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Medical Education

Author

Kayvon Izadpanah, MD
Emergency Medicine Resident
University of Virginia

Editors

Glenn Paetow, MD, MACM 
Medical Education & Simulation Fellow
Hennepin County Medical Center

Dimitrios Papanagnou, MD, MPH, EdD(c)
Vice-Chair of Education, Department of Emergency Medicine
Assistant Dean for Faculty Development
Thomas Jefferson University

Special thanks to our 1st edition writing team

Abdullah Bakhsh, MD
Holly Caretta-Weyer, MD
Patrick Olivieri, MD
Joshua Kim, MSIV
Nicholas Reid, MD
Nicholas Governatori, MD 
Dimitrios Papanagnou, MD, MPH, EdD(c)

INTRODUCTION

Description of the specialty
Medical education fellowships within emergency medicine cover a broad skillset related to the education of medical students, residents, and faculty. This typically includes topics such as curriculum design, learner assessment, program evaluation, education research, education and adult learning theory, simulation and immersive learning, pedagogy, as well as faculty development and continuing medical education (CME). While content typically focuses on undergraduate and graduate medical education in emergency medicine, skills developed are readily transferable to other domains of medical education and leadership.

History of the specialty/fellowship pathways
Emergency medicine physicians have been involved in medical student and resident leadership and education for decades. Therefore, medical education fellowships were originally developed to address the need for advanced training to assist education champions tasked with training the next generation of physicians. Historically, medical education fellowships were institution-wide, and focused on early to mid-career faculty in order to hone their skills in pedagogy. 

The number of fellowships began to sporadically grow in the early 2000’s; in recent years, however, the number of fellowship programs have proliferated exponentially. Programs range from 1-2 years in length, and usually depend on whether or not a certificate or a master’s degree is offered as part of the fellowship. Online hybrid courses with partial required in-person sessions are also options to pursue advanced degrees in medical education.

Why residents choose to follow this career path
Commonly, residents follow a career path in medical education to further refine their skills in education as they begin their respective careers in academic emergency medicine. A subset of this cohort, however, also enter fellowship to pursue more specialized areas (ie, education research, residency program leadership, or clerkship leadership). The skills developed during medical education fellowship also provide prospective fellows with the foundation for careers in institutional education leadership (i.e., assistant/associate deans, vice-chairs, or simulation center leadership). 

How do I know if this path is right for me?
If you enjoy teaching medical students and being involved in resident/student education, then fellowship training in medical education may be an intuitive career decision. Alternatively, if you want to gain experience in educational research, curriculum development, assessment design, or other areas of medical education, fellowship would provide these skills. Refined training in educational theory and curricular methods can provide you with ample opportunities for your career development, particularly if you see yourself pursuing a position as a medical student clerkship director, associate program director, or even program director. 

Career options after fellowship
Career options after fellowship are endless! Some fellowship graduates choose to focus on academics, and publish research in medical education that pertains to both undergraduate and medical education audiences; others seek out opportunities in residency program leadership (i.e., residency program director or associate/assistant residency program director). Other future career options often include positions as assistant or associate deans of a medical school (i.e., in faculty development, graduate medical education (GME), student affairs, curriculum); or a designated institutional officer (DIO) for GME at your institution. There are also positions available in national education organizations, such as the Agency for Healthcare Research and Quality (AHRQ).2

Splitting time between departments
Your time will likely be split between administrative/educational duties and clinical shifts. It is up to you and your prospective chair to determine how much time is split between these activities. 

Academic vs. community positions
Some fellowship graduates choose to work part-time in the community or primarily at a community-academic affiliate in order to maintain their independent practice, while others work solely in academic institutions with medical students and residents full-time. 

IN-DEPTH FELLOWSHIP INFORMATION

Number of programs
The number of education fellowships has rapidly increased due to its popularity, with more than 30 programs (and growing). Please reference the EMRA Match website for the most up-to-date list. If you are interested in medical education fellowships, it would be useful to discuss this with your program director or a mentor in the field, who is typically the first to know of new programs via the CORD email listserv; he or she can forward these opportunities to you as they arise.

Additional searches for online or distance-learning programs can be undertaken yearly (as an alternative to completing a fellowship, or in conjunction with fellowship) as new programs appear each year.

Some of the most well-known online learning programs include the University of New England Master’s in Medical Education, Johns Hopkins Master’s of Education in the Health Professions (MEHP), University of Southern California's Masters in Academic Medicine (MACM), and the Masters of Education Program (MHPE) through the University of Illinois (UIC); however, there are many others. 

Differences between programs
Generally, all programs are designed to develop leaders in resident and medical student education, curriculum development, and educational research. The facilities and methods in achieving these goals may differ from program to program. As an example, some programs provide opportunities to get involved in podcasts, while others allow teaching the United States Navy procedures on cadaveric models. Some programs even provide training for some of the major sports teams in their respective cities! While most programs have a wealth of information on their website, newer programs may not have such detailed information available; for this reason, it is encouraged that you contact the fellowship director(s) directly with any questions.  

Typically, for academic emergency departments, the strengths of that respective department will be well represented in the fellowship’s training opportunities. Therefore, if there is an emergency department known for its innovative contributions to emergency medicine, it is highly likely that the respective fellowship will afford the fellow the chance to immerse himself/herself in this area during training.

Length of time required to complete fellowship
Program length varies from 1 to 2 years. Most 2-year fellowships encourage, and often help fund, an advanced degree in education and/or research at an affiliated academic institution.

Skills acquired during fellowship
A medical education fellowship generally provides a foundation for a career in academic medicine. Each program should be able to provide you with mentorship in many, if not all, of the following areas: undergraduate and graduate medical education; understanding of academic medicine and credentialing bodies; competency-based medical education and the Accreditation Council for Graduate Medical Education (ACGME) milestones; curriculum development; education research; adult learning theory; assessment; program evaluation; healthcare simulation; continuing medical education; mentorship; and faculty development. Many programs will have projects already in progress that you can join. If you have a specific area of interest, however, there are often opportunities to develop new projects. Because the community is small, immersion in a medical education fellowship opens the door a wide-variety of networking opportunities with like-minded educators and academicians across the country.

Typical rotations/curriculum
There are no formal rotations that take part in a medical education fellowship. Most fellowships have a shift-load requirement of 7-10 shifts per month, where the fellow functions as an attending physician in either an academic environment or a community affiliate. There is typically an informal curriculum used to teach the aforementioned skills. There may be a formal curriculum in place, or the fellow may pursue an advanced degree that will cover educational core content in more depth. Completion of projects related to new curriculum development, learner assessment, or educational research are usually required components of these fellowships. 

Board certification afterwards?  
No. As mentioned previously, some programs will include an advanced degree (i.e., certificate or Master’s in Medical Education). 

Average salary during fellowship
The average salary varies by institution, given that medical education is not an ACGME-accredited fellowship. The lowest salary is that of a PGY-4 or PGY-5 trainee, while the highest can range upward of $120,000 per year if hired as a junior clinical faculty member. Institutions with lower salaries may incorporate the fellow into the bonus structure of the department, which will significantly increase the fellow’s earning potential. Many programs will also allow some external moonlighting during the fellowship to supplement income, so long as it does not interfere with training and fellowship responsibilities.

Many programs set aside funds for the fellow to subsidize training opportunities outside of the department, such as the American College of Emergency Physician (ACEP) Teaching Fellowship or the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. While these funds could be part of the fellow’s salary, having the option of pre-tax funds available may appeal to fellows who will choose to pursue an advanced degree or certificate, or may choose to attend more conferences throughout the fellowship year.

PREPARING TO APPLY

How competitive is the fellowship application process?
The application process for medical education fellowships is fairly competitive. There are generally anywhere from 4-12 applicants per fellowship position. Be aware that some fellowships are created for internal institutional needs and vary on number of external applicants considered (because departments invest time and money in these fellowships, the goal for some is to groom and retain these fellows as academic faculty members). 

Requirements to apply
Requirements include board eligibility or board certification in emergency medicine; a personal statement or letter of intent; and generally 2-3 letters of recommendation, including one letter from your program director. Some fellowship programs require acceptance to a Master’s degree program in order to be accepted into the fellowship program. 

Research requirements
There are no definitive research requirements, although previous research in medical education that results in a national presentation or publication is always a plus. 

Suggested elective rotations to take during residency
If you have elective time, you should seek opportunities to spend this time teaching and building your education portfolio. Multiple templates are available for you to start populating your educational portfolio; chances are your institution already has a template that you can start using. Many programs allow residents to spend time teaching one-on-one with medical students while on a shift. You could also develop conference content, teach advanced cardiovascular life support (ACLS) or advanced trauma life support (ATLS) certification courses, or assist with writing, running, and debriefing simulation cases. You can also seek mentorship from faculty and develop curricula for medical students and residents. It is strongly advised that you take the time to write-up your educational activities for publication in education-focused journals, including educational scholarship opportunities (i.e., the AAMC’s MedEdPORTAL or the Journal of Education and Teaching Emergency Medicine, JETem). 

Suggestions on how to excel during these elective rotations
As with anything, be enthusiastic, professional, and organized. Seek mentorship from the clerkship and/or residency leadership on how to develop bedside teaching skills. Think about the educators that helped you the most during your training and what teaching styles they modeled. 

Should I complete an away rotation?
It is not necessary to complete an away rotation in order to secure a fellowship position in medical education; however, if there is a particular institution where you would like to match, you may choose to do so. 

If you have time available during the last year of residency, consider taking the ACEP Resident Teaching Fellowship. Spots may be limited, so inquire early; but this experience will serve as a good primer as to what will await you as a prospective medical education fellow. Be sure to apply for the EMF-ACEP Teaching Fellowship Award, which will help cover the cost of the course! Additionally, you may pursue this course as a fellow or junior faculty member with continued benefit.

What can I do to stand out from the crowd?
The best way to stand out from the crowd is by developing a CV that strongly demonstrates your interest in medical education through meaningful activities. This can include research, curriculum development, publications, blog posts, leadership activities (i.e., chief resident, EMRA involvement), and involvement in medical student education. 

Additionally, if you are able to attend the CORD Academic Assembly, this is a great opportunity for national exposure, whether it’s just meeting educators from across the country, presenting an abstract, a presentation, or even joining a committee.

Should I join a hospital committee?
For medical education fellowships, try to get involved in your residency program and with the medical student clerkship in ways that are pertinent to applying for fellowship. For example, you can get involved with teaching shifts where you work one-on-one with medical students, you can work with your clerkship director to learn how to write standardized letters of evaluation (SLOEs), or you can work on core content delivery for students through simulation, lectures, or podcasts. With regard to resident education, you can get involved with hospital graduate medical education (GME) committees, monthly resident simulation, conference content, or creation of podcasts.

Publications other than research
If you have the opportunity to develop a curriculum or specific educational content, you should attempt to publish it! There are several journals, both within emergency medicine and within medical education as a whole, that accept educational innovations. Another great avenue to get your hard work noticed is MedEdPORTAL, JETem, and the Technical Report in the Cureus Journal of Medical Science, which are all peer-reviewed. 

How many recommendations should I get? Who should write these recommendations?
You should have at least 2-3 letters of recommendation when applying to medical education fellowships. One must be from your program director. The other 1-2 should be from faculty members who know you well, both in regards to your clinical work and educational involvement. 

What if I decide to work as an attending before applying? Can I still be competitive when I apply for fellowship?  
Absolutely! You would still be competitive, especially if you decided to take a faculty position at an academic institution prior to completing a fellowship, and develop an interest in medical education during that process and wish to pursue further training. 

What if I’m a DO applicant?
If you are a DO applicant who has completed or will complete a residency in emergency medicine in the United States and become board-certified or board-eligible by the time of entering a medical education fellowship, you will certainly be considered. 

What if I’m an international applicant?
If you are an international applicant that has completed or will complete a residency in emergency medicine in the United States and become board-certified or board-eligible by the time of entering a Medical Education fellowship, you will be considered. You must have a valid visa at the time of application and at the time of entering the fellowship. It is advised that you check with a program’s policies and procedures for international applicants, as these will vary from institution to institution. 

APPLICATION PROCESS

How many applications should I submit?
As always, where you are going to spend the next 1-2 years of your life is a very personal decision. Make sure wherever you end up is somewhere you could move with your loved ones. That being said, as programs become more competitive you may want to apply broadly to give yourself the best chance of success. 

How do I pick the right program for me?
This one will be hard to know until after interviews. As most programs are accommodating for interviews, we recommend going on all interviews at institutions you are seriously considering. Education requires a team-based approach, and as such, finding the right “fit” is very important. As of now, there is not a large discrepancy in history or prestige, so pick the place you believe that would give you the support in order to thrive as a future academician. 

Common mistakes during the application process
We believe that one of the biggest mistakes would be not being true to yourself or to the program that is interviewing you. Make sure you are serious about applying somewhere before going on an interview. If you do not have a serious interest in attending a specific program, then it is advised that you do not interview at that program. If you are seen as dishonest during this process, that view may stick with you longer than you would like. Remember, this is an increasingly small professional world, so treat everyone as you would like to be treated. 

Application deadlines
All variable, but as a general rule of thumb, you should start applying in the late summer as interview season generally starts in the Fall. 

Tips for writing your personal statement
Being honest and true to yourself and your experiences will paint a picture that you would want to convey. As a general rule of thumb, a good story about education is better than a generic experience. Be yourself, and you shouldn’t have any issues. 

Is there a match process?
No. In fact, many applicants are frustrated by the lack of consistency with the timing of offers for fellowships. For example, one program may offer a position and need confirmation of an applicant’s decision before the applicant has had a chance to hear back from other programs. Because of this lack of a standardized process, it is important to be honest and open with fellowship directors. Communication is key. If you find yourself in this situation, simply let the fellowship director know.

What happens if I do not secure a fellowship position?
There are many alternative ways to contribute to the education process other than a dedicated medical education fellowship. Any academic position will lend you the opportunity to contribute to the education of current and future doctors, though they may focus less on the educational theory. Fortunately, EM is a specialty that rewards the motivated. If you keep at it and make it a productive year, you will increase your chances for securing a fellowship position the following year!

INTERVIEW PROCESS

How do I stand out from the crowd?
You have managed to impress your prospective program director on paper with your academic achievements and clinical experience. Now it is time to show them in person how you are different from other applicants. It is very important you package and present yourself by identifying your qualities and strengths, and aligning them with the program’s objectives to display compatibility. Researching the program’s website will give the interview dialogue a two-way feel, and you will come across as a well-informed candidate. Rehearse and decide what message you want to convey to the interviewer, showing how the connection between your achievements and the fellowship’s opportunities will help you reach your goals. 

What types of questions are typically asked?
Predicting questions and preparing answers ahead of time can certainly make you come across as a strong candidate. Interviewers want to know about your past and current educational activities to gauge how much of a fit you are to their respective program. This is your time to shine and demonstrate your strengths. Be prepared to talk about your educational and administrative activities (i.e., publications in magazines/journals, medical student and resident teaching activities, presentations, lectures, resident recruitment). Express to them what you are eager to teach and how you would teach it.

You may also be asked about your educational philosophy, or in other words, what your personal worldview on teaching and learning is. Are you a proponent of self-directed learning, and want to increase this skill in your residents? Or do you value experiential learning, and want to immerse your trainees in multiple experiences to enhance their learning? Chances are you have already developed your philosophy. Being mindful of this philosophy, and talking about it during your interview is a sign of educator maturity.

How many interviews should I go on?
Go to every interview that you are offered. Medical education fellowships are competitive, and there are still not many programs. As long as you think you’d be happy there, you should go on the interview.

PREPARING FOR FELLOWSHIP

Textbooks to consider reading
Your potential fellowship will likely recommend some textbooks on educational theory. Kern’s Curriculum Development for medical education is a classic. Academic Life in Emergency Medicine’s Faculty Incubator have also published eBooks on the basics of medical education theory; these can be found at www.aliem.com. We also encourage podcasts/Ted Talks on leadership and education, and would recommend browsing titles at your leisure.

Important skills to practice while in residency to prepare for fellowship
Take any teaching opportunity you can: medical students, residents, mid-level providers, nurses, volunteers. An equally important aspect for you will also be to start understanding educational theory. Pay attention when your curriculum changes, and ask questions about the reasoning behind it.

Tips on how to succeed as a fellow
Motivation and hard work trump book knowledge. Really try to immerse yourself as a member of the program, especially if you are not staying at your home program.

CONCLUSION

Additional resources

National organizations
It is recommended you maintain membership in ACEP and EMRA, if possible.

Strongly consider joining the Council of Emergency Medicine Residency Directors (CORD), an educational organization striving to improve resident education. There are many committees that will accept residents as members.

You can consider joining the Society for Simulation in Healthcare (SSH) to develop simulation ideas and network with others interested in simulation. They have committees you can consider joining as well.

Conferences
The yearly CORD academic assembly is where all the big names in emergency medical education gather. Some fellowship programs emphasize simulation, and subsequently recommend attending the annual International Meeting on Simulation in Healthcare (IMSH) provided by the SSH.

How to find a mentor
You can attempt to find a mentor within your own program or reach out to a desired program for a faculty advisor from the Medical Education Fellowship program there.

EMRA has an Academic Career Mentorship Program where you can electronically request a mentor.

References

  • Lin M, et al. "Development of a training needs assessment for an education scholarship fellowship in emergency medicine." Acad Emerg Med. 19.12 (2012): 1419-1424.
  • Yarris LM, Coates WC. "Creating educational leaders: experiences with two education fellowships in emergency medicine." Acad Emerg Med. 19.12 (2012): 1481-1485.
  • Yarris LM, et al. "A suggested core content for education scholarship fellowships in emergency medicine." Acad Emerg Med. 19.12 (2012): 1425-1433.