Incubator was unique from other faculty development initiatives in several key ways. Several incubatees (n = 4) highlighted the unique longitudinal format. To illustrate, one incubatee comparing the Faculty Incubator with other faculty development initiatives noted that “enthusiasm at the [other traditional faculty development] sessions [wanes] when participants return home and life gets in the way.” Although the Faculty Incubator required a longer commitment, it nurtured relationships, allowing incubatees to create a sense of community. One incubatee observed, “It felt more like a MedEd community than a group of classmates,” and another felt the platform made approaching established clinician educators easier: “It can be incredibly intimidating to reach out to powerhouses in the field, but seemed significantly less so in this setting.”
Three incubatees specifically noted that the online platform prompted more interaction on a daily-to-weekly scale, resulting in more engagement. To illustrate, one incubatee felt that the online community served as “a means to fire off and bounce ideas off one another, [which] was novel for me.” Incubatees also deemed the diverse mentors involved in the Faculty Incubator a unique facet. One participant summarized this best: “[It is a] Virtual Program [sic] with no geographic ties, bringing together a group of diverse people with different perspectives.”
Incubatees also noted that the monthly assignments differentiated this initiative from most faculty development programs. Whereas some participants reflected that the assignments allowed them to learn (n = 2) and increased their ability to generate scholarship (n = 3), others felt that the assignments created an excessive workload (n = 4). Attrition and disinterest affected assignment completion; the absence of a small minority of incubatees made completing some group assignments challenging for the scholars who were more engaged. Two incubatees found integrating their online responsibilities (e.g., group work, assignments) with the rest of their work and lives to be challenging, and one noted that other synchronous courses tend to provide participants with protected time, away from existing obligations, allowing for a greater focus on learning. One incubatee aptly remarked that the Faculty Incubator is “[m]uch more in-depth and work intensive, but you get out what you put in.”
This initial report is by no means conclusive. On the basis of feedback from the inaugural year, we have revised the curriculum. Specifically, we have assigned fewer mandatory projects and allowed more optional projects in the most recent (March 2017–February 2018) iteration. We have also combined and condensed topics to allow for two wellness breaks (one in July because workload for residency leadership is higher, and the other in December to accommodate holidays). Details of the revised curriculum appear on the ALiEM Faculty Incubator website. We have invited alumni to co-teach during the 2017–2018 cohort.
Further, we realize that Slack engagement statistics may not tell the whole story, especially given that incubatees and mentors also used e-mail and phone calls to facilitate their work. Future research may clarify the optimal duration of the ALiEM Faculty Incubator, ideal cohort size, and associations between the frequency of messaging (i.e., engagement) and curricular topics. Further evaluation might explore the mentors’ experiences in this online program or explore the sustainability of a distributed model of faculty development. We have also planned a longitudinal observational study to determine the efficacy of the initiative in helping faculty members produce educational scholarship.
We look forward to building on our initial outcomes, which provide proof of concept that the ALiEM Faculty Incubator effectively works to engage an international group of early- to midcareer medical educators in creating an interactive, online CoP.
The authors would to thank Drs. Michelle Lin, Adaira Chou, Nikita Joshi, and Michael Gisondi for their support of this initiative. They would especially like to thank all the incubatees who signed up to be part of the inaugural Faculty Incubator in 2016–2017 and those who have participated subsequently. The authors are so proud of all that the incubatees have accomplished so far, and they look forward to seeing them thrive in the years to come.