The Value of Supporting Education Research in the Academic Environment: The Hospital for Special Surgery Academy of Rheumatology Medical Educators : Academic Medicine

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Innovation Reports

The Value of Supporting Education Research in the Academic Environment: The Hospital for Special Surgery Academy of Rheumatology Medical Educators

Berman, Jessica R. MD1; Aizer, Juliet MD, MPH2; Tiongson, Michael D.3; Bass, Anne R. MD4; Parrish, Edward J. MD5; Robbins, Laura DSW6; Paget, Stephen A. MD7

Author Information
doi: 10.1097/ACM.0000000000003884

Abstract

Problem

Previous work has demonstrated that educators do not receive the same recognition as their colleagues in clinical and basic science for their academic contributions and that financial support for education research is often inadequate. 1 Those who wish to pursue high-quality and nationally recognized research in education have limited funding and support for such activities in comparison to that for clinical practice and bench, translational, and clinical research. 1 To address this deficiency, academies to support medical education have grown significantly. 2 Their missions, while variable, serve to recognize and promote educators and scholarship in education.

A 2008 survey of U.S. medical schools found that less than 50% offered any monetary awards to scholars and only 8% offered protected time to conduct research. 3 A systematic review in 2016 found that most successful medical education research programs received funding from endowments, departments or the medical school itself, or collaborative medical societies. 4 Some academies, such as the one at the University of California, San Francisco—one of the oldest and the one from which we drew inspiration for our academy—have a long funding history and outcomes that include not only the development of innovative programs but also career advancement for clinician–scholar–educators (CSEs) as well. 5

With this in mind, in 2011, we held an education retreat in the Division of Rheumatology at the Hospital for Special Surgery (HSS) in New York, New York, to perform a strengths, weaknesses, opportunities, and threats analysis focused on fostering innovation and excellence in our education programs. We brought together various stakeholders—including fellowship program and associate program directors, the division chief and chief emeritus, academic training, teaching faculty, and fellows—to generate new ideas to further the hospital mission to be the most trusted educator. One result was the formation of the HSS Academy of Rheumatology Medical Educators. The academy was developed to create a stimulating academic environment for educators that would enhance the quality of teaching and foster novel teaching methods. It was established initially in the Division of Rheumatology with the hope that it would later be adopted by other departments within the hospital and Weill Cornell Medicine. 6 To further the academy’s mission, we created a pilot innovations grants program to support educators interested in medical education research and elevate their academic value to a level on par with bench, translational, and clinical investigators. 7 In this report, we describe that grants program and its subsequent outcomes.

Approach

The Academy of Rheumatology Medical Educators is a subspecialty hospital–based academy, not dissimilar from the Boston Children’s Hospital Academy, which was also founded outside the affiliated medical school. 8 Our academy is distinct from the majority of academies reported in the literature, however, in that its funding comes neither from the medical school nor from institutional funds. To fund our innovations grants pilot program, then, we used directed fundraising, and we earmarked funds specifically for these annually awarded education grants. Donors who had previously supported basic and clinical research projects at HSS were approached by the director of the academy, who, as the former chair of the Division of Rheumatology, had proven his dedication to mentoring junior faculty educators and had prior fundraising experience. A longstanding relationship of trust between HSS and the donor and a history of demonstrated productivity from researchers at the hospital were critical to the success of our program.

Every year from 2012 to 2016, we sent out a request for proposals to the HSS faculty. The request announced the creation of the innovations grants program and explained that it was designed to serve as an impetus for the development of new teaching programs and to promote curricular change through the formation of new or improved teaching programs and learning opportunities.

The academy’s funding priorities were carefully delineated and initially included the following areas: (1) teaching strategies involving multiple levels of learners, (2) unique assessment tools for learners, (3) integration of innovative technologies and asynchronous learning into the curriculum, and (4) patient-centered preventative care. In 2012, the program was piloted in the rheumatology division. Since enthusiasm for a hospital-wide academy—which was our ultimate goal—was still absent in 2014, to increase interest, we extended funding to physicians and nurses in other departments including anesthesia, physiatry, and orthopedics. We offered to pay for half of each grant awarded if the chair of each recipient’s department would match the amount as a show of commitment to such research.

All grant applications were reviewed by a carefully selected external panel of educators who were nationally recognized for their education expertise; several panelists had previous experience developing academies, but the majority were Rheumatology Research Foundation Clinician Scholar Educators. The panel assessed application merit according to Glassick’s criteria for education research. 9 The HSS Rheumatology Education Council, created to provide ongoing oversight of the academy’s grant activities, reviewed the composite scores and comments for each grant application. Applicants with merit who met the requisite funding priorities and scored the highest received up to $50,000 a year for one year. Grant recipients presented their work at monthly research meetings and the annual academy day education research symposium. If the recipients demonstrated ongoing productivity, their grants were renewed for a second year.

The initial pilot enabled us to understand how these educator–scientists fit into the HSS environment and which aspects of the innovations grants program the hospital would continue to support and develop. Although HSS did not assume ownership of the academy, its leaders praised the success of the innovations grants program and the academy because it fulfilled the hospital’s unmet needs.

Through the continued generous support of donors, the academy transitioned to indefinitely supporting the research projects of a core group of educators who received grants during the pilot phase of the program. These educators were chosen by consensus of members of the Rheumatology Education Council and had the interest and demonstrated research outcomes to justify continued support.

Grant recipients annually provided information about themselves, their presentations, and their publications to the academy. We obtained additional information regarding their attitudes; award impact; and subsequent promotions, awards, and grants via an emailed survey in 2017. The academy research assistant entered survey responses into REDCap (Vanderbilt University, Nashville, Tennessee) before analysis. The information presented in this report is up to date as of October 19, 2019.

Outcomes

From 2012 to 2019, the academy awarded 32 grants for a total of $954,045. At the time of the survey in 2017, there were a total of 14 recipients who had received 23 grant awards. It is their information that we analyzed for this report. Of these, 9 identified as female and 5 as male; 12 recipients were physicians at the time of the award and 2 were nurses. The physician recipients were of various ranks, including 1 instructor, 6 assistant professors, 3 associate professors, and 2 full professors. Of the 2 nurse recipients, 1 was a clinical nurse and 1 an assistant vice president. Most of the recipients already devoted at least some percentage of their time to education activities before receiving the award, with 2 recipients spending less than 10%, 7 spending 10%–29%, and 5 spending 30% or more.

Grants included projects in 4 educational areas: (1) curriculum, (2) digital learning tools, (3) assessment, and (4) mentoring. The breadth of topics speaks to the success of the academy in drawing scholars with diverse research interests to focus on education. Their projects targeted various groups, including 21 medical students, 25 residents, 6 fellows, 5 faculty members, and 2 patients. After receiving the award, recipients produced 21 national meeting abstracts, 25 oral presentations, 6 publications in peer-reviewed journals, 5 enduring curricula, and 3 digital learning tools. A list of pilot grants is available as Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/B53.

In their responses to the 2017 survey, recipients recognized many benefits to their careers following receipt of an innovations grant, including increased recognition as an educator, additional time for research activities, promotions, and other grants. Of the 14 grant recipients, 11 completed the survey. When asked to “rate the impact the HSS Academy grant has had on your career” (where least = 0 and greatest = 5), 10 (91%) respondents noted the impact on their career to be “great” or “greatest,” 3 (30%) said they felt the grant had been instrumental in a promotion (1 respondent was promoted to associate professor on the education track), and 3 (30%) received new academic appointments as educators—1 to the medical school as an education scholar and unit leader of patient care and physicianship and 1 to the institution as director of the faculty mentoring curriculum. Grant recipients received 6 teaching awards and gained recognition for their research, which enabled further success in their careers. Five recipients (45%) received additional funding, and 2 (18%) pursued advanced certification following receipt of the award. Ten recipients (71%) continued their education research after the grant funding ran out.

In the years following the pilot program, 4 recipients continued to be academically productive and received annual support with grants in the range of $50,000–$75,000. As of 2019, this support was ongoing. Most have been able to negotiate protected research time (on average, 20%); however, because of concomitant burdens to continue caring for patients, we hired an education research assistant to provide additional support to these scholars in 2015. This assistance allowed us to support 2 new hospital-based programs: a novel rheumatology ultrasound program and a hospital-wide mentoring program. It also allowed us to more widely disseminate education tools, including the ROSCE (Rheumatology Objective Structured Clinical Exam)—an assessment of trainee professionalism used across New York City programs—and HSS CLASS-Rheum—the nationally disseminated digital learning tool used to teach critical appraisal of the literature to rheumatology trainees.

Next Steps

We created the HSS Academy of Rheumatology Medical Educators and the innovations grants program to stimulate an academic education environment that enhances the quality of teaching and promotes teaching careers and education research. The number of academic contributions and the measurable success of our grants-funded recipients highlight the value of such a structure for education research. Our academy is unique in that it is supported by self-directed funding.

An additional benefit of the academy has been the creation of a core group of institutional educators who continue to produce high-quality curricular materials and scholarship. These 4 individuals now devote a majority of their time to innovative program development and produce education scholarship that is the same quality as that produced by basic scientists and clinical researchers. Their education scholarship is nationally recognized, and they now serve as mentors to other CSEs. The launch of the innovations grants pilot program has highlighted the talents of heretofore under-supported and under-recognized teaching faculty by allowing them to distinguish themselves academically.

In the future, we would like to harness the resources of the academy to foster the academic and scholarly interests of a trainee as well—one who has already identified an interest in education upon starting as a fellow. While supporting the research of our trainees has always been a priority of HSS, the focus was on the basic and clinical research arenas. Those interested in education are often told that they can develop as a CSE after fellowship but are not adequately prepared to take on those roles later. The scholarly work of a new fellow would be supported through a competitive grant provided by the academy, as would a master’s degree in education. We believe strongly that support at this early stage, both monetary and professional, would foster education careers for interested individuals and infuse medical education with the most talented individuals rather than funneling them to other areas of research.

The academy has created an environment that promotes and values teaching careers and education research and raises the importance and quality of teaching to match those of clinical care and research.

References

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Supplemental Digital Content

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