Why is making time for scholarship in academic medicine so hard to achieve?
That question was at the forefront of a Sunday session titled “Thinking Outside the Box: Turning Your Clinical Activities or Teaching into Scholarship” at the 2013 annual meeting of the Association of American Medical Colleges in Philadelphia. Led by Wendy Hobson-Rohrer, M.D., a professor of pediatrics and associate dean for faculty development at the University of Utah and Emily Walvoord, M.D., an associate professor of clinical pediatrics and assistant dean for faculty affairs at Indiana University School of Medicine, the session delved into ways that clinicians can look at their work to “make it count twice” —or finding ways to turn clinical case studies into articles for journals, methods for developing best practices and a host of other examples of scholarship.
Most people engaged in academic medicine have a busy schedule balancing research, teaching duties and clinic time. Scholarship can often be tossed to the back burner —but it doesn’t have to be that way, say Hobson-Rohrer and Walvoord.
“Think of ways to maximize work and to make projects count twice,” says Hobson-Rohrer.
She offered an example from her own work at the University of Utah, in which as part of her job duties she needed to offer remediation to a medical student. Instead of developing a simple plan for the student and leaving it at that, Hobson-Rohrer decided to broaden her efforts to help peers around the country who might find themselves in similar situations with medical students. She collaborated with a national group of educators to create a peer-reviewed workshop on remediation and traveled around the country to present the workshop. The work eventually ended up published on the web site, mededportal.org, where it continues to be a resource to others —and a piece of scholarship from what started as a regular work assignment for Hobson-Rohrer.
“There were a whole lot of different things that came ouf of that,” says Hobson-Rohrer.
Walvoord offered a similar example from Indiana University School of Medicine, where clinicians turned an announcement of new guidelines for the care of girls with Turner syndrome into a chance for study. Clinicians at Indiana asked the question, “Are we providing the best care for our girls with Turner syndrome?” They carried out a chart review to see if health care providers within their system were following guidelines and based on their findings, made a poster to present at a national meeting along with an abstract. That development turned into more presentations at Grand Rounds, which turned into publishing a manuscript on their chart reviews. Finally, they came up with developing a flow sheet to see if they could improve outcomes of adherence to guidelines and care.
Hobson-Rohrer and Walvoord both noted that it’s essential that young faculty members be assigned mentors who emphasize the importance of scholarship in academic medicine, and who encourage young faculty members to squeeze time in for such activities. The two say when they are working with young faculty, they ask them to reflect on a series of questions, including “Who am I? Where am I going? What do I really want? What work that I do is most satisfying to me? What will give me fulfillment?”
Those conversations can help steer young faculty to the direction in which they are most passionate —which often is the same direction in which they will find the most success.
As for incorporating more scholarship into day-to-day practices, Hobson-Rohrer and Walvoord encouraged clinicians to look to different types of scholarship outlined in Boyer’s Types of Scholarship. Instead of focusing simply on discovery science resulting in new knowledge that gets published in peer-reviewed journals, clinicians should look toward integration/sharing knowledge through a comprehensive literature review or writing a textbook chapter. They might also use application scholarship, which entails bringing knowledge to bear in addressing societal needs like developing practice standards. Offering a reflective critique on mentorship can also be turned into scholarship, Hobson-Rohrer says.
“Does an intern that you taught about screening for anemia actually do it? Do they order an anemia test? And in the end do anemia rates go down – which would be the gold standard?” she says.
Both also encouraged clinicians to work hard to disseminate their scholarship to multiple sources by evaluating the “3P’s”: Make sure it is given to the public, to peer-reviewed places and to platforms for others to build upon.